RESEARCH ARTICLE
The Relationship between Compassion Experienced by Social Workers and Job Performance: The Double Mediating Effect of Positive Psychological Capital and Affective Commitment
Sung-Hoon Ko1, In Ae Ryu2, *, Yongjun Choi3
Article Information
Identifiers and Pagination:
Year: 2022Volume: 15
E-location ID: e187435012204140
Publisher ID: e187435012204140
DOI: 10.2174/18743501-v15-e2204140
Article History:
Received Date: 2/8/2021Revision Received Date: 23/11/2021
Acceptance Date: 15/12/2021
Electronic publication date: 21/06/2022
Collection year: 2022
open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Background:
Compassion at work is integral for employees experiencing suffering in a wide range of contexts. Especially, it could be more critical for social workers who have relatively high levels of emotional demands. Thus, this current study aims to explore the mechanisms through how the experiences of compassion at work enhance social workers’ job performance.
Methods:
The participants were 356 social workers in South Korea. This study used a cross-sectional research design along with a self-report survey. Path analyses were used to test our hypotheses.
Results:
Compassion was positively related to positive psychological capital, and positive psychological capital was also positively related to affective commitment and job performance. In addition, we found that effective commitment was positively related to job performance. Accordingly, positive psychological capital mediated the positive relationships between compassion and affective commitment as well as compassion and job performance. Furthermore, the serial multiple mediation effect of positive psychological capital and affective commitment on the relationship between compassion and job performance was significant.
Conclusion:
Our findings suggest that social workers engaged in social welfare facilities build positive psychological capital through compassion and make an affective commitment to their work, eventually improving their job performance. Our findings provide practical insights for organizations, especially social welfare organizations, by shedding light on the importance of spreading an empathetic and positive organizational culture in enhancing social workers’ job performance.
1. INTRODUCTION
Research on compassion has been used as a concept of compassion in the field of religious studies and has a long tradition in medicine, sociology, theology, and philosophy; however, the studies are limited, specifically in the field of business administration, and organizational behavior [1]. In terms of cognitive, emotional, and behavioral dimensions, compassion means not only the “high quality of connection” (HQC) with others but also the act of caring in response to the suffering of others. It is distinguished from other emotions in that it involves “Acts” [2, 3].
The compassion experienced by the members of the organization within the organization is responding to the material and psychological suffering experienced by their employees, subordinates, and superiors. In addition, compassion arises as a response to suffering induced in interpersonal relationships between coworkers and coworkers, and between bosses and subordinates. Suffering is defined as experiencing the pain that causes ontological bitterness and desolation [4]. Examples of such suffering include illness or injury, the death of a loved one, and trauma that may occur at work [5]. The empathy experienced by members is the key to caring and healing for other members of the organization who are in difficulties within the organization [2, 6].
Compassion is an emotion that suffers, feels, and experiences the pain of others as if it were one's own [7]. Wuthnow [6] states that compassion is the act of helping others altruistically, and that claims to induce positive emotion. Compassion is the display of an emotional state that expresses warmth, goodwill, and kindness, regardless of any motive [8]. Compassion is also a relational process that involves recognizing the suffering of others, empathizing with someone's emotional pain, and acting in any way to help alleviate or reduce the suffering [9].
Through compassionate behavior, members have positive emotions within the organization, and through positive emotions, they become motivated to immerse themselves in the work within the organization [7]. Compassion helps others in the organization to feel cared for or seen and to feel that they are not alone. In this way, compassion heals the organization. Dutton and his colleagues at the University of Michigan formed the Positive Organizational Scholarship (POS) in 2003 and have been actively researching compassion, positive emotion and identity, and job crafting. They conducted case studies to examine compassion, including a compassion scale [7]. Lilius et al. [7] empirically investigated the causal relationships among compassion, positive emotion, and affective commitment for the first time. Dutton et al. [10] revealed the relationship between virtue—a higher concept of compassion—and positive organizational identity (POI) through a qualitative study. Dutton et al. [11] explained the organization of compassion. Frost et al. [1] described the organization from the perspective of compassion through qualitative research.
Hur et al. [12] demonstrated the relationships between corporate social responsibility (CSR), compassion, and creativity. Moon et al. [13] revealed the causal relationship between compassion and positive work-related identity. Since Lilius et al. [7], research on the relationship between compassion and other outcome variables has been actively conducted in the field of business administration [12-16].
