TH

THE MASLACH BURNOUT INVENTORY – HUMAN SERVICES SURVEY
(MBI-HSS): FACTOR STRUCTURE, WORDING EFFECT AND

PSYCHOMETRIC QUALITIES OF KNOWN PROBLEMATIC ITEMS
Florent Lheureux, Didier Truchot, Xavier Borteyrou, Nicole Rascle
Presses Universitaires de France | « Le travail humain »
2017/2 Vol. 80 | pages 161 à 186

ISSN 0041-1868
ISBN 9782130788645
DOI 10.3917/th.802.0161
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31 mai 2017 04:03 - Le travail humain n°2/2017 - Collectif - Le travail humain - 155 x 240 - page 161 / 240
RECHERCHE EMPIRIQUE
EMPIRICAL RESEARCH
THE MASLACH BURNOUT INVENTORY

– HUMAN SERVICES SURVEY (MBI-HSS):
FACTOR STRUCTURE, WORDING EFFECT
AND PSYCHOMETRIC QUALITIES OF KNOWN
PROBLEMATIC ITEMS
L’INVENTAIRE D’ÉPUISEMENT PROFESSIONNEL

DE MASLACH – VERSION POUR PROFESSIONS
RELATIONNELLES : STRUCTURE
FACTORIELLE, EFFET DE FORMULATION
ET QUALITÉS PSYCHOMÉTRIQUES D’ITEMS
PROBLÉMATIQUES Notoires
by/par Florent Lheureux1, Didier Truchot2,
Xavier Borteyrou3, Nicole Rascle4

summary
This article concerns the measurement of burnout among human serv-

ices professionals through its most widely used measure: the Maslach Burnout
Inventory – Human Services Survey (MBI-HSS). In particular, it deals with
its factor structure, the inclusion or non-inclusion of the personal accomplish-
ment construct in burnout conceptualization (and measurement), the possibil-
ity of a “wording effect” in respondents’ answers, as well as the issue of known
problematic items. A large sample (N = 2357) of French healthcare provid-
ers answered the French version of the MBI-HSS. A sub-sample (n = 1824)
also completed the General Health Questionnaire 12-item version (GHQ-12).
Exploratory factor analysis was first used to analyze the data. Then, four theo-
retical models were tested through confirmatory factor analysis on complete
and shortened versions of the scale. The cross-validation procedure was used to
assess model invariance across two random sub-samples. The GHQ-12 enabled
the nomological validity of the three MBI sub-scales to be tested. The results
1. Laboratoire de psychologie (EA3188), université de Bourgogne Franche-Comté –

email : florent.lheureux@univ-fcomte.fr
email : didier.truchot@univ-fcomte.fr
email : xavier.borteyrou@univ-fcomte.fr
4. Laboratoire de psychologie, santé et qualité de vie (EA4139), université de Bordeaux
– email : nicole.rascle@u-bordeaux.fr
Le Travail Humain, tome 80, n°2/2017, 161-186
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31 mai 2017 04:03 - Le travail humain n°2/2017 - Collectif - Le travail humain - 155 x 240 - page 162 / 240 31 ma
162 Florent Lheureux et al.
confirmed the three-factor structure but called into question the inclusion of
personal accomplishment in the conceptualization/measurement of burnout.
However, they also corroborated the existence of a “wording effect” that blurs
the “true” relationships between the burnout constructs. Thus, the develop-
ment of a new version of the MBI-HSS using bipolar scales is recommended.
Finally, these analyses suggest the removal of two to five items, a 17-item ver-
sion appeared to be the most satisfactory.
Keywords: Burnout measurement, Factor structure, Wording effect, Cross-
validation, Nomological validity, Item removal.
résumé
Cet article concerne la mesure de l’épuisement professionnel chez les profes-

sions à caractère relationnel par le biais de l’échelle la plus fréquemment utilisée :
le Maslach Burnout Inventory – Human Services Survey (MBI-HSS). Il traite
tout d’abord de sa structure factorielle (test du modèle en trois facteurs corrélés)
et de la pertinence de l’inclusion ou non-inclusion de d’accomplissement personnel
(réduit) dans la définition théorique de ce syndrome ainsi que dans sa mesure. En
lien avec ces deux questions, sont également examinées la possibilité d’un « effet de
formulation » dans les réponses obtenues (i.e., biais de mesure induit par l’usage
d’items connotés négativement pour deux dimensions et par l’usage d’items conno-
tés positivement pour la troisième), ainsi que la suppression éventuelle d’items

posant régulièrement question dans la littérature. Un grand échantillon (N =
2357) de professionnels de santé français (médecins, infirmiers, aides-soignants
notamment) a répondu à la version française du MBI-HSS. Un sous-échantillon
(n = 1824) a également répondu au General Health Questionnaire en 12 items
(GHQ-12), échelle permettant le dépistage préliminaire de troubles mineurs de
l’état de santé psychologique. Une analyse factorielle exploratoire a été d’abord
utilisée (méthode d’extraction des axes principaux et rotation de type oblimin
direct), suivie du test de quatre modèles théoriques en analyse factorielle confir-
matoire sur des versions complète (22 items) et abrégées (19, 18 ou 17 items) de
l’échelle. Une procédure de validation croisée a été utilisée pour évaluer l’inva-
riance de ces modèles sur deux sous-échantillons aléatoirement constitués. Le
GHQ-12 a été utilisé afin de tester la validité nomologique des trois sous-échelles
de l’outil. Les résultats confirment la structure tri-factorielle, mais remettent en
question l’inclusion de l’accomplissement personnel dans la conceptualisation et
la mesure de l’épuisement professionnel. Cependant, cette conclusion est mitigée
par la présence avérée d’un « effet de formulation » (l’ajout d’un facteur latent
associé à tous les items négatifs améliore l’ajustement aux données). Celui-ci nuit
dès lors à la mise en évidence des « vraies » relations entre construits (biais dans le
test du modèle tri-factoriel théorique). De ce fait, le développement d’une nouvelle
version du MBI-HSS utilisant des échelles bipolaires est recommandé, option
méthodologique pouvant permettre de lever cette ambiguïté. Enfin, ces analyses
indiquent que la suppression de deux à cinq items est requise pour optimiser l’outil,
une version en 17 items apparaît en tous les cas plus adaptée dans un contexte
français (suppression des items 6, 12, 13, 16 et 22).
Mots-clés : Épuisement professionnel, structure factorielle, effet de formula-
tion, validation croisée, validité nomologique, suppression d’items.
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Burnout definition and measurement 163
I. introduction
I.1. Burnout: its definition and measurement using the mbi-hss
First introduced by Freudenberger (1974) and Maslach (1976), the

concept of burnout refers to a prolonged occupational stress resulting from
the difficult relationships that people have with their work. Maslach and
Jackson (1981) defined burnout as “a syndrome of emotional exhaustion,
depersonalization, and reduced personal accomplishment that can occur among
individuals who do people work” (p. 1). Emotional exhaustion is the key
aspect of the syndrome and is viewed as its primary manifestation. It refers
to the depletion of emotional resources, feelings of strain, and chronic
fatigue, thus reflecting the stress component underlying the construct.
Emotionally exhausted employees lack adaptive resources and cannot give
any more to their jobs. Depersonalization refers to impersonal, negative,
and uncaring responses towards the recipients of one’s service, care, treat-
ment, or instruction. It occurs in response to the aforementioned emotional
exhaustion. By placing distance between the employee and the recipient,
depersonalization makes job demands more manageable. Finally, reduced
personal accomplishment refers to a sense of low self-efficacy, a decline in
feelings of competence as well as a tendency to evaluate oneself negatively
(Maslach & Jackson, 1981; Maslach, Jackson, & Leiter, 1996).

