Cross-Cultural Adaptation and Validation of the Emotional Contagion Scale among Nurses in China

Cross-Cultural Adaptation and Validation of the Emotional Contagion Scale among Nurses in China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cross-Cultural Adaptation and Validation of the Emotional Contagion Scale among Nurses in China Hao Liu, Dong Zhang, Yaning Zhu, Hongwen Ma This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8360628/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Emotional contagion, the ability to automatically mimic and synchronize with others' emotional expressions, significantly impacts nurses' mental health in healthcare settings. The lack of a validated instrument to assess emotional contagion among nurses in China has hindered related research. This study aimed to cross-culturally adapt the Emotional Contagion Scale (ECS) and validate the Chinese version among nurses in China. Methods Following established cross-cultural adaptation guidelines, the Chinese version of the ECS was developed through forward translation, synthesis, back-translation, expert committee review, and pre-testing. A convenience sample of 221 ICU nurses from three tertiary hospitals was recruited via an online questionnaire survey. Data analyses included item analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), internal consistency reliability, split-half reliability, and assessments of content validity, construct validity, convergent validity, and discriminant validity using statistical software. Results The Chinese version of the ECS consisted of 15 items and five dimensions: happiness, love, fear, anger, and sadness, with a cumulative variance contribution rate of 70.821%. CFA indicated good model fit. The scale demonstrated excellent internal consistency with a Cronbach's α coefficient of 0.903 and a split-half reliability of 0.807. The content validity index was 0.989, and the average variance extracted (AVE) for all dimensions exceeded 0.5, indicating good convergent and discriminant validity. Conclusion The Chinese version of the Emotional Contagion Scale exhibits good reliability and validity among ICU nurses in China. It serves as an effective tool for assessing nurses' susceptibility to emotional contagion, providing a scientific basis for future research and the development of targeted psychological intervention strategies. Emotional contagion Scale validation Chinese nurses Psychometric properties Cross-cultural adaptation 1 Introduction We can copy the emotions of others and produce corresponding changes in behavior and neural signals, a special ability known as emotional contagion.Hatfield et al define emotional contagion as “Observer's tendency to automatically imitate and synchronise the facial expressions, voice, posture and movements of the demonstrator, and thus to emotionally converge” [ 1 ] .Emotional contagion may be a fairly ancient ability, and before 450 million years, the underlying mechanisms of emotional contagion may have been engraved in genes [ 2 ] . In order to ensure the continuation of the race, social animals often learn environmental information from others, whether positive or negative, through emotional contagion to protect themselves. Humans are a highly social social race, recognizing other people's emotions and responding correctly is the ability that normal people should have, and this ability to contagion emotion firmly binds individuals together, making people part of social groups and behaving prosocially [ 3 , 4 ] , this unique ability plays the role of "social glue" [ 5 ] . However, the protective effect of this unique ability sometimes backfires, especially the spread of negative emotions among the population. Individuals who live with depressed patients for a long time are twice as likely to develop depression as normal people [ 6 ] .The conclusions of this study can also be applied to others who are on the same social network as people with depression, that is, people with depression will spread depression in their social networks through emotional contagion [ 7 ] . Nurses are the largest group of healthcare workers [ 8 ] , and as a bridge between patients and doctors, they have numerous medical responsibilities but are often questioned [ 9 , 10 ] , and unfriendly emotional outbursts can directly affect nurses' enthusiasm for work [ 11 , 12 ] , and these negative emotions spread like an infectious disease in the nurse community, and the vector of these "emotional viruses" may be verbal abuse by patients [ 13 ] , burnout of colleagues [ 14 , 15 ] , or criticism from leaders [ 16 ] . Studies have found that nurses are more likely to be affected by bad emotions in the medical environment than doctors [ 15 ] . ICU nurses in Asia suffer from more severe negative emotions than nurses working in other regions and departments [ 17 ] , manifesting as physical or psychological distress and even severe empathy fatigue [ 18 ] . In China, the number of studies on emotional contagion in medical settings is still small, and researchers tend to focus on the retention of individual emotions, such as the causes of anxiety and depression and the effects of long-term retention of these emotions on nurses' bodies and minds [ 19 , 20 ] , but the transmission process of these emotions in the healthcare community is rarely mentioned. One of the problems is that the lack of tools limits the research and development of emotional contagion in medical settings, and how to quantify the differences in emotional contagion among different individuals is the first step in conducting relevant research. In order to more easily measure the ability to measure emotional contagion, it is a quick and effective way to distinguish the differences in individual emotional contagion through self-reporting. Doherty et al [ 21 ] constructed a 15-item emotional contagion scale to measure the susceptibility of subjects to emotional contagion, which has been translated into multiple languages and used and tested in different cultural contexts [ 22 – 25 ] . However, evidence for the application of the Emotional Contagion Scale in the nurse population is still lacking. Therefore, this study aims to cross-culturally adjust the original items and dimensions of the Emotional Contagion Scale, establish the Chinese version of the Emotional Contagion Scale in the context of Chinese culture, and validate it in the nursing community, so as to stimulate researchers' enthusiasm for the study of emotional contagion in medical settings. 2 Materials and Methods 2.1Translation and Cross-Cultural Adaptation This study obtained authorization for the original emotional contagion from the original author team via email [ 21 ] , referring to the self-reported cross-cultural adaptation guidelines established by Beaton et al [ 26 ] during the translation process, which mainly included six steps. Stage 1: initial translation The original scale was translated separately by two graduate students, both of whom passed the College English Test Band 6, one with a medical background and the other without, forming two initial versions of the Emotional Contagion Scale, T1 and T2. Stage2: Synthesis of the translations A graduate student in nursing combined the T1 and T2 versions, and after consulting with the two translators in Stage 1, the T12 version of the Emotional Contagion Scale was formed. Stage3: Back translation Two professionals who are fluent in English and Chinese were invited to back-translate the T12 version of the Emotional Contagion Scale to form the BT1 and BT2 versions of the Emotional Contagion Scale, both of whom had no medical-related background. Stage4: Expert Committee Six experts were invited to form an expert committee, including 3 nursing professors, 1 director of the nursing department, and 2 nursing psychology experts, to review all the translated versions (T1, T2, T12, BT1, BT2) by email or on-site distribution, and finally formulate the pre-final version of the Emotional Contagion Scale. Stage5: Test of the Prefinal Version According to the recommendation of Beaton et al [ 26 ] , the pre-test phase should contain 30–40 samples, so we conducted a pre-final version of the Emotional Contagion Scale through an online questionnaire collection platform (Questionnaire Star, www-wjx-cn-s.libyc.nudt.edu.cn) and asked them what they thought of the items, and after consulting them for final adjustments, an official version of the Chinese version of the Emotional Contagion Scale was formed. 2.2 Participants and Procedures From February 2025 to May 2025, nurses working in ICUs in three tertiary hospitals in Tianjin were selected as the research objects. The inclusion criteria are as follows: (1) Obtain the nurse practice qualification of the People's Republic of China; (2) Nurses who have been engaged in nursing work for ≥ 1 year; (3) Informed consent and voluntary participation. Exclusion criteria: (1) trainee nurses; (2) Rotating nurses; (3) Continuing education as a nurse. The distribution of the questionnaire was done through the Questionnaire Star, which had a minimum of 10 participants per entry and considered 20% of the invalid sample [ 27 ] , with a minimum sample size of 180. In this study, 229 nurses were surveyed, of which 8 questionnaires were excluded due to regular answers, and 221 participants were left after excluding invalid questionnaires, with a questionnaire recovery rate of 96.5%. 