Unlike previous research on compassion in the field of business administration, this study examined the effect of compassion experienced by social workers in social welfare facilities on affective commitment and job performance through positive psychological capital. It examined the serial multiple mediation effect of positive psychological capital and affective commitment on the pathway from compassion experienced by social workers to their job performance.
This study shows that when social workers experience compassion in social welfare facilities, which are sites of suffering and healing, and exchange compassion with each other, they build positive psychological capital and improve their affective commitment and job performance. This study contributes toward opening social workers’ eyes to see their customers as personal subjects who need their care if they experience compassion as an emotional response to suffering and form positive psychological capital. It also contributes toward understanding social workers in terms of creating an empathetic organizational culture through compassion and developing a positive organizational culture through the construction of positive psychological capital.
2. HYPOTHESES DEVELOPMENT
2.1. Compassion and Positive Psychological Capital
Historically, rationality has become a primary focus of organizational studies, and emotions at the workplace are issues that have been disregarded in OB studies [17-19]. Recently, there has been a growing school of thought that consideration of emotion and affect in organizations, rather than exclusive concentration on the rational and systematic perspectives to see organizations, contributes to organizational success. A shift from bounded rationality that underlines reasoning and decision making to bounded emotionality that emphasizes care, altruism, and compassion sheds new light on organizational studies. There are compelling practical reasons for scholars and practitioners to give more attention to emotional aspects, particularly compassion in the workplace.
Organizations are currently faced with a severe economic crisis and the highest unemployment rates in recent history, in addition to the scarcity of natural resources, intense competition, corporate downsizing, and an increase of threats to our natural environment. Correspondingly, employees within organizations suffer from many sources outside and within their respective organizations (i.e., natural disasters, human-made disasters, personal tragedies, and job stressors) [11]. Cassell [20] defines suffering as a state of severe distress associated with events that threaten the intactness of the person at an individual, an organizational, and a national level. A serious level of suffering residing in an organization causes enormous financial, psychological, and social costs for organizations and their members [21]. Ignorance of employee’s suffering is even costlier. As the “heart’s response to others’ suffering” [22], compassion plays an important role in organizational life by reducing or alleviating others’ suffering or pain within labor organizations [1, 2, 9, 11]. Scholars widely agree that compassion involves sympathetic consciousness of others’ distress and suffering and caring for those others often in communicative or behavioral ways. Kornfield [22] defines compassion as “the heart’s response to sorrow” (p. 326). Kanov et al. [9] define compassion as a relational process of noticing another person’s suffering, experiencing an emotional empathy for their pain, and behaving in some way that alleviates their pain.
Lilius et al. [7] report that there is a significant relationship between compassion and positive emotions experienced within an organization through an empirical study. In this respect, the compassion with authenticity experienced within the organization induces positive emotions in the personal and social identity of the organization members and plays a role in forming a positive psychological state among the organization members.
Cameron and Dutton [23] argued that compassion experienced within an organization improves its members’ physical health and happiness, self-esteem or self-efficacy, and buffering function and resilience. They found that compassion can positively effect self-efficacy, self-esteem, and hope for the future and optimism, and strength resilience further.
Ko and Choi [14] argued that compassion significantly affected outcome variables by forming positive psychological capital among organizational members and that positive emotions elicited resources like self-efficacy, resilience, optimism, and hope. These are the resources through which an individual can overcome a negative state. An individual with lots of psychological resources can interpret an unfortunate event that occurs to him or her more positively, showing a willingness to solve it rather than falling into a negative state such as anxiety.
Organizational members who experience compassion tend to have hope and optimism, which are sub-dimensions of positive psychological capital [17, 24-27], and self-efficacy, which enables them to work with more confidence [28]. Organizational members who experience compassion tend to experience resilience, a sub-dimension of positive psychological capital, from stress, mental exhaustion, and excessive workload [8, 29-35].
Hypothesis 1. Compassion has a positive effect on positive psychological capital.
2.2. Positive Psychological Capital and Affective Commitment
Recent research on POB has revealed that organizational members with positive psychological capital like self-efficacy, hope, resilience, and optimism show higher productivity and performance than those without it. Youssef and Luthans [36] studied positive psychological capital and organizational members’ attitudes and behaviors and confirmed that positive psychological capital has a positive effect on job satisfaction and happiness and organizational commitment.
