Streamlining psychosocial risk assessment: An exploratory adaptation of the COPSOQ III for Flemish healthcare workers

Background: Healthcare workers are particularly vulnerable to psychosocial stress due to high emotional and cognitive demands, staffing shortages, and complex care responsibilities. The Copenhagen Psychosocial Questionnaire (COPSOQ III) is a widely used tool for assessing psychosocial risks at work, but its extended Flemish version has not been systematically evaluated in healthcare settings, and evidence on its psychometric performance in this context remains limited. Objective: This exploratory study aimed to examine the factor structure and internal consistency of the extended Flemish version of the COPSOQ III among healthcare workers in Flanders, Belgium, and to provide initial psychometric evidence. Methods: A cross-sectional survey was conducted among 242 employees across three healthcare institutions. Construct validity was examined through exploratory factor analysis (EFA) on polychoric correlations (oblimin rotation) to derive a revised factor structure of the extended Flemish COPSOQ III. Internal consistency of the resulting dimensions was assessed using Cronbach’s alpha, ordinal alpha, and McDonald’s omega (total and hierarchical). Multiple imputation was used in sensitivity analyses to evaluate the robustness of the factor structure and reliability estimates to missing data. A preliminary confirmatory factor analysis (CFA) was conducted as a supplementary, internal check of the proposed structure, rather than as a full confirmatory validation, given the limited sample size. Results: EFAs supported retention of the original COPSOQ III domain framework while indicating meaningful within-domain refinements, including merged, split, and reallocated dimensions; the number of dimensions was reduced from 45 to 34. Most resulting dimensions showed acceptable internal consistency (ordinal α and ω_total generally ≥ 0.70), although a small number of brief scales showed lower reliability. Sensitivity analyses using multiple imputation yielded highly similar factor solutions and reliability estimates. Domain-specific CFAs provided preliminary support for the revised structures with acceptable fit on commonly used indices (e.g., CFI/TLI, RMSEA, SRMR), but these results should be interpreted cautiously as internal checks rather than definitive confirmation. Conclusion: This exploratory study suggests that the extended Flemish version of COPSOQ III, with an adapted and more parsimonious structure, shows generally acceptable reliability and promising, though preliminary, evidence of construct validity for assessing psychosocial risks in healthcare settings. The adapted structure enhances its practical applicability while preserving theoretical integrity. Further research with larger and more diverse samples is recommended to confirm these findings in broader occupational contexts, test the stability of the proposed structure, and explore the utility of shorter versions in broader occupational contexts.