2.3 Instruments General information questionnaire It mainly includes the demographic characteristics of the participants, including age, gender, marital status, education level, years of work and professional title. Emotional Contagion Scale The ECS was developed by Doherty et al [ 21 ] to assess an individual's susceptibility to the emotions of others. The ECS contains 15 items and 5 dimensions (happiness, love, fear, anger, sadness), scored on a 4-point Likert scale (1 = never, 4 = always), and none of the items are scored in reverse, with a total score of 60 points, and higher scores indicate stronger individuals' susceptibility to emotional empathy. The scale has good internal consistency and structural validity, with a Cronbach's α coefficient of 0.90, indicating high reliability and validity. 3 Data Analysis Data analysis was performed using IBM SPSS Statistics (version 24.0) and IBM SPSS AMOS (version 26.0) software. These tools provide powerful statistical capabilities, supporting everything from basic descriptive statistics to complex multivariate analyses such as factor analysis and structural equation models.We employ a rigorous statistical method to ensure the reliability and validity of our findings. In terms of descriptive statistical analysis, we used means ± standard deviation to describe normally distributed quantitative data, median and quartile to describe non-normally distributed quantitative data, and frequency and percentage to describe categorical data. The comprehensive validity of the scale was ensured through multiple evaluations of content, structure, convergent and discriminant validity. In the exploratory factor analysis (EFA) phase, we used Kaiser-Meyer-Olkin (KMO) measurements and Bartlett sphericity test to confirm that the data were suitable for factor analysis. Subsequently, we performed a confirmatory factor analysis (CFA) and evaluated the fit and adequacy of the model using metrics such as Comparative Fit Index (CFI), Goodness-of-Fit Index (GFI), Incremental Fitting Index (IFI), Tucker-Lewis Index (TLI), Approximate Root Mean Square Error (RMSEA), Normative Fitting Index (NFI), and Chi-Square-to-Degrees of Freedom Ratio (2/df). Acceptable model fitting criteria include CFI, GFI, IFI, TLI, and NFI greater than 0.9, RMSEA less than 0.08, and a 2/df ratio of less than or equal to 3. Then, the Cronbach α coefficient, half-method cross-validation, and test-retest reliability were used to further confirm the reliability of the scale. All statistical analyses determined the statistical significance of the difference at the level of p < 0.05. 4 Ethics approval and consent to participate This study follows the ethical principles in Helsinki Declaration and is approved by the Ethics Committee of The First Affiliated Hospital of Nankai University (No.2025-B263). All participants were informed of the research objectives, volunteered to participate in this survey, and have the right to refuse to participate at any time. All participants have obtained informed consent. The research data is strictly confidential and only used for research. 5 Result 5.1 Participant characteristics A total of 221 nurses completed the survey, with an average age of 32.09±6.91 years, of which 179 were females and 42 were males. Additional general information about participants is detailed in Table 1. Table 1 Demographic characteristics of the participants (n = 221) Variable N（%） M(SD) Age（year） 32.09±6.91 Work life（year） 9.45±7.13 Gender Male 42（19） Female 179（81） Educational College or below 18（8.14） Bachelor 199（90.05） Master 4（1.81） Marital status Married 90（40.72） Single 127（57.47） Divorce 4（1.81） Professional title Junior 157（71.04） Intermediate 58（26.24） Advanced 6（2.71） 5.2 Content validity Content validity was assessed by six experts who participated in the cross-cultural adaptation of the questionnaire. The content validity index (S-CVI/Ave) of the Chinese version of the Emotional Contagion Scale was 0.989 (≥0.90), and the content validity index (I-CVI) was 0.833~1.000 (≥0.78), indicating that the content validity was good. 5.3 Construct validity 5.3.1 Exploratory factor analysis Data from 221 respondents were analyzed for exploratory factors. The Kaiser-Meyer-Olkin (KMO) value of 0.84 indicates a high suitability for information extraction, and Bartlett's sphericity test is significant (χ² = 1290.231, p < 0.05), confirming that this data is suitable for exploratory factor analysis. The maximum variance method was used for spinning principal component analysis. After rotation, the cumulative variance for these factors interpreted was 70.821%, with each item showing a factor loading greater than 0.400 on its respective factor. These results (Table 2) confirm the strong construct validity of the questionnaire. Table 2 ITEMS Factor Loading Communality Factor1 Factor2 Factor3 Factor4 Factor5 1. When i look into the eyes of the one i love,my mind is filled with thoughts of romance. 0.151 0.08 0.75 0.15 0.201 0.654 2. I melt when the one i love holds me close. 0.069 0.109 0.807 0.042 0.194 0.708 3. I sense my body responding when the one i love touches me. 0.095 0.151 0.816 0.213 0.033 0.745 4. If someone i'm talking with begins to cry,I get teary-eyed. 0.074 0.143 0.078 0.745 0.227 0.639 5. I get filled with sorrow when people talk about the death of their loved ones. 0.09 0.151 0.081 0.807 0.22 0.738 6. I cry at sad movies. 0.154 0.084 0.274 0.784 0.094 0.729 7. I clench my jaws and my shoulders get tight when i see the angry faces on the news. 0.059 0.855 0.095 0.16 0.117 0.782 8. It irritates me to be around angry people. 0.168 0.734 0.126 0.118 0.163 0.623 9. I tense when overhearing an angry quarrel. 0.128 0.797 0.119 0.089 0.224 0.724 10. Watching the fearful faces of victims on the news makes me try to imagine how they might be feeling. 0.805 0.132 0.146 0.007 0.15 0.71 11. I notice myself getting tense when i'm around people who are stressed out. 0.873 0.079 0.025 0.152 0.122 0.807 12. Listening to the shrill screams of a terrified child in a dentists waiting room makes me feel nervous. 0.817 0.143 0.149 0.155 0.146 0.755 13. Being with a happy person picks me up when i'm feeling down. 0.141 0.235 0.118 0.202 0.756 0.701 14. When someone smiles warmly at me,I smile back and feel warm inside. 0.142 0.11 0.2 0.278 0.729 0.682 15. Being around happy people fills my mind with happy thoughts. 0.179 0.21 0.156 0.124 0.715 0.627 Eigenvalue (Before Rotation) 5.362 1.594 1.44 1.298 0.929 - Variance Explained % (Before Rotation) 35.75% 10.63% 9.60% 8.65% 6.19% - Cumulative Variance Explained % (Before Rotation) 35.75% 46.37% 55.98% 64.63% 70.82% - Eigenvalue (After Rotation) 2.272 2.151 2.129 2.119 1.952 - Variance Explained % (After Rotation) 15.15% 14.34% 14.20% 14.13% 13.01% - Cumulative Variance Explained % (After Rotation) 15.15% 29.49% 43.68% 57.81% 70.82% - KMO Value 0.84 - Bartlett's Test of Sphericity Value 1290.231 - df 105 - p-value 0 - （Factor 1=fear；Factor 2=anger；Factor 3=love；Factor 4=sadness；Factor 5=happiness） 5.3.2 Confirmatory factor analysis In this study, 50% of the sample (111) was randomly selected for confirmatory factor analysis (CFA). The results showed that the chi-square degree-of-freedom ratio (χ²/ν)=1.339 (0.900), the comparative fitting index (CFI)=0.978 (>0.900), the non-canonical fitting index (TLI)=0.971 (>0.900), the incremental fitting index (IFI)=0.978 (>0.900), It means that the model fits well (Table 3). Table 3 confirmatory factor analysis χ2 df p χ2/df GFI RMSEA RMR CFI NFI NNFI - - >0.05 0.9 <0.10 0.9 >0.9 >0.9 107.11 80 0.023 1.339 0.94 0.039 0.029 0.978 0.92 0.971 TLI AGFI IFI PGFI PNFI PCFI SRMR RMSEA 90% CI >0.9 >0.9 >0.9 >0.5 >0.5 >0.5 <0.1 - 0.971 0.911 0.978 0.627 0.701 0.745 0.04 0.015 ~ 0.057 5.4 Convergent validity and Discriminant validity The average variance extracted (AVE) is used to reflect the convergent validity, which must meet the AVE > of 0.45. The square root of AVE for each latent variable according to the Fornell-Lacker criterion needs to be greater than the absolute value of its correlation coefficient with other latent variables. Scale The AVE of the five dimensions > 0.45, and the square root of the AVE values of the five dimensions was greater than the absolute value of the correlation coefficients with other latent variables, indicating that the convergent validity and discriminative validity were good, as shown in Table 4. Table 4 Dimension CR AVE Discriminant validity Factor1 Factor2 Factor3 Factor4 Factor5 Factor1 0.779 0.541 0.736 Factor2 0.78 0.543 0.39 0.737 Factor3 0.796 0.567 0.332 0.363 0.753 Factor4 0.835 0.628 0.306 0.313 0.33 0.793 Factor5 0.753 0.505 0.429 0.512 0.485 0.41 0.71 （The diagonal bold number is the AVE square root value） 5.5 Reliability analysis The Cronbach α coefficient of the Chinese version of the Emotional Contagion Scale was 0.903 (>0.8), indicating excellent overall reliability. A total of 15 items of the scale were analyzed for halving reliability, and when the scale was divided into two parts, the number of analysis items in the two parts was not equal, so the Spearman-Brown coefficient should be used to judge the reliability quality. The Spearman-Brown half-reliability coefficient value is 0.807, which is greater than 0.8, indicating that the half-reliability quality is high. 6 Discussion This study followed strict cross-cultural adaptation guidelines, successfully sinicized the Chinese version of the Emotional Contagion Scale. and verified its reliability and validity in the Chinese nurse population. 