A Multidimensional Assessment of the Impact of Healthcare Volunteering in a War-Affected Setting

Background: Medical students who volunteer during armed conflict may help sustain overwhelmed health services while experiencing concurrent social, academic, psychological, and physical consequences. However, no context-sensitive instrument has been available to assess these multidimensional benefits and burdens in active conflict settings. This study primarily aimed to develop and conduct an initial psychometric evaluation of the Volunteering Impact Scale (VIS) among medical students volunteering in Gaza and, secondarily, to characterize their volunteering experiences. Methods: A cross-sectional survey was conducted among 169 medical students who volunteered in hospitals in Gaza during the ongoing war. An initial 28-item pool was generated from a focused literature review, relevant theoretical frameworks, and consultations with Gaza-based medical students and clinicians. A multidisciplinary team reviewed the items for relevance, clarity, redundancy, and contextual appropriateness. Following item refinement and psychometric evaluation, the final 16-item VIS comprised five domains: social impact, mental burden, physical burden, academic development, and wellbeing and fulfillment. Its structure was assessed using exploratory factor analysis with principal axis factoring and Promax rotation, followed by confirmatory factor analysis. Internal consistency and convergent and discriminant validity were also examined. Domain scores and their associations with participant, volunteering, and war-exposure characteristics were subsequently analyzed. Results: Exploratory factor analysis revealed a five-factor structure explaining 51.2% of the variance. Parallel analysis favored three factors, whereas a theoretically informed five-domain solution was retained for further evaluation. Primary factor loadings ranged from 0.23 to 0.89. Most items met the prespecified loading criterion of 0.40; however, three Social items demonstrated weaker loadings and were retained provisionally because of their conceptual relevance to the construct. Confirmatory analysis provided support for the proposed measurement structure (RMSEA = 0.059, SRMR = 0.075, CFI = 0.911, and TLI = 0.888). Cronbach's alpha coefficients ranged from 0.64 to 0.75, and discriminant validity was supported by heterotrait-monotrait ratios below 0.85. Participants reported perceived social (M = 4.31/5), academic (M = 4.19), and wellbeing-related (M = 3.96) benefits. Mean reverse-scored Mental and Physical scores were 2.71 and 2.60, respectively, with lower scores indicating greater burden. Longer volunteering was associated with greater physical strain but also with stronger academic and wellbeing outcomes. Conclusions: The VIS demonstrated a conceptually coherent five-domain structure and promising initial psychometric properties for assessing the concurrent benefits and burdens of healthcare volunteering in a war-affected setting. Further validation in independent and more diverse samples is required. The findings also indicate that volunteer programs should combine meaningful clinical participation with structured supervision, recovery time, role rotation, and context-sensitive psychosocial support.