Environmental awareness and sustainable behaviors of healthcare professionals: validation of the healthcare environmental awareness tool (HEAT)

Abstract

Background Climate change poses a significant challenge to public health, requiring healthcare personnel to recognize their responsibility and adopt environmentally responsible behaviors. The aim of this study was to conduct a cultural adaptation and psychometric validation of the Healthcare Environmental Awareness Tool (HEAT) to assess the level of environmental awareness, sustainable behaviors, and their relationship to healthcare professionals' health in Spain. Methods A cross-sectional observational study was conducted to translate, adapt, and validate the HEAT questionnaire for the Spanish context. The sample comprised 450 healthcare professionals from 9 Spanish hospitals. The HEAT questionnaire was validated using item response theory, specifically through the polytomous Rasch model. It is organized into three main scales: HAS (Healthcare Awareness Scale), HPEB (Healthcare Professional Ecological Behavior Scale), and PEB (Personal Ecological Behavior Scale). Each scale includes two dimensions per item derived from paired questions. The first dimension addresses the specific topic of the scale, while the second focuses on the respondent’s belief about how environmental impacts affect human health. Results The HEAT questionnaire, initially comprising 62 items, was refined to a final version of 50 items. This version demonstrated robust reliability and validity, with satisfactory fit for both items and persons. Reliability indices were: HAS-1 (0.76 for persons, 0.98 for items), HAS-2 (0.82, 0.96), HPEB-1 (0.77, 0.99), HPEB-2 (0.79, 0.94), PEB-1 (0.83, 0.99), and PEB-2 (0.87, 0.97). Internal consistency, measured using Cronbach’s α and McDonald’s ω, yielded strong results: HAS-1 (0.79), HAS-2 (0.90), HPEB-1 (0.75), HPEB-2 (0.87), PEB-1 (0.81), and PEB-2 (0.92). No significant group differences were observed, confirming the instrument’s fairness in differential item analysis. Conclusions The HEAT questionnaire is a useful and accurate tool for measuring environmental awareness, sustainable behaviors, and perceived health impacts among healthcare professionals.