6.1 Summary of main research findings The main purpose of this study is to sinicize the Emotional Contagion Scale and test its validity and reliability in the Chinese nurse population. The results show that the Chinese version of ECS has good psychometric properties. Exploratory factor analysis extracted five factors, which were consistent with the dimensional structure of the original scale (love, sadness, anger, fear, and happiness), and the cumulative variance contribution rate was 70.821%, indicating that the scale could effectively explain most of the variations of emotional contagion. Confirmatory factor analysis further confirmed that the fit of the five-factor model was good (χ²/df=1.339, RMSEA=0.039, CFI=0.978, etc.), which supported the structural validity of the scale. In addition, the internal consistency reliability (Cronbach's α = 0.903) and halving reliability (Spearman-Brown coefficient = 0.807) of the scale reached excellent levels, indicating that it is a stable and reliable measurement tool in the Chinese nurse population. 6.2 Comparison with the original scale and other cultural versions The five-factor structure derived from this study is consistent with the dimensional division of the original ECS scale developed by Doherty [21] , indicating that the core components of emotional contagion are universal across cultures. However, compared with the studies in some Western cultural contexts, the project load patterns and correlations between factors in this study show some slight differences. For example, the item "When I gaze into my lover's eyes, my heart is full of romantic thoughts" has a high load (0.75) in the "love" dimension, which is consistent with the original study, but the cross-load pattern between factors in some items may reflect the uniqueness and implicit nature of emotional expression in the context of Chinese culture. Compared with the adapted version in Sweden, Greece, and other countries [22, 23] , the Chinese version of ECS showed comparable or even better reliability and validity indicators in the nurse population, proving the success of this Sinicization and its applicability in the Chinese medical context 6.3 Factor structure and cultural adaptability analysis The results of EFA and CFA jointly validated the structural validity of the Chinese version of ECS. The five factors clearly characterize the transmission pathways of different emotional types. It is worth noting that the correlation coefficient between factors is at a moderate level, indicating that although various emotional contagions are relatively independent constructs, there is a low to medium degree of association between them, which is consistent with the complex nature of emotional experience. The translation and adaptation process of the scale takes into account cultural adaptability. The Expert Committee has repeatedly considered the wording of the entries to ensure that they are faithful to the original meaning and in line with the daily expression habits of Chinese and the clinical context of Chinese nurses. For example, for the expression of intimate emotions, while maintaining the original meaning, the translation is avoided too straightforward, so as to better fit the expression in Chinese culture and ensure the good content validity of the scale. 6.4 Reliability and validity analysis The reliability and validity test results of this study are satisfactory, and the excellent Cronbach's α coefficient (0.903) indicates high internal consistency of the scale, which is comparable to the reliability level of the original scale (α=0.90) and other cross-cultural versions [23, 25] . In terms of validity, good content validity is ensured through expert review. Structural validity is strongly supported by EFA and CFA. In addition, the convergent validity (AVE value of each dimension >0.5) and discriminative validity (AVE in each dimension are greater than the correlation coefficient with other dimensions) both meet the psychometric standards, indicating that the scale can not only effectively measure the target construct, but also have sufficient discrimination between each dimension. 6.5 Applicability and significance in the nurse community This study is the first time that ECS has been applied to a specific occupational group of Chinese nurses, which is of great practical significance. Nurses are one of the groups with the heaviest emotional labor load in the medical environment, and are at high risk of emotional contagion due to long-term exposure to multiple emotional sources such as patient distress [28] , family anxiety [29] , colleague burnout [30] , and high work pressure [31] . The Chinese version of ECS provides an efficient and convenient tool for quantifying nurses' emotional susceptibility. Through this scale, medical institution managers can identify high-risk individuals who are prone to negative emotions, so as to implement targeted psychological interventions and resilience training, such as mindfulness stress reduction [32] , emotion regulation workshops [33] , etc. At the same time, the scale can also be used to evaluate the contagious effect of positive emotions, and by creating a positive and supportive team atmosphere, it can improve overall work happiness and nursing quality, and block the "contagion chain" of negative emotions, which is crucial for preventing nurse burnout [34] and improving patient care outcomes [35] . 6.6 Research on the contribution of theory and practice At the theoretical level, this study enriches the cross-cultural research literature on emotional contagion, confirms the factor structure of ECS in the context of Chinese culture, and provides a validated measurement tool for future empirical research in China. At the practical level, this study provides a scientific evaluation method for hospital nursing management. Managers can use this scale for psychological trait assessment for new nurse recruitment, regular mental health screening for in-service nurses, and evaluation of the effectiveness of team building or interventions, so as to realize the transformation from passive response to active management and improve the level of refinement of human resource management. 7 Limitations Despite the positive results of this study, there are some limitations. First, the samples were purposively sampling and were only sourced from a few tertiary hospitals in Tianjin, which may limit the representativeness and universality of the study results. Future studies should collect samples in a wider geographical area, in hospitals of different grades (e.g., secondary hospitals, community health centers) to further verify the stability of the scale. Secondly, this study is a cross-sectional survey, and the causal relationship between variables cannot be inferred. In the future, a longitudinal study design can be used to explore the long-term predictive effect of emotional contagion on nurses' burnout and turnover intention. Finally, data collection relies on self-report scales, which may have biases in social expectations. Future studies can combine multiple methods such as physiological indicators (such as heart rate variability, cortisol levels) or behavioral observation methods to conduct multimodal measurements of emotional contagion to mutually validate the results. 8 Conclusion This study strictly followed the cross-cultural adaptation guidelines, successfully sinicized the Chinese version of the Emotional Contagion Scale, and verified its good reliability and validity in the Chinese ICU nurse population for the first time. The results show that the Chinese version of ECS retains the five-factor structure of the original scale, and all psychometric indicators meet the standards, making it a reliable and effective assessment tool. The formation of this scale fills the gap in domestic research tools to quantify individual differences in emotional contagion in medical contexts, which not only provides a solid foundation for carrying out research on emotional contagion in the context of Chinese culture, but also provides a scientific basis for clinical nursing managers to identify emotionally susceptible groups and formulate targeted psychological support strategies, which has important theoretical value and practical application prospects. Declarations Ethics approval and consent to participate This study follows the ethical principles in Helsinki Declaration and is approved by the Ethics Committee of The First Affiliated Hospital of Nankai University (No.2025-B263). All participants were informed of the research objectives, volunteered to participate in this survey, and have the right to refuse to participate at any time. All participants have obtained informed consent. The research data is strictly confidential and only used for research. Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Competing interests The authors declare that they have no competing interests. Funding Not applicable. Authors' contributions LH and ZD co-designed the ideas and methodologies of the study and were the main contributors to the writing of the manuscript, ZYN collected and analyzed the data, and MHW carried out quality control and revision of the manuscript. Acknowledgements Not applicable. References Hatfield E, Cacioppo JT, Rapson RL. Emotional Contagion[M]. 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Effects of mindfulness decompression therapy on mental health and job burnout among nurses working in the frontline of the novel coronavirus pandemic: A retrospective study[J]. J Occup Health. 2023;65(1):e12398. Sarazine J, Heitschmidt M, Vondracek H, et al. Mindfulness Workshops Effects on Nurses' Burnout, Stress, and Mindfulness Skills[J]. Holist Nurs Pract. 