Development and validation of a flow state scale for healthcare professionals

Nowadays, healthcare workers generally face mental health risks such as occupational burnout, depression, and low job satisfaction, which negatively affect both their physical and mental well-being as well as organizational performance. Flow, as a positive internal motivational state, may help address these challenges. Therefore, this study aimed to develop and validate a flow state scale suitable for healthcare professionals offering a scientific and useful instrument for evaluating flow experience among healthcare workers.

An initial item pool was generated based on a literature review, existing scales, and the specific nature of healthcare work. The items were then translated and back-translated by bilingual experts (Chinese and English) to ensure linguistic and conceptual equivalence. We refined the items through a two-round Delphi expert consultation (n = 15). All items were rated on a 5-point Likert scale. Participants were instructed to respond based on their experience during the medical service activity they had just completed. Using a convenience sampling strategy via an online platform, we collected 1,240 valid questionnaires from healthcare professionals in China, predominantly from Beijing and Fujian provinces. The sample was randomly divided into two equal parts. The first set (n = 620) was used for item analysis and initial reliability and validity testing to establish the factor structure. The second set (n = 620) was used for cross-validation.

The flow state scale for healthcare professionals includes 15 items measuring four dimensions of the flow experience: concentration and directional feedback, intrinsic empowerment and control, transformation of time, and loss of self-consciousness. The scale showed high internal consistency (Cronbach's α from 0.813 to 0.911 for the full and subdimension scales). Confirmatory factor analysis supported the four-factor structure (χ ²/df = 2.661, RMSEA = 0.073, GFI = 0.915, AGFI = 0.878, SRMR = 0.049, RMR = 0.037). While the AGFI value fell slightly below the 0.90 threshold for "good" fit, it exceeded the acceptable criterion of 0.85, and all other indices indicated good model fit. The final model was developed using the first subsample (12 items deleted based on modification indices) and cross-validated in an independent second subsample. The scale also demonstrated sound convergent and discriminant validity.

The flow state scale for healthcare professionals has good reliability and validity. It can serve as an effective tool for assessing the flow state among healthcare professionals and provides a valuable reference for healthcare institutions in management practices such as personnel motivation, burnout intervention, performance management, and further service quality improvement.