Hatfield et al. [37] suggested that the positive emotions experienced by an individual can be transferred to other people in the organization, and that these emotions actually affect overall group effectiveness and satisfaction [38-40]. Weiss and Cropanzano [41], drawing on affective events theory (AET), asserted that emotions form the emotional factors of job satisfaction during job performance, thus indicating that workers who are satisfied with their lives have higher job satisfaction and performance than those who are not.
Hypothesis 2. Positive psychological capital has a positive effect on affective commitment.
2.3. Positive Psychological Capital and Job Performance
The literature shows that self-efficacy, which is a sub-dimension of positive psychological capital, affects job performance significantly depending on the extent of effort an organizational member puts into a specific task [28]. As a sub-dimension of positive psychological capital, hope and optimism help improve job performance because they are driving forces that help overcome difficulties like job stress and emotional exhaustion [36, 42]. Research has shown that as a sub-dimension of positive psychological capital, self-efficacy has a positive effect on various job-related performance variables [43] and that hope has a positive impact on performance variables like job performance, satisfaction, and attitude [36]. Research also revealed that organizational members with positive, optimistic thinking show higher job performance than those without it [44-47].
When organizational members in a company experience compassion, they experience self-efficacy, hope, optimism, and resilience, which are sub-dimensions of positive psychological capital, which eventually serve as a driving force to enhance job performance [43]. Empirical research has indicated that organizational members’ hope and optimism significantly affect job performance [36], and self-efficacy and resilience help improve job performance among employees [28, 42].
Hypothesis 3. Positive psychological capital has a positive effect on job performance.
2.4. Affective Commitment and Job Performance
Members who are emotionally immersed in the organization tend to have a strong sense of belonging to and identify strongly with the organization, which increases their desire to engage members in organizational activities, achieve organizational goals, and remain in the organization [48]. Research has shown that affective commitment is related to turnover, absenteeism, and performance [49-53]. Affective commitment buffers side effects even when employees experience unfairness and unmet expectations while performing their jobs.
Employees with high affective commitment have a more tolerant attitude than those with low affective commitment even when the organization’s wage increase is insufficient, having fewer negative effects on the organization [54]. The emotional attachment related to affective commitment affects the relationship between the employer and the employee and motivates organizational members to remain in the organization. When organizational members’ basic needs and expectations are met, they show stronger emotional attachment to the organization than those whose basic needs and expectations remain unmet [55]. Emotionally immersed members exhibit positive behaviors while doing their work with a strong sense of belonging to the organization and the will and desire to devote themselves to it [56-58]. The higher the affective commitment, the more positive the job performance will be.
Hypothesis 4. Affective commitment has a positive effect on job performance.
2.5. Serial Multiple Mediation of Positive Psychological Capital and Affective Commitment
Lilius et al. [7] empirically found that compassion and positive emotion experienced within an organization influence each other significantly. Sincere compassion shared within the organization induces positive feelings among organizational members and plays a role in forming a positive psychological state [15, 16, 59-62]. This has been confirmed in several studies that have demonstrated the causal relationship between compassion and positive variables. Davidson [63], confirming the relationship between compassion and positive emotion, argued that positive emotion helps secure psychological resources to reduce negative emotions like worries and anxiety.
As a sub-dimension of positive psychological capital, hope and optimism help improve affective commitment and job performance as they are the driving forces for overcoming work-related difficulties like job stress and emotional exhaustion [36, 42]. The literature has shown that as a sub-dimension of positive psychological capital, self-efficacy has a positive effect on various job-related performance variables [43, 64-66] and that hope has a positive effect on performance variables like job performance and satisfaction, and affective commitment [36]. Research has also shown that organizational members with positive, optimistic thinking showed higher job performance than those without it [44]. Therefore, this study established the following hypothesis that when social workers in a facility exchange compassion, an emotional response to the suffering of others, they form positive psychological capital, strengthen their affective commitment, and eventually improve their job performance [67, 68].
Hypothesis 5. Positive work-related identity and psychological capital have a serial multiple mediation effect on the relationship between compassion and job performance.