2021;35(1):10–8. Quesada-Puga C, Izquierdo-Espin FJ, Membrive-Jimenez MJ, et al. Job satisfaction and burnout syndrome among intensive-care unit nurses: A systematic review and meta-analysis[J]. Intens Crit Care Nur. 2024;82:103660. Cecere L, de Novellis S, Gravante A, et al. Quality of life of critical care nurses and impact on anxiety, depression, stress, burnout and sleep quality: A cross-sectional study[J]. Intens Crit Care Nur. 2023;79:103494. Additional Declarations No competing interests reported. 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Center, The First Affiliated Hospital of Nankai University","correspondingAuthor":false,"prefix":"","firstName":"Dong","middleName":"","lastName":"Zhang","suffix":""},{"id":574885569,"identity":"c72f2a34-8b84-4b36-8b7a-c8465541c143","order_by":2,"name":"Yaning Zhu","email":"","orcid":"","institution":"Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University","correspondingAuthor":false,"prefix":"","firstName":"Yaning","middleName":"","lastName":"Zhu","suffix":""},{"id":574885570,"identity":"e72d5d25-fd95-4e79-9849-51b61de00085","order_by":3,"name":"Hongwen Ma","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYFACxsYDCQwMCXxAJjMDgw0PP3sDQS0NYC1sEC1pMpI9BwjbA1IC03LYxuCGA37l8u7NDQcettnlsbE3sG4ubDvPw3CDgfHDxxzcWgzPHGw4kNiWXMzGc4Dt9sy22zyMsxuYJWduw6NlRiLQL2eYE9skEthu8267zcMsc4CNmReflvkPQVrqE9vkH4C0nONhA+rFq0VeAhRiFYeBtjCAtBzg4SGkxYAH5LCK40C/gBz2L5lHgudgM16/yLcff/jwh0F1Hj870Ps8Z+zs7Y83H/zwEZ8tB+BM/g9QBmMDbvUgW/BLj4JRMApGwSgAAgCITFTZmjV21QAAAABJRU5ErkJggg==","orcid":"","institution":"Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University","correspondingAuthor":true,"prefix":"","firstName":"Hongwen","middleName":"","lastName":"Ma","suffix":""}],"badges":[],"createdAt":"2025-12-15 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citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e.Emotional contagion may be a fairly ancient ability, and before 450\u0026nbsp;million years, the underlying mechanisms of emotional contagion may have been engraved in genes\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. In order to ensure the continuation of the race, social animals often learn environmental information from others, whether positive or negative, through emotional contagion to protect themselves. Humans are a highly social social race, recognizing other people's emotions and responding correctly is the ability that normal people should have, and this ability to contagion emotion firmly binds individuals together, making people part of social groups and behaving prosocially\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, this unique ability plays the role of \"social glue\"\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHowever, the protective effect of this unique ability sometimes backfires, especially the spread of negative emotions among the population. Individuals who live with depressed patients for a long time are twice as likely to develop depression as normal people\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e.The conclusions of this study can also be applied to others who are on the same social network as people with depression, that is, people with depression will spread depression in their social networks through emotional contagion\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eNurses are the largest group of healthcare workers\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e, and as a bridge between patients and doctors, they have numerous medical responsibilities but are often questioned\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, and unfriendly emotional outbursts can directly affect nurses' enthusiasm for work\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, and these negative emotions spread like an infectious disease in the nurse community, and the vector of these \"emotional viruses\" may be verbal abuse by patients\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, burnout of colleagues\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e, or criticism from leaders\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Studies have found that nurses are more likely to be affected by bad emotions in the medical environment than doctors\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. ICU nurses in Asia suffer from more severe negative emotions than nurses working in other regions and departments\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, manifesting as physical or psychological distress and even severe empathy fatigue\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn China, the number of studies on emotional contagion in medical settings is still small, and researchers tend to focus on the retention of individual emotions, such as the causes of anxiety and depression and the effects of long-term retention of these emotions on nurses' bodies and minds\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e, but the transmission process of these emotions in the healthcare community is rarely mentioned. One of the problems is that the lack of tools limits the research and development of emotional contagion in medical settings, and how to quantify the differences in emotional contagion among different individuals is the first step in conducting relevant research.\u003c/p\u003e \u003cp\u003eIn order to more easily measure the ability to measure emotional contagion, it is a quick and effective way to distinguish the differences in individual emotional contagion through self-reporting. Doherty \u003cem\u003eet al\u003c/em\u003e\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e constructed a 15-item emotional contagion scale to measure the susceptibility of subjects to emotional contagion, which has been translated into multiple languages and used and tested in different cultural contexts\u003csup\u003e[\u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. However, evidence for the application of the Emotional Contagion Scale in the nurse population is still lacking. Therefore, this study aims to cross-culturally adjust the original items and dimensions of the Emotional Contagion Scale, establish the Chinese version of the Emotional Contagion Scale in the context of Chinese culture, and validate it in the nursing community, so as to stimulate researchers' enthusiasm for the study of emotional contagion in medical settings.\u003c/p\u003e"},{"header":"2 Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1Translation and Cross-Cultural Adaptation\u003c/h2\u003e \u003cp\u003eThis study obtained authorization for the original emotional contagion from the original author team via email\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e, referring to the self-reported cross-cultural adaptation guidelines established by Beaton \u003cem\u003eet al\u003c/em\u003e\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003eduring the translation process, which mainly included six steps.\u003c/p\u003e \u003cp\u003eStage 1: initial translation\u003c/p\u003e \u003cp\u003eThe original scale was translated separately by two graduate students, both of whom passed the College English Test Band 6, one with a medical background and the other without, forming two initial versions of the Emotional Contagion Scale, T1 and T2.\u003c/p\u003e \u003cp\u003eStage2: Synthesis of the translations\u003c/p\u003e \u003cp\u003eA graduate student in nursing combined the T1 and T2 versions, and after consulting with the two translators in Stage 1, the T12 version of the Emotional Contagion Scale was formed.\u003c/p\u003e \u003cp\u003eStage3: Back translation\u003c/p\u003e \u003cp\u003eTwo professionals who are fluent in English and Chinese were invited to back-translate the T12 version of the Emotional Contagion Scale to form the BT1 and BT2 versions of the Emotional Contagion Scale, both of whom had no medical-related background.\u003c/p\u003e \u003cp\u003eStage4: Expert Committee\u003c/p\u003e \u003cp\u003eSix experts were invited to form an expert committee, including 3 nursing professors, 1 director of the nursing department, and 2 nursing psychology experts, to review all the translated versions (T1, T2, T12, BT1, BT2) by email or on-site distribution, and finally formulate the pre-final version of the Emotional Contagion Scale.\u003c/p\u003e \u003cp\u003eStage5: Test of the Prefinal Version\u003c/p\u003e \u003cp\u003eAccording to the recommendation of Beaton \u003cem\u003eet al\u003c/em\u003e\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e, the pre-test phase should contain 30\u0026ndash;40 samples, so we conducted a pre-final version of the Emotional Contagion Scale through an online questionnaire collection platform (Questionnaire Star, www-wjx-cn-s.libyc.nudt.edu.cn) and asked them what they thought of the items, and after consulting them for final adjustments, an official version of the Chinese version of the Emotional Contagion Scale was formed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Participants and Procedures\u003c/h2\u003e \u003cp\u003eFrom February 2025 to May 2025, nurses working in ICUs in three tertiary hospitals in Tianjin were selected as the research objects. The inclusion criteria are as follows: (1) Obtain the nurse practice qualification of the People's Republic of China; (2) Nurses who have been engaged in nursing work for \u0026ge;\u0026thinsp;1 year; (3) Informed consent and voluntary participation. Exclusion criteria: (1) trainee nurses; (2) Rotating nurses; (3) Continuing education as a nurse. The distribution of the questionnaire was done through the Questionnaire Star, which had a minimum of 10 participants per entry and considered 20% of the invalid sample\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e, with a minimum sample size of 180. In this study, 229 nurses were surveyed, of which 8 questionnaires were excluded due to regular answers, and 221 participants were left after excluding invalid questionnaires, with a questionnaire recovery rate of 96.5%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Instruments\u003c/h2\u003e \u003cp\u003e \u003cb\u003eGeneral information questionnaire\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIt mainly includes the demographic characteristics of the participants, including age, gender, marital status, education level, years of work and professional title.