Burnout is a threat for employees, clients (or patients, etc.) and
organizations. In fact, a considerable amount of research demonstrates
that burnout leads to serious negative consequences (e.g., Borteyrou
& Paillard, 2014; Dagot & Perié, 2014; Lheureux, Truchot, & Borteyrou,
2016; Nicolas, Desrumaux, Séguin, & Beauchamp, 2016; Truchot, 2009;
Schaufeli & Enzmann, 1998; Vandenberghe, Stordeur, & d’Hoore, 2009).
At the individual level, burnout increases psychosomatic and psycho-
logical complaints (anxiety, depression, addictive behaviors, sleep distur-
bances). At the organizational level, it causes a decline in the quality of
service and client derogation, as well as absenteeism, high turnover rates,
and impaired productivity.
Establishing a reliable and valid instrument to assess burnout is neces-
sary not only for research purposes but also for pragmatic ones, in particular
to assess this psychological syndrome in organizational settings. The mea-
surement of burnout was first advanced by the development of the MBI-HSS
(Maslach & Jackson, 1981). This scale contains 22 items that capture the
three above-mentioned dimensions: emotional exhaustion (EE) with 9 items,
depersonalization (DP) with 5 items, and (reduced) personal accomplish-
ment (PA) with 8 items. Since then, several other scales have been developed
to measure burnout (see Zawieja, 2015 for a presentation and compari-
son), in particular the Burnout Measure (Pines, Aronson, & Kafry, 1981,
validated in French by Lourel, Gueguen, & Mouda, 2007), the Oldenburg
Burnout Inventory (Halbesleben & Demerouti, 2005), the Copenhagen
Burnout Inventory (Kristensen, Borritz, Villadsen, & Christensen, 2005)
and the Shirom-Melamed Burnout Measure (Shirom & Melamed, 2006,
validated in French by Sassi & Neveu, 2010). However, the MBI-HSS is
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currently the most widely used scale to measure burnout among human
services workers and was translated into many languages, such as French,
Greek, Italian, Dutch, German, Japanese, Arabic, Spanish, Finnish, Swedish
and Norwegian. According to Schaufeli and Enzman (1998), 90 % of all
studies examining burnout have used the MBI.
I.2. Is the (reduced) personal accomplishment construct

a part of the burnout syndrome and should it be included
in its measurement?
The three-factor structure of the MBI-HSS first described by Maslach

and Jackson (1981), with EE, DP, and PA, has been confirmed in many
studies (Beckstead, 2002; Cordes, Dougherty, & Blum, 1997; Hallberg
& Sverke, 2004; Kanste, Miettunen, & Kyngâs, 2006; Koeske & Koeske,
1989; Kokkinos, 2006; Lee & Ashforth, 1990; Loera, Converso, & Viotti,
2014; Lourel & Gueguen, 2007; Poghosyan, Aiken, & Sloane, 2009;
Richardsen & Martinussen, 2004; Schaufeli & Van Dierendonck, 1993;
Vanheule, Rosseel, & Vlerick, 2007). Nevertheless, both theoretical rea-
soning and empirical evidence question the inclusion of the (reduced) PA
construct. From a theoretical perspective, as stated by Schaufeli (2003, p. 3)
“[…] the MBI is neither grounded in firm clinical observation nor based on sound
theorizing. Instead, it has been developed inductively by factor-analyzing a rather

arbitrary set of items”. The PA construct in particular poses several problems.
Primarily, it remains unclear whether this concept refers to a specific burn-
out-related phenomenon, independent of another known phenomenon/
concept, or, conversely, is identical to concepts such as “self-efficacy, accom-
plishment or achievement, personal productivity of performance, and personal per-
formance [which each] represents a distinct field of research in the behavioral
sciences” (Shirom & Melamed, 2005, p. 601). Thus, a two-factor definition of
burnout (EE+DP) has been advocated, given that PA may be better viewed
as a distinct correlated construct (e.g., Schaufeli & Taris, 2005).
Empirically speaking, it appears that EE and DP are strongly correlated,
while correlations with PA are lower, and sometimes non-significantly different
from zero (Cordes & Dougherty, 1993; Lee & Ashforth, 1996). Furthermore,
some factor-analytic studies have observed a better fit for a two-factor solu-
tion (Holland, Michael, & Kim, 1994; Walkey & Green, 1992). They found
that the EE and DP items formed a single factor, sometimes referred to as
the “core of burnout” with PA being the second factor. Thus, although most
exploratory and confirmatory factor-analytic studies found a three-factor
solution to be optimal (for a review, see Worley, Vassar, Wheeler, & Barnes,
2008), the related disagreement over the factor structure of the MBI-HSS
highlights the need for a deeper analysis of its factor structure.
I.3. Is the difference between pa and the other two constructs
(ee and dp) due to a “wording effect”?
An alternative explanation to the results obtained by the above-

mentioned factor analytic studies was offered by Schaufeli and Salanova
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(2007, see also Bresó, Salanova, & Schaufeli, 2007). Considering the factor
structure of the Dutch version of the MBI-General Survey, they hypoth-
esized that using positively worded items in order to measure a negative
phenomenon could be the cause of the weak magnitude of the correlations
between PA and the other two constructs (EE and DP). They considered
that “it would not make sense to assess lack of efficacy with reversed efficacy
items” and that using negatively worded items constitutes a better way to
measure such a lack. Hence, they used both kinds of items in four samples
(total N = 1099) and observed that positively worded items (measuring
efficacy) were more correlated with work engagement, while negatively
worded items (measuring inefficacy) were more correlated with burnout
(emotional exhaustion and cynicism).
However, they did not really assess the possibility of a “wording effect”
in Confirmatory Factor Analysis (CFA). This effect occurs when positively
and negatively worded items of the same scale do not induce symmetrically
opposed answers from the respondents. In other words, agreeing with a
positively worded item is not similar to rejecting a negatively worded one
and vice versa. Thus, these two types of items tend to constitute two cor-
related but distinct sets of items. The possibility of a “wording effect” has
been tested, for instance, in CFA on the Rosenberg self-esteem scale by
Horan, DiStefano and Motl (2003). In particular, they hypothesized that
the observed distinction between positive and negative items, which theo-
retically reflect the same latent factor, may be due to a personality trait or

a “response style”. Bentler, Jackson, and Messick (1971, cited by Horan
et al., 2003) defined “response style” as “a behavioral consistency operating
across measures of several conceptually distinct content traits” (p. 188), and such
“a style is thus identified by the existence of a latent variable […] which is associ-
ated with response tendencies in several distinct content areas” (p. 188). Horan
and colleagues corroborated their response style hypothesis empirically
through a set of analyses that showed that adding a “negatively worded
items” latent factor in CFA improved model fit indices.
Concerning the MBI-HSS, we can hypothesize that respondents
quickly perceive the existence of two types of items (negative and posi-
tive) and thus process them largely on the basis of their valence, indepen-
dently of their more precise content. In other words, we could expect that
participants process EE and DP items similarly because they are of the
same valence while they process PA items differently because of their dif-
ferent valence (for a similar rationale, see Seng Kam & Meyer, 2015). This
phenomenon is likely to increase artificially the correlations between EE
and DP items and to decrease artificially their correlations with PA items.
Accordingly, we can expect a fourth latent factor to influence answers to
both EE and DP items, independently of their specific content, a factor
that would be negatively correlated with PA.
I.4. Should the mbi-hss be shortened?
In their first study, Maslach and Jackson (1981) constituted a pool of