3. MATERIALS AND METHODS
3.1. Research Model
This study empirically examined the serial multiple mediation effect of positive psychological capital and affective commitment on the pathway from compassion to job performance. Fig. (1) presents the research model.
 |
Fig. (1). Research Model. |
3.2. Participants and Procedure
A survey was employed to collect data. A total of 365 social workers were invited to take the survey. Excluding 9 surveys with incomplete or insincere responses, 356 surveys were used for statistical data analysis, indicating an effective response rate of 97.5%. The sample comprised 181 males (50.8%) and 175 females (49.2%). Of them, 62 respondents (17.8%) were in their 20s, 130 (36.5%) were in their 30s, and 102 (28.7%) were in their 40s. By religion, non-religion represented the highest proportion (132 respondents, 37.1%), followed by Christianity (122, 34.3%) and Buddhism (54, 15.2%). A total of 169 respondents (47.5%) had graduated from a two-year college course and 140 (39.3%) from a four-year college course. Further, 177 (49.7%) respondents had a monthly income of less than 3 million Korean won. Most of the respondents (140; 39.3%) had 5 to 9 years’ work experience, followed by 139 respondents (39.0%) with 1 to 4 years’ experience.
3.3. Measures
3.3.1. Compassion
This study defined compassion as an emotional response to the suffering of others through action. Three items developed by Lilius et al. [7] were adapted to measure compassion: “I often experience compassion in social welfare facilities,” “I often experience compassion from my boss in social welfare facilities,” and “I often experience compassion from my co-workers in social welfare facilities.” The items were rated on a 5-point Likert scale and the Cronbach’s alpha of compassion was α=.784.
3.3.2. Positive Psychological Capital
This study defined positive psychological capital as hope, self-efficacy, optimism, and resilience formed through compassion experienced by organizational members while working. A total of 24 question items developed and used by Youssef and Luthans [36] and Luthans et al. [31] were adapted to measure positive psychological capital (e.g., “I can devise many ways to overcome difficulties in social welfare facilities when I face them,” “I overcome frustration and hopelessness in social welfare facilities when I face them,” and “I do not experience much difficulty while recovering”). The items were rated on a 5-point Likert scale, and the Cronbach’s alpha of positive psychological capital was α=.892.
3.3.3. Affective Commitment
Drawing on emotional attachment presented by Meyer and Allen [50], this study defined affective commitment as the degree of attachment that an individual identifies with, participates in, and feels strongly toward the organization. Five question items developed by Allen and Meyer [69] were adapted to measure affective commitment (e.g., “I feel emotionally attached to my work when I work,” “I feel like the work of our institution is my own,” and “I have a strong sense of belonging to my institution I work for when I work”). The items were rated on a 5-point Likert scale. The Cronbach’s alpha of this construct of affective commitment was α=.770.
3.3.4. Job Performance
This study defined job performance as the degree to which one performs the job in charge accurately and responsibly. Five items developed by Williams and Anderson [70] were used to measure job performance (e.g., “I fulfill the responsibilities specified in my job while working in social welfare facilities” and “I tend to perform well in work expected of the organization while working in social welfare facilities”). The items were rated on a 5-point Likert scale, and the Cronbach’s alpha of job performance was α=.821.
4. RESULTS AND DISCUSSION
4.1. Confirmatory Factor Analysis
The results of the confirmatory factor analysis (CFA) were as follows: χ2(500)=942.138; p<.001. The latent variables’ measurement items used in this study satisfied the traditional criteria. All values from the CFA were satisfactory [71], as shown in Table 1.
4.2. Correlation Analysis
This study employed both Pearson correlation and regression analyses to test multicollinearity. The results showed that all the variance inflation factor values (VIFs) ranged between 1.338 and 1.714, confirming that multicollinearity was not a serious issue. Table 2 presents the results of the correlation analysis.