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEmotional Contagion Scale\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe ECS was developed by Doherty \u003cem\u003eet al\u003c/em\u003e\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e to assess an individual's susceptibility to the emotions of others. The ECS contains 15 items and 5 dimensions (happiness, love, fear, anger, sadness), scored on a 4-point Likert scale (1\u0026thinsp;=\u0026thinsp;never, 4\u0026thinsp;=\u0026thinsp;always), and none of the items are scored in reverse, with a total score of 60 points, and higher scores indicate stronger individuals' susceptibility to emotional empathy. The scale has good internal consistency and structural validity, with a Cronbach's α coefficient of 0.90, indicating high reliability and validity.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Data Analysis","content":"\u003cp\u003eData analysis was performed using IBM SPSS Statistics (version 24.0) and IBM SPSS AMOS (version 26.0) software. These tools provide powerful statistical capabilities, supporting everything from basic descriptive statistics to complex multivariate analyses such as factor analysis and structural equation models.We employ a rigorous statistical method to ensure the reliability and validity of our findings. In terms of descriptive statistical analysis, we used means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation to describe normally distributed quantitative data, median and quartile to describe non-normally distributed quantitative data, and frequency and percentage to describe categorical data. The comprehensive validity of the scale was ensured through multiple evaluations of content, structure, convergent and discriminant validity.\u003c/p\u003e \u003cp\u003eIn the exploratory factor analysis (EFA) phase, we used Kaiser-Meyer-Olkin (KMO) measurements and Bartlett sphericity test to confirm that the data were suitable for factor analysis. Subsequently, we performed a confirmatory factor analysis (CFA) and evaluated the fit and adequacy of the model using metrics such as Comparative Fit Index (CFI), Goodness-of-Fit Index (GFI), Incremental Fitting Index (IFI), Tucker-Lewis Index (TLI), Approximate Root Mean Square Error (RMSEA), Normative Fitting Index (NFI), and Chi-Square-to-Degrees of Freedom Ratio (2/df). Acceptable model fitting criteria include CFI, GFI, IFI, TLI, and NFI greater than 0.9, RMSEA less than 0.08, and a 2/df ratio of less than or equal to 3.\u003c/p\u003e \u003cp\u003eThen, the Cronbach α coefficient, half-method cross-validation, and test-retest reliability were used to further confirm the reliability of the scale. All statistical analyses determined the statistical significance of the difference at the level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"4 Ethics approval and consent to participate","content":"\u003cp\u003eThis study follows the ethical principles in Helsinki Declaration and is approved by the Ethics Committee of The First Affiliated Hospital of Nankai University (No.2025-B263). All participants were informed of the research objectives, volunteered to participate in this survey, and have the right to refuse to participate at any time. All participants have obtained informed consent. The research data is strictly confidential and only used for research.\u003c/p\u003e"},{"header":"5 Result","content":"\u003cp\u003e\u003cstrong\u003e5.1 Participant characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 221 nurses completed the survey, with an average age of 32.09\u0026plusmn;6.91 years, of which 179 were females and 42 were males. Additional general information about participants is detailed in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1 \u0026nbsp; Demographic characteristics of the participants (n\u0026thinsp;=\u0026thinsp;221)\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eN（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003eM(SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eAge（year）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e32.09\u0026plusmn;6.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eWork life（year）\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e9.45\u0026plusmn;7.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e42（19）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e179（81）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eEducational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eCollege or below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e18（8.14）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e199（90.05）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eMaster\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e4（1.81）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e90（40.72）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e127（57.47）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eDivorce\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e4（1.81）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eProfessional title\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eJunior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e157（71.04）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e58（26.24）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eAdvanced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e6（2.71）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e5.2 Content validity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eContent validity was assessed by six experts who participated in the cross-cultural adaptation of the questionnaire. The content validity index (S-CVI/Ave) of the Chinese version of the Emotional Contagion Scale was 0.989 (\u0026ge;0.90), and the content validity index (I-CVI) was 0.833~1.000 (\u0026ge;0.78), indicating that the content validity was good.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5.3 Construct validity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5.3.1 Exploratory factor analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData from 221 respondents were analyzed for exploratory factors. The Kaiser-Meyer-Olkin (KMO) value of 0.84 indicates a high suitability for information extraction, and Bartlett\u0026apos;s sphericity test is significant (\u0026chi;\u0026sup2; = 1290.231, p \u0026lt; 0.05), confirming that this data is suitable for exploratory factor analysis. The maximum variance method was used for spinning principal component analysis. After rotation, the cumulative variance for these factors interpreted was 70.821%, with each item showing a factor loading greater than 0.400 on its respective factor. These results (Table 2) confirm the strong construct validity of the questionnaire.\u003c/p\u003e\n\u003cp\u003eTable 2\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"712\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 364px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eITEMS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 266px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Factor Loading \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommunality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003e1. When i look into the eyes of the one i love,my mind is filled with thoughts of romance.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.75\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.654\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003e2. I melt when the one i love holds me close.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.807\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.708\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003e3. I sense my body responding when the one i love touches me.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.816\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.745\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003e4. If someone i\u0026apos;m talking with begins to cry,I get teary-eyed.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.745\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.639\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003e5. I get filled with sorrow when people talk about the death of their loved ones.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.807\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.738\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003e6. I cry at sad movies.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.784\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.729\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003e7. I clench my jaws and my shoulders get tight when i see the angry faces on the news.