47 items derived from a content analysis of interviews and subsequently
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tested them on a sample of 605 individuals. Then, they deleted several

items iteratively and tested a 25-item version of their instrument on a sec-
ond sample (N = 420). The same analytic procedure led to the removal of
3 other items and the identification of a three-factor structure (using the
eigenvalues > 1.00 criterion).
Since then, the validity of some items of the MBI-HSS has been
questioned. Above all, several validation studies found that item 12 and
item 16 failed to measure the latent construct and yielded low loadings
on the factor or cross-loaded on two factors. Item 12, designed to mea-
sure PA, has been found to cross-load on the EE factor (Byrne, 1991;
Golembiewski, Munzenrider, & Carter, 1983). As suggested by Schaufeli
and Van Dierendonck (1993), from a psychological point of view, it makes
sense that item 12 (“I feel very energetic”) also loads on EE since not feeling
energetic can be considered a symptom of exhaustion. Similarly, item 16
(“Working directly with people puts too much stress on me”) is an EE item
for which significant loadings on the DP sub-scale have regularly been
observed. It is understandable that the stress resulting from working directly
with people can be a symptom of DP. In their manual, Maslach, Jackson,
and Leiter (1996) recommend excluding these two items in the calculation
of composite scores. Note that some other items, apart from 12 and 16,
were problematic in several studies, particularly items 6 and 22, which did
not load on the expected factor or did not load on any factor (see Worley et
al., 2008, for a review). Accordingly, several translation/adaptation/valida-

tion studies have removed two or three of these items in order to obtain a
valid instrument (e.g., Gil-Monte, 2005; Kanste et al., 2006; Loera et al.,
2014; Richardsen, & Martinussen, 2004; Schaufeli & Van Dierendonck,
1993; Van Heule et al., 2006). Following this perspective, this article also
aims to confirm (or refute) the superiority of a shortened version of the
MBI-HSS in a large French sample.
I.5. Is the three-factor structure of the french version

of the mbi-hss confirmed in confirmatory factor analysis?
The MBI-HSS was translated and adapted by Dion and Tessier

(1994). They established its factorial validity, internal consistency, long-
range stability, convergent validity and hypothetico-deductive validity.
However, to our knowledge, no other study has sought to validate the
MBI-HSS-Fr. Furthermore, the validation process implemented by Dion
and Tessier did not include the use of CFA and the data were collected
from two relatively small samples of 260 Quebec day-care workers and
123 Quebec nurses. Hence, this article also aims to assess the validity
of the MBI-HSS-Fr on a large sample of French healthcare provid-
ers through the use of CFA. This issue is all the more important as the
three-factor structure of the MBI-HSS has not been confirmed in sev-
eral empirical studies (alternative two-factor [e.g., Holland et al., 1994;
Walkey & Green, 1992], four-factor [e.g., Firth, McIntee, McKeown,
& Britton, 1985, Iwanicki & Schwab, 1981] or five-factor [Densten,
2001] structures have been found).
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To summarize, our empirical study reported here aimed (1) to test with
CFA the three-factor structure of the French version of the MBI-HSS,
(2) to estimate whether the PA construct must be included in the defini-
tion and the measurement of burnout, (3) to examine the possibility that
a “wording effect” explain the difference between this construct and the
other two (EE and DP) and (4) to consider the removal of items that
caused problems in other validation studies (items 6, 12, 16 and 22).
Table 1. Participants’ demographics. a in French: “Agents de Services

Hospitaliers” (A.S.H.), an occupation specific to the French context.
b
for instance: physiotherapist, dietician.
Tableau 1. Caractéristiques démographiques des participants. NOTE.
a
Agents de Services Hospitaliers (A.S.H.), une profession spécifique au contexte français.
b
pour exemples : kinésithérapeute, diététicien.
Variables N (total = 2357) %
Gender
Men 798 33.86
Women 1559 66.14
Age (categories)
18-29 344 14.59

30-39 567 24.06
40-49 685 29.06
50-59 381 16.16
≥60 74 3.14
Not indicated 306 12.98
Care specialty
Oncology 1316 55.83
General practice 661 28.04
Endocrinology 246 10.44
Emergency 82 3.48
Overall hospital services 52 2.21
Occupation
Physician 1059 44.93
Nurse 485 20.58
Care auxiliary 232 9.84
Radiographer 142 6.02
Hospital services agenta 141 5.98
Medical secretary 122 5.18
Nurse supervisor 54 2.29
Psychologist 13 0.55
Otherb 109 4.62
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II. method
II.1. Participants
2357 French healthcare providers responded on a voluntary basis

to different surveys, including the MBI-HSS-Fr, about their working
conditions (data collection in 2011, 2012 and 2013). A large proportion
of them (44.6 %) were physicians; other significant occupational catego-
ries were nurses (20.6 %) and care-auxiliaries (9.8 %). Informed consent
was appropriately obtained before questionnaire completion. Participants
mainly came from four French regions (Bourgogne, Franche-Comté,
Poitou-Charentes and Ile-de-France) and worked in two emergency units,
in (about) ten oncology units (public hospitals, private clinics and spe-
cialized cancer care centers) or in private practice as general practitioners
or endocrinologists. The complete demographic characteristics of partici-
pants are shown in Table 1.
II.2. Procedure and materials

After providing demographic information, the participants filled out
the French version of the MBI-HSS (Dion & Tessier, 1994). They were
asked to rate the frequency of experiencing feelings related to each sub-

scale using a 7-point scale (0 = never; 6 = daily). The nine items of the
EE scale refer to feelings of being exhausted by one’s work (e.g., “I feel
depressed at work”). The five items of the DP scale assess a detached and
impersonal response toward the recipients (e.g., “I don’t really care what
happens to some recipients”). The eight items of the PA sub-scale refer to
feelings of competence and successful achievement at work (e.g., “I have
accomplished many worthwhile things in this job”).
One sub-sample (n = 1824) also answered the 12-item General Health
Questionnaire (GHQ-12). This was developed by Goldberg (1972) for
detecting minor psychiatric disorders among respondents in commu-
nity settings. A short version (GHQ-12) was developed by Banks, Clegg,
Jackson, Kemp, Stafford and Wall (1980) and has been used extensively as
a screening instrument in large population surveys. Each of the 12 items
(e.g., “Have you recently lost much sleep over worry?”; “Have you recently
been able to concentrate on whatever you’re doing?”) was scored on a 4-point
Likert-type scale (1 = less than usual to 4 = much more than usual). We
used the ordinal scoring approach for the four possible responses (i.e., “4,
3, 2, 1” for negatively worded items and “1, 2, 3, 4” for positively worded
items) as it was recently identified on a large sample as the best scoring
method (Campbell & Knowles, 2007). Because this scale constitutes a
measure of poor psychological health, it can be used as a criterion in order
to assess the nomological validity of the MBI-HSS-Fr. A scale is nomologi-
cally valid when it is correlated with a different but related concept/phe-
nomenon. Thus, we can expect a positive correlation between the GHQ
score and the EE and DP scores and a negative correlation with the PA
score. Moreover, the use of this criterion offers the possibility of comparing
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the three MBI-HSS sub-scales. If, as expected, the correlation between the
GHQ and the PA scores is lower in magnitude than with the EE and DP
scores, this would constitute additional evidence of the distinctiveness of
the PA construct.
II.3. Data analyses
An exploratory factor analysis (EFA) was performed. The Kaiser-