| Construct | Items | λ | SE | CR | Cronbach's α | AVE | CR |
|---|---|---|---|---|---|---|---|
| Compassion | Com1 | .685 | - | - | .784 | .703 | .873 |
| Com2 | .657 | .087 | 11.439 | ||||
| Com3 | .920 | .107 | 12.497 | ||||
| Positive Psychological Capital |
PsyCapital1 | .655 | - | - | .892 | .652 | .821 |
| PsyCapital2 | .688 | .090 | 11.431 | ||||
| PsyCapital3 | .651 | .088 | 10.891 | ||||
| PsyCapital4 | .668 | .088 | 11.125 | ||||
| PsyCapital5 | .645 | .087 | 10.829 | ||||
| PsyCapital6 | .642 | .077 | 10.780 | ||||
| PsyCapital7 | .656 | .079 | 11.045 | ||||
| PsyCapital8 | .660 | .083 | 11.080 | ||||
| PsyCapital9 | .479 | .084 | 8.278 | ||||
| PsyCapital10 | .627 | .086 | 10.572 | ||||
| PsyCapital11 | .674 | .081 | 11.243 | ||||
| PsyCapital12 | .592 | .083 | 10.085 | ||||
| PsyCapital13 | .545 | .087 | 9.331 | ||||
| PsyCapital15 | .489 | .082 | 8.482 | ||||
| PsyCapital16 | .508 | .084 | 8.748 | ||||
| PsyCapital18 | .468 | .087 | 8.111 | ||||
| PsyCapital20 | .533 | .078 | 9.136 | ||||
| PsyCapital21 | .439 | .086 | 7.629 | ||||
| PsyCapital22 | .443 | .086 | 7.696 | ||||
| PsyCapital23 | .616 | .099 | 10.408 | ||||
| PsyCapital24 | .545 | .094 | 9.320 | ||||
| Affective Commitment |
AC1 | .675 | - | - | .770 | .664 | .863 |
| AC2 | .472 | .109 | 8.002 | ||||
| AC3 | .741 | .102 | 11.569 | ||||
| AC4 | .767 | .092 | 12.301 | ||||
| AC5 | .635 | .088 | 10.199 | ||||
| Job Performance | JP1 | .711 | - | - | .821 | .615 | .888 |
| JP2 | .763 | .088 | 12.744 | ||||
| JP3 | .699 | .097 | 11.811 | ||||
| JP4 | .686 | .093 | 11.602 | ||||
| JP5 | .623 | .101 | 10.615 | ||||
| X2(500) = 942.138 (p=.000), CFI= .911, TLI= .900, IFI= .912, RMSEA= .050, RMR= .033 | |||||||
Table 2. Construct means, standard deviations, and correlations.
| 1 | 2 | 3 | 4 | |
|---|---|---|---|---|
| 1. Compassion | .838 | |||
| 2. PsyCapital | .376** | .807 | ||
| 3. Affective Commitment | .405** | .582** | .814 | |
| 4. Job Performance | .288** | .521** | .417** | .784 |
| Mean | 3.718 | 3.528 | 3.561 | 3.795 |
| SD | .655 | .440 | .599 | .617 |
| Max | 5.00 | 5.00 | 5.00 | 5.00 |
| Min | 1.00 | 2.42 | 1.20 | 2.20 |
| Hypothesis | Path | b | SE | CR | P | Test |
|---|---|---|---|---|---|---|
| Hypothesis 1 | Compassion → PsyCapital | .253 | .033 | 7.643 | p<.001 | Accept |
| Hypothesis 2 | PsyCapital → AC | .793 | .059 | 13.502 | p<.001 | Accept |
| Hypothesis 3 | PsyCapital → JP | .572 | .077 | 7.437 | p<.001 | Accept |
| Hypothesis 4 | AC → JP | .178 | .056 | 3.145 | p<.01 | Accept |
| Effect | LLCI95% | ULCI95% | BootSE | |
|---|---|---|---|---|
| Total indirect effect | .2007 | .1114 | .3202 | .0526 |
| Compassion -> PsyCapital -> JP | .1498 | .0810 | .2360 | .0394 |
| Compassion -> AC -> JP | .0280 | .0051 | .0595 | .0140 |
| Compassion -> PsyCapital -> AC -> JP | .0230 | .0045 | .0485 | .0113 |
4.3. Hypotheses Testing
After removing items that showed a high correlation or very low factor load (λ) based on the CFA results, the following were selected for structural equation modeling in order to test the hypotheses: 3 items to measure compassion, 21 items to measure positive psychological capital, 5 items to measure affective commitment, and 5 items to measure job performance. Table 3 presents the results of the structural equation modeling, supporting Hypotheses 1 through 4.
4.4. Serial Multiple Mediation Effect of Positive Psychological Capital and Affective Commitment on the Relationship between Compassion and Job Performance
This study employed the PROCESS bootstrap sampling to test the significance of the mediating effect [72, 73]. This method has been used widely to overcome the limitations of conventional approaches (e.g., regression analysis). Bootstrapping helps judge whether the indirect effect is statistically significant (CI95%=LLCI value, ULCI value). As seen in Table 4, the indirect effect between compassion and job performance turned out to be between LLCI95=0.0045 and ULCI95=0.0485, confirming the significance of the serial multiple mediation effect of positive psychological capital and affective commitment, thus supporting Hypothesis 5.