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.855\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.782\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003e8. It irritates me to be around angry people.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.734\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.623\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003e9. I tense when overhearing an angry quarrel.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.797\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.724\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003e10. Watching the fearful faces of victims on the news makes me try to imagine how they might be feeling.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.805\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003e11. I notice myself getting tense when i\u0026apos;m around people who are stressed out.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.873\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.807\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003e12. Listening to the shrill screams of a terrified child in a dentists waiting room makes me feel nervous.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.817\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.755\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003e13. Being with a happy person picks me up when i\u0026apos;m feeling down.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.756\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.701\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003e14. When someone smiles warmly at me,I smile back and feel warm inside.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.729\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.682\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003e15. Being around happy people fills my mind with happy thoughts.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.715\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e0.627\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003eEigenvalue (Before Rotation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e5.362\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e1.594\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e1.298\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.929\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003eVariance Explained % (Before Rotation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e35.75%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e10.63%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e9.60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e8.65%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e6.19%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003eCumulative Variance Explained\u0026nbsp;% (Before Rotation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e35.75%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e46.37%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e55.98%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e64.63%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e70.82%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003eEigenvalue (After Rotation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e2.272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e2.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e2.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e2.119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e1.952\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003eVariance Explained % (After Rotation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e15.15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e14.34%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e14.20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e14.13%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e13.01%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003eCumulative Variance Explained % (After Rotation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e15.15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e29.49%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e43.68%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e57.81%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e70.82%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003eKMO Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 266px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003eBartlett\u0026apos;s Test of Sphericity Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 266px;\"\u003e\n \u003cp\u003e1290.231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 266px;\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 364px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 266px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e（Factor 1=fear；Factor 2=anger；Factor 3=love；Factor 4=sadness；Factor 5=happiness）\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5.3.2 Confirmatory factor analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, 50% of the sample (111) was randomly selected for confirmatory factor analysis (CFA). The results showed that the chi-square degree-of-freedom ratio (\u0026chi;\u0026sup2;/\u0026nu;)=1.339 (\u0026lt;3.000), the approximate root mean square error (RMSEA)=0.039, the goodness-of-fit index (GFI)=0.94 (\u0026gt;0.900), the comparative fitting index (CFI)=0.978 (\u0026gt;0.900), the non-canonical fitting index (TLI)=0.971 (\u0026gt;0.900), the incremental fitting index (IFI)=0.978 (\u0026gt;0.900), It means that the model fits well (Table 3).\u003c/p\u003e\n\u003cp\u003eTable 3\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"558\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 558px;\"\u003e\n \u003cp\u003econfirmatory factor analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026chi;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003edf\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026chi;2/df\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRMSEA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRMR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNNFI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e107.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.339\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.971\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTLI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAGFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePGFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePNFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePCFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSRMR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRMSEA 90% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.971\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.627\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.701\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.745\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.015 ~ 0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e5.4 Convergent validity and Discriminant validity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe average variance extracted (AVE) is used to reflect the convergent validity, which must meet the AVE \u0026gt; of 0.45. The square root of AVE for each latent variable according to the Fornell-Lacker criterion needs to be greater than the absolute value of its correlation coefficient with other latent variables. Scale The AVE of the five dimensions \u0026gt; 0.45, and the square root of the AVE values of the five dimensions was greater than the absolute value of the correlation coefficients with other latent variables, indicating that the convergent validity and discriminative validity were good, as shown in Table 4.\u003c/p\u003e\n\u003cp\u003eTable 4\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDimension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eCR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eDiscriminant validity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFactor1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFactor2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFactor3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFactor4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFactor5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFactor1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.779\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.541\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.736\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFactor2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.737\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFactor3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.363\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.753\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFactor4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.628\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.793\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFactor5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.753\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.505\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.71\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e（The diagonal bold number is the AVE square root value）\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5.5 Reliability analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Cronbach \u0026alpha; coefficient of the Chinese version of the Emotional Contagion Scale was 0.903 (\u0026gt;0.8), indicating excellent overall reliability. A total of 15 items of the scale were analyzed for halving reliability, and when the scale was divided into two parts, the number of analysis items in the two parts was not equal, so the Spearman-Brown coefficient should be used to judge the reliability quality. The Spearman-Brown half-reliability coefficient value is 0.807, which is greater than 0.8, indicating that the half-reliability quality is high.