Meyer-Olkin measure of sampling adequacy (KMO) and Bartlett’s test
of Sphericity were examined first. Then, Velicer’s (1976) MAP test was
used with O’Connor’s (2000) SPSS macro to identify the number of fac-
tors to be extracted. Finally, the principal axis extraction method and the
oblimin direct rotation method were used to analyze the factor structure
and item loadings.
Then, several models were tested through confirmatory factor analysis
(CFA) on the variance-covariance matrix and with the maximum likeli-
hood method using the Lisrel 8.80 program (Jöreskog & Sörbom, 2001).
Four theoretical models were compared:
– M1: One-factor model consisting of one latent variable (burnout)
– M2: Two-correlated factor model consisting of 2 latent variables, PA (1)
and EE + DP (2)

– M3: Three-correlated factor model consisting of EE (1), PA (2) and
DP (3). The same 3-factor model with a second-order latent factor
(burnout) was also estimated in order to compare the links between the
three theoretical factors (EE, DP and PA) and this encompassing one.
For each factor, we fixed to 1 the loading of the item which reflected it
most in the EFA.
– M4: Four-correlated factor model; the same as M3 plus a fourth factor
influencing both EE and DP items (i.e., a “negative wording” factor).
To evaluate the fit of these models, various indices were used (Bollen,
1989; Browne & Cudeck, 1993). These included the traditional χ² value,
the ratio of the chi square statistic to the degrees of freedom (χ²/df), the
root mean square error of approximation (RMSEA), the non-normed fit
index (NNFI), the comparative fit index (CFI), the standardized root mean
square residual (SRMR) and the Akaike information criterion (AIC). As
a rule of thumb, a RMSEA between .05 and .08 indicates a reasonable
fit of the model while a value ≤ .05 indicates a good fit. The CFI and
the NNFI should have values of .90 or higher and the SRMR must be
lower than .08. Furthermore, the lower the values of the AIC, χ² and χ²/
df statistics, the better the model. Because these models were nested, the
χ² difference test (Δχ²) was also used. Loadings and error-variances of
items were also examined in order to evaluate their psychometric qualities.
As the data were collected from a large sample, the cross-validation proce-
dure advocated by Cudeck and Browne (1983) was followed. The sample
was randomly dichotomized into two groups of equal size: the calibration
sample (n = 1178) and the validation sample (n = 1179). This procedure
consisted of three stages (Byrne, 1991): (1) the known theoretical models
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were tested on the calibration sample; (2) then, the modification indices
were examined in order to identify a possible optimization of the fit of the
best model (note: these modifications must be theoretically interpretable),
(3) finally, the models previously estimated on the calibration sample were
tested on the validation sample, and the invariance of the models across
the two sub-samples was estimated via the χ² difference test (Δχ²). This
test was preferred to Cudeck and Browne’s (1983) Cross-Validation Index
(CVI) because the models were nested (Bollen, 1989). This two-sample
cross-validation technique was preferred to the Expected Cross-Validation
Index (ECVI, Browne & Cudeck, 1989) over the entire sample because the
use of two sub-samples eliminates bias in the a posteriori modification of
the models tested (e.g., on the basis of the so-called modification indices)
(Browne, 2000).
The four theoretical models were first estimated on the complete
22-item scale. Models M3 and M4 were also tested on shortened versions
of the scale (i.e., 20-item, 18-item and 17-item versions) in order to esti-
mate the gain in item removal. Overall, eleven CFA models were applied to
both sub-samples. Next, two CFA models were also implemented to assess
the invariance of models across them.
Finally, the internal consistency of sub-scales was estimated (Cronbach’s
alpha) and the nomological validity was assessed by computing correla-
tions between the MBI dimensions and the GHQ-12 score.

III. Results
III.1. Exploratory factor analysis
Both the KMO (0.90) and Bartlett’s test (χ²(231) = 23144.976,

p < 0.00001) indicated the factoriability of the correlation matrix.
The MAP test corroborated the three-factor structure (lowest squa-
red average partial correlation: 2 factors = .01433, 3 factors = .01140,
4 factors = .01376). Table 2 presents the factor loadings included in both
the pattern and the structure matrixes. The three factors accounted for
48.28 % of the total variance. The first factor accounted for 26.88 %
(eigenvalue = 5.91) of the total variance, with the 9 items measuring
the EE construct. The second factor accounted for 13.37 % of the total
variance (eigenvalue = 3.00) with the 8 items measuring the PA construct.
The third factor accounted for 7.73 % of the total variance (eigenvalue
= 1.70) and contained the 5 items measuring the DP construct. The first
factor (EE) was moderately correlated (r = .42) with the third factor
(DP), while non-correlated (r = -.09) with the second (PA). The second
(PA) and the third factors (DP) were moderately correlated (r = .21).
The analysis of item saturations on the pattern matrix revealed that item
12 (“I feel energetic”) had a double loading on both the first and second
factors. Item 22 (“I feel some recipients blame me for some of their pro-
blems”) did not load sufficiently (<.30) on the intended factor 3 (DP).
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The structure matrix, which reflects the correlations between the latent
factors through the different items, illustrates that most items reflected the
expected factor more than the other two, except item 6 (“Working with
people all day is really a strain for me”) and item 16 (“Working directly
with people puts too much stress on me”). Such results suggest the exclu-
sion of all these items in order to optimize scaling (i.e., to retain only
18 items).
Table 2. Exploratory factor analysis results of the French version of the

MBI-HSS, with principal axis and oblimin direct methods (N = 2357).
Factor loadings >.30 are bolded. EE = emotional exhaustion,
PA = personal accomplishment, DP = depersonalization.
Tableau 2. Résultats de l’analyse factorielle exploratoire de la version française du MBI-
HSS, avec les méthodes des axes principaux et de rotation oblimin direct (N = 2357).
Les saturations >.30 sont en gras. EE = épuisement émotionnel, PA = accomplissement
personnel, DP = dépersonnalisation.
Pattern matrix Structure matrix

F1 F2 F3 F1 F2 F3
(EE) (PA) (DP) (EE) (PA) (DP)
2. Used up .867 .032 -.071 .834 -.028 .289