CONCLUSION
This study empirically found that compassion experienced by social workers as an emotional response to mental, physical, and material suffering formed positive psychological capital and significantly enhanced affective commitment and job performance. The findings supported all the hypotheses framed in the study, including the serial multiple mediation effect of positive psychological capital and affective commitment. When social workers exchange compassion with each other, they build positive psychological capital in the form of hope, optimism, self-efficacy, and resilience around their work, which eventually enhances their job performance.
IMPLICATIONS
First, this study is different from previous studies in that it demonstrates the serial multiple mediation effects of positive psychological capital and affective commitment on the relationship between compassion and job performance with data from social workers. Ko and Choi [14] demonstrated the mediation effect of positive psychological capital on the pathway from compassion to job performance with organizational members within a company. They verified the serial multiple mediation effect of positive work-related identity (PWRI) and collective self-esteem (CSE) on the pathway from compassion to job performance. However, unlike Ko and Choi [14], this study examined the serial multiple mediation effect of positive psychological capital and affective commitment on the pathway from compassion to job performance among social workers.
Second, the existing research on compassion has mainly focused on the mediation effect of positive emotions on the pathway from compassion to affective commitment [7], to collective pride [14], and to PWRI [74]. Moon et al. [13] empirically demonstrated the mediation effect of PWRI on the pathway from compassion to performance variables. Ko and Choi [14] examined the mediation effect of positive psychological capital on the pathway between compassion and job performance. Rhee et al. [75] verified the moderating effect of compassion and self-efficacy on the relationship between rudeness and job performance. However, the current study quantitatively demonstrated the causal relationships between compassion experienced by social workers and positive psychological capital, affective commitment, and job performance.
Third, this study has a practical implication for improving social workers’ empathy levels by providing compassion as an act of temporal, material, and mental care for those struggling with excessive workloads and job stress. This study shows that compassion serves as a buffer for social workers at the individual level as it helps them have hope for the future, optimism, self-efficacy, and resilience [9, 76].
Finally, this study has a practical implication for forming an empathetic and positive organizational culture by building resilience and positive psychological capital through compassion experienced by social workers exposed to sufferings at the workplace. This study also opens up an avenue for social workers who have improved their sense of empathy through compassion, through which they can treat their customers with subjectivity rather than objectivity.
LIMITATIONS AND FUTURE RESEARCH
First, this study is a cross-sectional one in which samples were collected at a certain point in time. Compassion experienced by social workers, positive psychological capital, and affective commitment are formed and maintained over a considerable period of time, and therefore a longitudinal approach can help derive more valid findings [77].
Second, the findings of this study cannot be generalized as the sample data were collected from social workers in social welfare facilities located in Seoul and Gyeonggi-do in Korea alone. Future research should compare countries in order to validate the significance of the relationships between compassion experienced by social workers and other outcome variables. While compassion is a human emotion that responds to suffering, it may differ from country to country in terms of degree.
Third, this study used data from social workers and empirically examined the causal relationships among compassion, positive psychological capital, affective commitment, and job performance for the first time in the field of social science. Future research should continue to quantitatively investigate the causal relationships between positive variables like positive emotion, psychological capital, and work-related identity and performance variables.
Finally, the scales employed may be a limitation for future research to overcome by securing their validity. This study used a three-item scale developed by Lilius et al. [7] to measure compassion. Empirical research on compassion has been conducted regularly [7, 13, 14, 74], but future empirical research on the relationship between compassion and outcome variables should be accompanied by the development of more accurate scales through a mixed method comprising qualitative and quantitative approaches.
ETHICS APPROVAL AND CONSENT TO PARTICIPATE
The survey did not identify specific individuals, and the participation was voluntary. Thus, no ethics approval was required.
HUMAN AND ANIMAL RIGHTS
Not applicable.
CONSENT FOR PUBLICATION
Consent form has been obtained from the study participants.
STANDARDS OF REPORTING
STROBE guidelines have been followed.
AVAILABILITY OF DATA AND MATERIALS
The data used in this study are available upon request from the corresponding author.
FUNDING
None.
CONFLICT OF INTEREST
The authors declare no conflict of interest, financial or otherwise.
ACKNOWLEDGEMENETS
Declared none.