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"6 Discussion","content":"\u003cp\u003eThis study followed strict cross-cultural adaptation guidelines, successfully sinicized the Chinese version of the Emotional Contagion Scale. and verified its reliability and validity in the Chinese nurse population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.1 Summary of main research findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe main purpose of this study is to sinicize the Emotional Contagion Scale and test its validity and reliability in the Chinese nurse population. The results show that the Chinese version of ECS has good psychometric properties. Exploratory factor analysis extracted five factors, which were consistent with the dimensional structure of the original scale (love, sadness, anger, fear, and happiness), and the cumulative variance contribution rate was 70.821%, indicating that the scale could effectively explain most of the variations of emotional contagion. Confirmatory factor analysis further confirmed that the fit of the five-factor model was good (χ²/df=1.339, RMSEA=0.039, CFI=0.978, etc.), which supported the structural validity of the scale. In addition, the internal consistency reliability (Cronbach's α = 0.903) and halving reliability (Spearman-Brown coefficient = 0.807) of the scale reached excellent levels, indicating that it is a stable and reliable measurement tool in the Chinese nurse population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.2 Comparison with the original scale and other cultural versions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe five-factor structure derived from this study is consistent with the dimensional division of the original ECS scale developed by Doherty\u003csup\u003e[21]\u003c/sup\u003e, indicating that the core components of emotional contagion are universal across cultures. However, compared with the studies in some Western cultural contexts, the project load patterns and correlations between factors in this study show some slight differences. For example, the item \"When I gaze into my lover's eyes, my heart is full of romantic thoughts\" has a high load (0.75) in the \"love\" dimension, which is consistent with the original study, but the cross-load pattern between factors in some items may reflect the uniqueness and implicit nature of emotional expression in the context of Chinese culture. Compared with the adapted version in Sweden, Greece, and other countries\u003csup\u003e[22, 23]\u003c/sup\u003e, the Chinese version of ECS showed comparable or even better reliability and validity indicators in the nurse population, proving the success of this Sinicization and its applicability in the Chinese medical context\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.3 Factor structure and cultural adaptability analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of EFA and CFA jointly validated the structural validity of the Chinese version of ECS. The five factors clearly characterize the transmission pathways of different emotional types. It is worth noting that the correlation coefficient between factors is at a moderate level, indicating that although various emotional contagions are relatively independent constructs, there is a low to medium degree of association between them, which is consistent with the complex nature of emotional experience. The translation and adaptation process of the scale takes into account cultural adaptability. The Expert Committee has repeatedly considered the wording of the entries to ensure that they are faithful to the original meaning and in line with the daily expression habits of Chinese and the clinical context of Chinese nurses. For example, for the expression of intimate emotions, while maintaining the original meaning, the translation is avoided too straightforward, so as to better fit the expression in Chinese culture and ensure the good content validity of the scale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.4 Reliability and validity analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe reliability and validity test results of this study are satisfactory, and the excellent Cronbach's α coefficient (0.903) indicates high internal consistency of the scale, which is comparable to the reliability level of the original scale (α=0.90) and other cross-cultural versions\u003csup\u003e[23, 25]\u003c/sup\u003e. In terms of validity, good content validity is ensured through expert review. Structural validity is strongly supported by EFA and CFA. In addition, the convergent validity (AVE value of each dimension \u0026gt;0.5) and discriminative validity (AVE in each dimension are greater than the correlation coefficient with other dimensions) both meet the psychometric standards, indicating that the scale can not only effectively measure the target construct, but also have sufficient discrimination between each dimension.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.5 Applicability and significance in the nurse community\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is the first time that ECS has been applied to a specific occupational group of Chinese nurses, which is of great practical significance. Nurses are one of the groups with the heaviest emotional labor load in the medical environment, and are at high risk of emotional contagion due to long-term exposure to multiple emotional sources such as patient distress\u003csup\u003e[28]\u003c/sup\u003e, family anxiety\u003csup\u003e[29]\u003c/sup\u003e, colleague burnout\u003csup\u003e[30]\u003c/sup\u003e, and high work pressure\u003csup\u003e[31]\u003c/sup\u003e. The Chinese version of ECS provides an efficient and convenient tool for quantifying nurses' emotional susceptibility. Through this scale, medical institution managers can identify high-risk individuals who are prone to negative emotions, so as to implement targeted psychological interventions and resilience training, such as mindfulness stress reduction\u003csup\u003e[32]\u003c/sup\u003e, emotion regulation workshops\u003csup\u003e[33]\u003c/sup\u003e, etc. At the same time, the scale can also be used to evaluate the contagious effect of positive emotions, and by creating a positive and supportive team atmosphere, it can improve overall work happiness and nursing quality, and block the \"contagion chain\" of negative emotions, which is crucial for preventing nurse burnout\u003csup\u003e[34]\u003c/sup\u003e and improving patient care outcomes\u003csup\u003e[35]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.6 Research on the contribution of theory and practice\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt the theoretical level, this study enriches the cross-cultural research literature on emotional contagion, confirms the factor structure of ECS in the context of Chinese culture, and provides a validated measurement tool for future empirical research in China. At the practical level, this study provides a scientific evaluation method for hospital nursing management. Managers can use this scale for psychological trait assessment for new nurse recruitment, regular mental health screening for in-service nurses, and evaluation of the effectiveness of team building or interventions, so as to realize the transformation from passive response to active management and improve the level of refinement of human resource management.\u003c/p\u003e"},{"header":"7 Limitations","content":"\u003cp\u003eDespite the positive results of this study, there are some limitations. First, the samples were purposively sampling and were only sourced from a few tertiary hospitals in Tianjin, which may limit the representativeness and universality of the study results. Future studies should collect samples in a wider geographical area, in hospitals of different grades (e.g., secondary hospitals, community health centers) to further verify the stability of the scale. Secondly, this study is a cross-sectional survey, and the causal relationship between variables cannot be inferred. In the future, a longitudinal study design can be used to explore the long-term predictive effect of emotional contagion on nurses' burnout and turnover intention. Finally, data collection relies on self-report scales, which may have biases in social expectations. Future studies can combine multiple methods such as physiological indicators (such as heart rate variability, cortisol levels) or behavioral observation methods to conduct multimodal measurements of emotional contagion to mutually validate the results.