1. Emotionally drained .846 .023 -.052 .830 -.096 .368
8. Burned out .821 -.021 .016 .822 -.040 .301
3. Fatigued in the morning .765 -.033 -.055 .745 -.089 .277
20. End of my rope .740 -.012 -.001 .741 -.077 .315
14. Working too hard .663 .091 .102 .698 .011 .363
13. Frustrated .498 .000 .200 .582 -.086 .411
6. Working with people .417 -.003 .033 .517 -.090 .413
16. Stress .392 -.060 .236 .485 -.138 .385
12. Energetic -.480 .418 .206 -.503 .453 -.259
9. I’m positively influencing .045 .698 .028 -.004 .688 -.101
7. I deal effectively -.006 .636 .000 -.061 .637 -.137
17. Relaxed atmosphere -.046 .605 .040 -.082 .600 -.108
18. I feel exhilarated -.019 .584 .019 -.063 .582 -.113
19. Accomplished -.055 .562 -.020 -.113 .571 -.163
21. Deal with emotional probl. -.040 .483 -.017 -.090 .490 -.136
4. I can understand .205 .396 -.109 .124 .402 -.107
10. Callous toward people -.037 -.002 .764 .287 -.161 .749
11. Hardening me emotionally -.003 .047 .639 .264 -.088 .628
5. Impersonal objects .159 -.014 .550 .393 -.145 .620
15. I don’t really care -.015 -.097 .502 .207 -.202 .516
22. Recipients blame me .229 .034 .253 .334 -.040 .343
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III.2. Confirmatory factor analyses
III.2.1. Comparison of the one-factor, two-factor and three-factor models

on the complete 22-item scale
As displayed in Table 3, M1 and M2 obtained insufficient indices for

both sub-samples. Except for the SRMR, M3a obtained acceptable values
and significantly fitted the data better than M1 and M2 (Δχ²). Thus, these
results argue in favor of a three-correlated factor structure. Figure 1 shows
the standardized solution for M3a.
Note that for DP and PA, most items obtained an error-variance above
.50, which illustrates that most of their variance did not reflect the target
theoretical construct. Three items of the EE sub-scale also had an error-
variance above .50 (items 13, 6 and 16). The correlations between the
three estimated factors were significant but of weak magnitude for PA.
The addition of a second-order latent factor (burnout) to M3a provided
intriguing results (not shown in Table 3). As theoretically expected, each
of the three first-order factors obtained a standardized parameter differ-
ent from zero, suggesting that they all reflected the burnout syndrome.
However, the parameter was stronger for DP (1.29) than for EE (0.80),
which is not congruent with theoretical expectations that consider EE the
main burnout dimension. Furthermore, PA obtained the weakest param-

eter with a value of -.30.
III.2.2. Comparison of fit indices of the three-factor model estimated

on shortened versions of the scale
Given that the residual variance of M3a was fairly high (SRMR > .08),
some problematic items were removed. The modification indices suggested
relating item 12 to EE (associated decrease in χ² = 268.4) and to DP (minus
68.2 in χ²). They also suggested adding an error covariance between items
6 and 16 (minus 168.1 in χ²), a result indicating that a non-negligible part
of their common variance reflected another factor absent from M3. Then,
considering both the EFA and CFA results, the three-factor model was
also estimated on a 20-item version of the scale (i.e., without items 12 and
16) (M3b). As a result, all indices were improved. In particular, the SRMR
was lower than the recommended value of .08.
Table 3. Comparison of model fit indices of the MBI-HSS in confirmatory factor analysis.
Tableau 3. Comparaison des indices d’ajustement des modèles testés sur le MBI-HSS en analyse factorielle confirmatoire.
Calibration sample (n = 1178) Validation sample (n = 1179)

RMSEA RMSEA
Question Models χ²/df NNFI CFI SRMR AIC Δχ² χ²/df NNFI CFI SRMR AIC Δχ²
[CI] [CI]
Does the M1: One factor 5303/209 .15 .82 .84 .12 5391 3812* 5029/209 .14 .82 .84 .12 5117 3666*
MBI-HSS (all EE+DP+PA items) = 25.37 [.14/.15] (M3a) = 24.06 [.14/.15] (M3a)
have a M2: Two correlated factors 2368/208 .096 .90 .91 .095 2458 877* 2321/208 .095 .90 .91 .094 2411 958*
three- (EE+DP/PA) = 11.38 [.093/.100] (M3a) = 11.16 [.092/.099] (M3a)
correlated-
factor M3a: Three correlated factors 1491/206 .075 .93 .94 .086 1585 / 1363/206 .071 .93 .94 .084 1457 /
structure? (EE/DP/PA) = 7.14 [.071/.078] = 6.62 [.067/.074]
Should M3b: Three correlated factors (EE/ 825/167 .059 .96 .96 .058 911 / 806/167 .058 .95 .96 .054 892 /
the MBI- DP/PA) minus items 12 and 16 = 4.94 [.055/.063] = 4.83 [.054/.063]
HSS be M3c: Three correlated factors (EE/ 610/132 .057 .96 .97 .051 688 / 620/132 .057 .96 .96 .051 698 /
shortened? DP/PA) minus items 6, 12, 16, 22 = 4.62 [.052/.062] = 4.70 [.053/.062]
Does a M4a: Three correlated factors 996/191 .061 .95 .96 .074 1120 495* 887/191 .057 .95 .96 .073 1011 476*
4th factor (EE/DP/PA) and one negative = 5.21 [.058/.065] (M3a) = 4.64 [.053/.061] (M3a)
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influence wording factor (all EE+DP items)

answers to M4b: Three correlated factors (EE 1066/194 .063 .95 .96 .075 1184 / 891/194 .057 .95 .96 .073 1009 /
negative minus items 6, 13, 16/DP/PA) and = 5.49 [.060/.067] = 4.59 [.060/.067]
items? one negative wording factor (all
EE+DP items)
Does M3d: Three correlated factors (EE/ 486/116 .053 .96 .97 .048 560 / 479/116 .053 .96 .97 .048 553 /
adding DP/PA) minus items 6, 12, 13, 16, 22 = 4.18 [.049/.058] = 4.13 [.048/.058]
this 4th M4c: Three correlated factors 451/120 .050 .97 .98 .044 553 159* 358/120 .042 .98 .98 .039 460 262*
factor (EE/DP/PA) minus items 6, 12, = 3.76 [.045/.055] (M3c) = 2.98 [.037/.047] (M3c)
increase 16, 22 and one negative wording
model factor (remaining EE+DP items)
fit with a
shortened M4d: Three correlated factors (EE/ 400/105 .050 .97 .98 .042 496 86* 311/105 .042 .98 .98 .039 407 168*
scale? DP/PA) minus items 6, 12, 13, 16, = 3.81 [.045/.055] (M3d) = 2.96 [.037/.047] (M3d)
22 and one negative wording factor
(remaining EE+DP items)

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Figure 1. Path diagram with standardized coefficients (all are significant) for the three-factor
model of the complete version (22-item) of the MBI-HSS-Fr for both sub-samples (M3a).
Figure 1. Diagramme de chemin avec coefficients standardisés (tous sont significatifs)
pour le modèle en trois facteurs appliqué sur la version complète (22 items) du MBI-HSS
pour les deux sous-échantillons (M3a).
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Considering the EFA and CFA results, the validity of an 18-item ver-
sion of the MBI-HSS, minus items 12, 16, 6 and 22 (M3c) was also esti-
mated. Concerning item 22, the modification indices suggested adding a
structural link with EE (minus 61.8 in χ²), which corresponded to the cross-
loading observed in the EFA. Moreover, it loaded insufficiently on the DP
factor with a very high error-variance of .88/.85. Item 6 cross-loaded in the
EFA and the addition of the error-covariance with item 16 suggested by
the modification indices also argued in favor of its removal. In addition, its
error-variance was equal to .75/.72. The suppression of these items slightly
decreased the SRMR and χ²/df, as well as moderately decreasing the AIC
(which can be used to compare non-nested models).
III.2.3. Model comparison associated with the “wording effect” hypothesis

on the 22-item scale
The addition of a fourth factor to M3a that explains the common
variance of all negatively worded items (i.e., EE and DP items) (see M4a
in Table 3) significantly decreased the chi-square value, Δχ2(15) = 495,
p < .0001. Overall, the fit indices were better for M4a than for M3a. As
illustrated in Figure 2, taking into account this fourth factor also rendered
the links between EE and the two other constructs non-significant, while
the relationship between the “negative wording” factor and PA was negative
and significant (-.20/-.22). Taking into account this factor also moderately

decreased the error-variance of items 13, 6 and 16 and modified strongly
their loadings on EE. They became negative (calibration sample) or non-
significant (validation sample) for items 6 and 16, and non-significant
(calibration sample) or weak (validation sample) for item 13. Thus, these
results call into question the psychometric qualities of these three items
as they were mostly linked to the “negative wording” factor. Accordingly,
a model without the paths between these items and EE was tested (M4b).
Given that the obtained fit indices were very similar to those of M4a, these
items could be viewed as unnecessary to estimate EE properly. Note that
the loading of item 22 on DP, although significant due to the large sample
size, was very weak (.13/.14) with 83 % - 85 % of variance unexplained.
III.2.4. Model comparison associated with the “wording effect” hypothesis

on shortened versions of the scale
In the analyses described above, the issues of item removal (should
the MBI-HSS be shortened?) and a possible wording effect (does a fourth
factor influence the answers to negative items?) were treated separately.
Thus, one question remained unanswered at this stage: does adding this
fourth factor (negative wording) increase model fit with a shortened scale?
Consequently, M4 was also tested on the 18-item version of the MBI-HSS
(M4c) and compared to M3c. Fit indices of M3 and M4 were also com-
pared on a 17-item version, given that, on the whole, five items appeared to
be problematic in the EFA and CFA (items 6, 12, 13, 16 and 22) (see mod-
els M3d and M4d). As a result, all fit indices were better and the chi-square
values were significantly lower (Δχ²) for both M4c and M4d.
ver, the invariance of models M4b, χ²(221) = 940.56, Δχ² (27) = 49.56, p < .01,
and M4d, χ²(126) = 453.08, Δχ² (16) = 142.08, p < .001, was not confirmed.
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Figure 2. Path diagram with standardized coefficients for the three-factor model plus
a negatively worded latent factor of the complete version (22-item) of the MBI-HSS-Fr
for both sub-samples (M4a). EE = emotional exhaustion, DP = depersonalization,
PA = personal accomplishment and NW = negative wording.
Figure 2. Diagramme de chemin avec coefficients standardisés pour le modèle en trois facteurs
plus le facteur latent « formulation négative » sur la version complète (22 items) du MBI-HSS-Fr
pour les deux sous-échantillons (M4a). EE = épuisement émotionnel, DP = dépersonnalisation,
PA = accomplissement personnel et NW = formulation négative.
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III.2.5. Estimation of the invariance of models across sub-samples

All analyses were first implemented on the calibration sample before
being applied in the same way to the validation sample. In order to assess
directly the invariance across sub-samples of models that were modified a
posteriori (Byrne, 1991), item loadings of M3c, M4b and M4d estimated
on the validation sample were constrained to be equal to those observed
for the calibration sample. These additional analyses confirmed the invari-
ance of M3c, χ²(150) = 641.46, Δχ² (18) = 21.46, ns.
III.3. Reliability analyses and nomological validity

The descriptive statistics, Cronbach’s alphas and correlations with the
GHQ-12 for the complete and shortened versions of the MBI-HSS are
shown in Table 4. Cronbach’s alpha value estimates for the three sub-scales
were satisfactory (≥ .70) for the complete 22-item version as well as for the
shortened versions of the MBI-HSS. Thus, shortening the sub-scales did
not reduce their reliability. All correlations with the GHQ-12 were signifi-
cant. The greatest correlation value concerned EE, which is considered the
“core” of burnout (r = .67 or .66). The positive correlation between DP
and the GHQ-12 (r = .30 or .29) and the negative correlation between PA
and the GHQ-12 (r = -.29 or -.28) also illustrate the nomological validity of
the MBI-HSS-Fr, although these correlations were of lower magnitude than

for EE. Note that item removal did not alter these correlations. The correla-
tions between the different versions of the EE and DP sub-scales were fairly
high (from .38 for the 17-item version to .46 for the 22-item one). The com-
plete 8-item version of the PA sub-scale was moderately correlated with DP
and EE (most r < .20). However, the shortened 7-item version was weakly
(-.06) or non-significantly correlated (-.04) with EE. Thus, these observa-
tions illustrate that item 12 (which also loaded on EE in factor analysis) was
responsible for the correlation between PA and EE with the 22-item version.
IV. Discussion
IV.1. Concerning the validity of the three-factor structure

and the reliability of the three sub-scales
Overall, our analyses showed that the French MBI-HSS assessed the
same three dimensions as the original measure. In the EFA, Velicer’s (1976)
MAP test corroborated the three-factor structure and most item load-
ings appeared to be satisfactory (with some exceptions). In the CFAs, the
three-factor model had a good fit with the complete 22-item version (M3a)
and an excellent fit with the shortened versions (M3b, M3c and M3d).
Moreover, this three-factor model outperformed the alternative one-factor
and two-factor models (Δχ²) and was found to be invariant across sub-
samples in cross-validation analysis (Byrne, 1991). Thus, the conformity
of the MBI-HSS to Maslach and Jackson’s (1981) theoretical model was
corroborated in our large sample of French healthcare providers.
Table 4. Descriptive statistics and correlation matrix for the different versions of the three sub-scales of the MBI-HSS
and for the GHQ-12. *p < .01; EE = emotional exhaustion, DP = depersonalization, PA = personal accomplishment
and GHQ = General Health Questionnaire. All correlations with the GHQ were obtained on a sub-sample (n = 1824),
all other correlations were obtained on the entire sample (N = 2357). All means (M) and standard deviations (SD) for
the MBI-HSS were calculated to be on the same scale [0 ≤ M ≤ 6], in order to facilitate the comparison between the
different versions of sub-scales. The GHQ score was scaled from 1 to 4. α refers to Cronbach’s reliability coefficient.
Tableau 4. Statistiques descriptives et matrice de corrélations pour les différentes versions des trois sous-échelles du MBI-HSS et pour le score au
GHQ-12. *p < .01 ; EE = épuisement émotionnel, DP = dépersonnalisation, PA = accomplissement personnel et GHQ = questionnaire général
de santé. Les corrélations avec le GHQ ont été obtenues à partir d’un sous-échantillon (n = 1824), toutes les autres corrélations proviennent de
l’échantillon complet (N = 2357). Toutes les moyennes (M) et tous les écart-types du MBI-HSS ont été calculés afin de pouvoir les situer sur
l’échelle de réponse fournie aux participants [0 ≤ M ≤ 6], ceci afin de faciliter les comparaisons entre les différentes versions des sous-échelles.
Le score au GHQ a été échelonné de 1 à 4. α renvoie au coefficient de fiabilité de Cronbach.
Measure M SD α EE8 EE7 EE6 EE5 DP5 DP4 PA8 PA7

EE 9-item 2.05 1.29 .90
all items (MBI-HSS 22-item)
EE 8-item 2.18 1.35 .90 .99*
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minus item 16 (MBI-HSS 20-item)

EE 7-item 2.27 1.41 .90 .98* .99*
minus items 16 and 6 (MBI-HSS 18-item)
EE 6-item 2.32 1.46 .90 .97* .98* .99*
minus items 16, 6 and 13 (MBI-HSS 17-item)
DP 5-item 1.30 1.15 .71 .46* .44* .43* .40*
all items (MBI-HSS 22-item and 20-item)
DP 4-item 1.30 1.28 .72 .41* .40* .38* .36* .97*

minus item 22 (MBI-HSS 18-item and 17-item)
PA 8-item 4.64 0.97 .78 -.14* -.13* -.13* -.12* -.19* -.21*
all items (MBI-HSS 22-item)
PA 7-item 4.67 1.00 .77 -.06* -.04 -.04 -.03 -.16* -.17* .98*
minus item 12 (MBI-HSS 20-item, 18-item and 17-item)
GHQ-12 1.87 0.46 .87 .67* .67* .66* .65* .30* .29* -.28* -.21*

31 ma
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Regarding the internal consistency of the complete 22-item scale, we

found alpha coefficients of .90 (EE), .71 (DP) and .78 (PA). In a recent
meta-analysis of more than 90 studies, Wheeler, Vassar, Worley and Barnes
(2011) reported internal consistency coefficients ranging from .72 to .95
for EE (M = .87), from .50 to .91 for DP (M = .71), and from .52 to .87
for PA (M = .76). Thus, the reliability coefficients of the 22-item version
are close to the average values reported in the literature.
IV.2. Concerning the inclusion of the (reduced) personal

accomplishment construct in the burnout conceptualization
(and measure) and the possibility of a “wording effect”
Although the EFA and CFA results corroborated the distinctiveness

of the three theoretical burnout dimensions (EE, DP and [reduced] PA),
the low (or non-significant) correlations between PA and the two other
constructs in the factor analyses (see Figures 1 and 2) or when composite
scores were used (see Table 4) clearly call into question the inclusion of the
(reduced) PA in the theoretical definition of the burnout syndrome and
its measurement. Moreover, the hypothesis of a second-order latent factor
(burnout) received poor support in CFA, given that the highest standard-
ized parameter was observed for DP (instead of EE as would be more theo-
retically coherent) and the lowest standardized parameter for PA. Finally,

PA was found to be less correlated than EE with the GHQ, which was
expected to correlate with burnout, thus adding another argument in favor
of considering the PA construct a distinct construct (like, for instance,
Schaufeli & Taris, 2005).
Nevertheless, we cannot firmly conclude on this issue given that the
observed differences between PA and the two other constructs (EE and
DP) could also be explained by a “wording effect”. This possibility was
investigated by Schaufeli and Salanova (2007, see also Bresó et al., 2007)
but they failed to analyze it entirely via CFA (see the Introduction). In
contrast, we consider that the blatant differences in item valence (positive
or negative) could artificially inflate correlations between EE and DP items
(which are all negative in valence) and weaken their correlations with PA
items (which are all positive in valence). In agreement with this reasoning,
adding a fourth factor influencing all negatively worded items markedly
increased model fit (see the comparison between M3a and M4a). This
result is all the more important as item removal only reduced this phenom-
enon but did not suppress it (see the comparison between M3c and M4c,
and between M3d and M4d).
In addition, without this fourth factor included in the model estima-
tion (see Figure 1) EE appeared to be significantly correlated with DP and
PA, while when this factor was included (see Figure 2) these correlations
became non-significant (and the “negative wording” factor was negatively
and moderately correlated with PA instead, r = -.20/-.22). In other words,
when controlling for the variance shared by all negative items, EE was no
longer correlated with DP and PA. Given that EE has been identified as the
primary manifestation of burnout and considered to be its core dimension
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(Maslach, Schaufeli, & Leiter, 2001), such a result calls into question the
conceptual validity of the three-factorial definition of burnout or, alterna-
tively, suggests that answers collected by the MBI-HSS are moderately
biased by the obvious contrast between negative and positive items, thus
challenging its measurement precision.
Thus, because of such a bias, it is almost impossible to conclude
concerning the relevance of the inclusion of the (reduced) PA construct
in the definition and measurement of burnout when using the MBI-HSS
in its current form. Consequently, alternative procedures and materials
must be implemented to study this “wording effect” and to reduce its
impact. At first glance, using two types of items for EE, DP and PA (in line
with Salanova & Schaufeli, 2007; Bresó et al., 2007) appears to be a suit-
able option. However, it is likely to inflate this valence-driven bias in item
processing, a bias that could explain the two negatively correlated second-
order latent factors observed by Salanova and Schaufeli (2007) in CFA,
namely burnout (assessed with negative items) and engagement (assessed
with positive items).
Instead, it might be more relevant to use one set of bipolar items, with
response options that reflect the highest levels of burnout and symmetrical
options that reflect the lowest levels of burnout (e.g., “Most of the time,
when I get up in the morning and have to face another day on the job I
feel… [no fatigue at all to an extreme fatigue]”). At least, when using two sets
of items (positive and negative), one could examine the magnitude of this

possible bias under several experimental conditions, such as presenting
the three MBI-HSS sub-scales simultaneously or with a delay (e.g., 2 or
3 days) or with an intermediate filler task, as well as counterbalancing their
order of presentation. Furthermore, one could manipulate the presence or
absence of other scales with both positive and negative items, as this could
increase or decrease this possible bias. The inclusion of these scales would
also offer the possibility of estimating the presence of this “wording effect”
across scales (see Horan et al., 2003).
IV.3. Concerning known problematic items and the relevance

of their removal
The original complete 22-item version cannot be rejected because both

alpha coefficients and fit indices are acceptable (M3). While our results did
not invalidate it, they showed that it can be improved with fewer items. The
EFA results suggest removing items 12, 16, 6 and 22 because they cross-
loaded or loaded insufficiently on the expected factor. The CFA results
obtained on two distinct sub-samples gave similar results. Firstly, removing
items 12 and 16 greatly increased model fit (see M3b). Given that they
were found to be problematic in other factor-analytic and cross-cultural vali-
dation studies (e.g., Aluja, Blanch, & Garcia, 2005; Byrne, 1994; Kanste
et al., 2006; Mor & Laliberte, 1984; Richardsen & Martinussen, 2004;
Sabbah et al., 2012; Schaufeli & Van Dierendonck, 1993; Vanheule et al.,
2007), as well as in the original English version (Maslach et al., 1996),
we can clearly recommend their removal from the MBI-HSS. Secondly,
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dropping items 6 and 22 also improved model fit slightly, especially the
AIC value (see M3c). Moreover, our results showed that they were poor
indicators of their theoretical factors. The error-variance of item 22 was
very high and, additionally, it was found to reflect more the “negative
wording” latent factor than DP (see Figure 2). Similar observations were
made concerning items 6, 16 and 13, which reflected the “negative word-
ing” factor more than their theoretical factor (EE) (M4a) (see Figure 2)
and had a high error-variance when this fourth factor was absent from the
model (M3a). Furthermore, removing these items diminished the differ-
ence (Δχ²) between Maslach and Jackson’s (1981) three-factor model (EE,
DP and PA) and this alternative model (see the comparison between M3c
and M4c, and between M3d and M4d).
Items 6, 22 and 13 have been regularly questioned in past research.
Various empirical studies have shown that one or several of them fail
to load on any factor or to cross-load (Abu-Hilal, 1995; Abu-Hilal
& Salameh, 1992; Densten, 2001; Golembiewski, et al., 1983; Kanste
et al., 2006; Koeske & Koeske, 1989; Mor & Laliberte, 1984; Olivares-
Faúndez, Mena-Miranda, Jélvez-Wilke, Macía-Sepúlveda, & 2014; Pierce
& Molloy, 1989; Sabbah et al., 2012; Schaufeli & Van Dierendonck, 1993).
Concerning item 13, we can also have some doubts regarding its content
validity. Clearly, being frustrated is not being exhausted. A worker could be
both frustrated and bursting with energy. Thus, item 13 probably reflects
more a general negative attitude toward the job (dissatisfaction) than EE.

This interpretation is all the more plausible as item 13 obtained a non-
significant (calibration sample) or a very low (validation sample) loading
on the EE factor in the CFA when the “negative wording” latent factor was
taken into account (see M4a).
Given that there is no consensus on this issue across studies (see, for
instance, Worley et al., 2008; Loera et al., 2014), we cannot formulate
a definitive and generalized conclusion concerning items 6, 13 and 22.
Considering the results obtained in EFA and regarding the structural and
measurement models in CFA, we can only conclude that a 17-item version
of the MBI-HSS (i.e., minus items 6, 12, 13, 16 and 22) was an optimal
measure of burnout in our large French sample. Nevertheless, given that
our study was the first to address the possibility of a “wording effect” via
the estimation of a latent factor in CFA and that these three items were
mainly linked to it, we invite other scholars to carry out similar analyses
on their data and, if their results are the same, to consider the removal of
these items.
Finally (see Table 4), shortening the scale neither alter the reliability
(Cronbach’s alpha) nor the nomological validity of the MBI-HSS (cor-
relations with the GHQ-12). Hence, these observations also render item
removal an acceptable option.
IV.4. Study limitations
In spite of its strengths, this study presents some limitations. Firstly,

other constructs than mental health (as measured by the GHQ-12) could
- © PUF -
have been considered to assess the nomological validity of the MBI-HSS-Fr.

In particular, burnout as measured by the MBI-HSS can be considered
as covering related but different aspects. According to Krisentensen et al.
(2005), EE can be viewed as an individual state, DP as a coping strategy
and PA as a consequence. More precisely, PA can be regarded as a per-
sonality or personal performance construct (Shirom & Melamed, 2005).
Thus, it would be relevant to consider other constructs (i.e., personal-
ity, coping or self-performance factors) to establish the nomological valid-
ity of the MBI-HSS-Fr. Likewise, its convergent validity (i.e., with other
burnout measures) and its reliability across time (i.e., test-retest) were not
investigated here. Additionally, given that the differences observed between
the versions of the MBI-HSS regarding the “problematic items” are likely
to be caused by cultural or linguistics factors, the cross-cultural relevance
of the removal of items 6, 13 and 22 remains unexamined because of the
use of the unique sample of French workers. Finally, given that we did not
include other occupational groups involved in “people work” (e.g., social
workers, customer advisers) we cannot generalize our results beyond the
medical /paramedical sector.
V. Conclusion

Our analysis of the psychometric properties of the MBI-HSS confirmed
that the expected three-factor structure (EE, DP and PA) fits the data well.
However, our results call into question the inclusion of the PA construct
in burnout definition and measurement and corroborate the presence of a
“wording effect” in CFA. In addition, our study clearly argues in favor of
the removal of five items (items 12, 16, 6, 22 and 13) because they did not
sufficiently load on the expected factor, cross-loaded or loaded more on
the “negative wording” factor. Finally, we recommend the development of
a revised version of the scale using bipolar items to control for the observed
“wording effect”.
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THE MASLACH BURNOUT INVENTORY – HUMAN SERVICES SURVEY

(MBI-HSS): FACTOR STRUCTURE, WORDING EFFECT AND

Florent Lheureux, Didier Truchot, Xavier Borteyrou, Nicole Rascle

Presses Universitaires de France | « Le travail humain »

2017/2 Vol. 80 | pages 161 à 186

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Distribution électronique Cairn.info pour Presses Universitaires de France.

Powered by TCPDF (www.tcpdf.org)

THE MASLACH BURNOUT INVENTORY

L’INVENTAIRE D’ÉPUISEMENT PROFESSIONNEL

© Presses Universitaires de France | Téléchargé le 09/12/2022 sur www.cairn.info (IP: 188.255.174.2)

This article concerns the measurement of burnout among human serv-

1. Laboratoire de psychologie (EA3188), université de Bourgogne Franche-Comté –

162 Florent Lheureux et al.

Cet article concerne la mesure de l’épuisement professionnel chez les profes-

© Presses Universitaires de France | Téléchargé le 09/12/2022 sur www.cairn.info (IP: 188.255.174.2)

Burnout definition and measurement 163

I.1. Burnout: its definition and measurement using the mbi-hss

First introduced by Freudenberger (1974) and Maslach (1976), the

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164 Florent Lheureux et al.

I.2. Is the (reduced) personal accomplishment construct

The three-factor structure of the MBI-HSS first described by Maslach

© Presses Universitaires de France | Téléchargé le 09/12/2022 sur www.cairn.info (IP: 188.255.174.2)

An alternative explanation to the results obtained by the above-

Burnout definition and measurement 165

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I.4. Should the mbi-hss be shortened?

In their first study, Maslach and Jackson (1981) constituted a pool of

166 Florent Lheureux et al.

tested them on a sample of 605 individuals. Then, they deleted several

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I.5. Is the three-factor structure of the french version

The MBI-HSS was translated and adapted by Dion and Tessier

Burnout definition and measurement 167

Table 1. Participants’ demographics. a in French: “Agents de Services

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168 Florent Lheureux et al.

2357 French healthcare providers responded on a voluntary basis

II.2. Procedure and materials

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Burnout definition and measurement 169

II.3. Data analyses

An exploratory factor analysis (EFA) was performed. The Kaiser-

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170 Florent Lheureux et al.

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III.1. Exploratory factor analysis

Both the KMO (0.90) and Bartlett’s test (χ²(231) = 23144.976,

Burnout definition and measurement 171

Table 2. Exploratory factor analysis results of the French version of the

Pattern matrix Structure matrix

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172 Florent Lheureux et al.

III.2. Confirmatory factor analyses

III.2.1. Comparison of the one-factor, two-factor and three-factor models

As displayed in Table 3, M1 and M2 obtained insufficient indices for

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III.2.2. Comparison of fit indices of the three-factor model estimated

Calibration sample (n = 1178) Validation sample (n = 1179)

influence wording factor (all EE+DP items)

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Burnout definition and measurement 175

I.2. Is the (reduced) personal accomplishment construct

I.5. Is the three-factor structure of the french version

III.2.1. Comparison of the one-factor, two-factor and three-factor models

III.2.2. Comparison of fit indices of the three-factor model estimated

III.2.3. Model comparison associated with the “wording effect” hypothesis

III.2.4. Model comparison associated with the “wording effect” hypothesis

IV.1. Concerning the validity of the three-factor structure

IV.2. Concerning the inclusion of the (reduced) personal

IV.3. Concerning known problematic items and the relevance

Manuscrit reçu : juin 2016.