\u003c/p\u003e"},{"header":"8 Conclusion","content":"\u003cp\u003eThis study strictly followed the cross-cultural adaptation guidelines, successfully sinicized the Chinese version of the Emotional Contagion Scale, and verified its good reliability and validity in the Chinese ICU nurse population for the first time. The results show that the Chinese version of ECS retains the five-factor structure of the original scale, and all psychometric indicators meet the standards, making it a reliable and effective assessment tool. The formation of this scale fills the gap in domestic research tools to quantify individual differences in emotional contagion in medical contexts, which not only provides a solid foundation for carrying out research on emotional contagion in the context of Chinese culture, but also provides a scientific basis for clinical nursing managers to identify emotionally susceptible groups and formulate targeted psychological support strategies, which has important theoretical value and practical application prospects.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThis study follows the ethical principles in Helsinki Declaration and is approved by the Ethics Committee of The First Affiliated Hospital of Nankai University (No.2025-B263). All participants were informed of the research objectives, volunteered to participate in this survey, and have the right to refuse to participate at any time. All participants have obtained informed consent. The research data is strictly confidential and only used for research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLH and ZD co-designed the ideas and methodologies of the study and were the main contributors to the writing of the manuscript, ZYN collected and analyzed the data, and MHW carried out quality control and revision of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHatfield E, Cacioppo JT, Rapson RL. Emotional Contagion[M]. 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Workplace Health Saf; 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhai Y, Li R, Yan Z. Research on Application of Meticulous Nursing Scheduling Management Based on Data-Driven Intelligent Optimization Technology[J]. Comput Intel Neurosc. 2022;2022:3293806.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSucapuca C, Morales-Garcia WC, Saintila J. Work-Related Factors Associated With Burnout Among Peruvian Nurses[J]. J Prim Care Communit. 2022;13:27220051.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu B, Zhu N, Wang H et al. Protecting Nurses from Mistreatment by Patients: A Cross-Sectional Study on the Roles of Emotional Contagion Susceptibility and Emotional Regulation Ability[J]. Int J Env Res Pub He, 2021,18(12).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBakker AB, Le Blanc PM, Schaufeli WB. Burnout contagion among intensive care nurses[J]. J Adv Nurs. 2005;51(3):276\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePetitta L, Jiang L, Hartel C. Emotional contagion and burnout among nurses and doctors: Do joy and anger from different sources of stakeholders matter?[J]. Stress Health. 2017;33(4):358\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYvonne JXM, Benjamin B. F, Shaping emotional contagion in healthcare: the role of human resource practices and work harassment[J]. Pers Rev, 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXie W, Chen L, Feng F, et al. The prevalence of compassion satisfaction and compassion fatigue among nurses: A systematic review and meta-analysis[J]. Int J Nurs Stud. 2021;120:103973.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeters E. Compassion fatigue in nursing: A concept analysis[J]. Nurs Forum. 2018;53(4):466\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHsiao Y, Wu H, Chien L, et al. The differences in spiritual health between non-depressed and depressed nurses[J]. J Clin Nurs. 2012;21(11\u0026ndash;12):1736\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Q, Fang Y, Huang H, et al. Anxiety, depression and cognitive emotion regulation strategies in Chinese nurses during the COVID-19 outbreak[J]. J Nurs Manage. 2021;29(5):1263\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDoherty RW. The Emotional Contagion Scale: A Measure of Individual Differences[J]. J Nonverbal Behav. 1997;21(2):131\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLundqvist L. A Swedish adaptation of the Emotional Contagion Scale: factor structure and psychometric properties[J]. Scand J Psychol. 2006;47(4):263\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKevrekidis P, Skapinakis P, Damigos D, et al. Adaptation of the Emotional Contagion Scale (ECS) and gender differences within the Greek cultural context[J]. Ann Gen Psychiatr. 2008;7:14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRueff-Lopes R, Caetano A. The emotional contagion scale: factor structure and psychometric properties in a Portuguese sample[J]. Psychol Rep. 2012;111(3):898\u0026ndash;904.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYong W, Zhen-Hong W, Sha-Sha Q. Reliability and validity of the Chinese version of Emotional Contagion Scale in college students[J]. Chin Mental Health J. 2013;27(01):59\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeaton DE, Bombardier C, Guillemin F, et al. Guidelines for the process of cross-cultural adaptation of self-report measures[J]. Spine. 2000;25(24):3186\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZou GY. Sample size formulas for estimating intraclass correlation coefficients with precision and assurance[J]. Stat Med. 2012;31(29):3972\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShao Y, Li S, Wei L, et al. Nurses' second victim experience, job insecurity, and turnover intention: A latent profile analysis[J]. Res Nurs Health. 2023;46(3):360\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarrouste-Orgeas M, Max A, Lerin T et al. Impact of Proactive Nurse Participation in ICU Family Conferences: A Mixed-Method Study[J]. Crit Care Med, 2016,44(6):1116\u0026ndash;1128.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlgamdi M. Prevalence of oncology nurses' compassion satisfaction and compassion fatigue: Systematic review and meta-analysis[J]. Nurs Open. 2022;9(1):44\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWaterfield D, Barnason S. The integration of care ethics and nursing workload: A qualitative systematic review[J]. J Nurs Manage. 2022;30(7):2194\u0026ndash;206.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuo LX, Peng X, Hou J, et al. Effects of mindfulness decompression therapy on mental health and job burnout among nurses working in the frontline of the novel coronavirus pandemic: A retrospective study[J]. J Occup Health. 2023;65(1):e12398.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarazine J, Heitschmidt M, Vondracek H, et al. Mindfulness Workshops Effects on Nurses' Burnout, Stress, and Mindfulness Skills[J]. Holist Nurs Pract. 2021;35(1):10\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuesada-Puga C, Izquierdo-Espin FJ, Membrive-Jimenez MJ, et al. Job satisfaction and burnout syndrome among intensive-care unit nurses: A systematic review and meta-analysis[J]. Intens Crit Care Nur. 2024;82:103660.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCecere L, de Novellis S, Gravante A, et al. Quality of life of critical care nurses and impact on anxiety, depression, stress, burnout and sleep quality: A cross-sectional study[J]. Intens Crit Care Nur. 2023;79:103494.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Emotional contagion, Scale validation, Chinese nurses, Psychometric properties, Cross-cultural adaptation","lastPublishedDoi":"10.21203/rs.3.rs-8360628/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8360628/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEmotional contagion, the ability to automatically mimic and synchronize with others' emotional expressions, significantly impacts nurses' mental health in healthcare settings. The lack of a validated instrument to assess emotional contagion among nurses in China has hindered related research. This study aimed to cross-culturally adapt the Emotional Contagion Scale (ECS) and validate the Chinese version among nurses in China.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e Following established cross-cultural adaptation guidelines, the Chinese version of the ECS was developed through forward translation, synthesis, back-translation, expert committee review, and pre-testing. A convenience sample of 221 ICU nurses from three tertiary hospitals was recruited via an online questionnaire survey. Data analyses included item analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), internal consistency reliability, split-half reliability, and assessments of content validity, construct validity, convergent validity, and discriminant validity using statistical software.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe Chinese version of the ECS consisted of 15 items and five dimensions: happiness, love, fear, anger, and sadness, with a cumulative variance contribution rate of 70.821%. CFA indicated good model fit. The scale demonstrated excellent internal consistency with a Cronbach's α coefficient of 0.903 and a split-half reliability of 0.807. The content validity index was 0.989, and the average variance extracted (AVE) for all dimensions exceeded 0.5, indicating good convergent and discriminant validity.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe Chinese version of the Emotional Contagion Scale exhibits good reliability and validity among ICU nurses in China. It serves as an effective tool for assessing nurses' susceptibility to emotional contagion, providing a scientific basis for future research and the development of targeted psychological intervention strategies.\u003c/p\u003e","manuscriptTitle":"Cross-Cultural Adaptation and Validation of the Emotional Contagion Scale among Nurses in China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-19 19:15:18","doi":"10.21203/rs.3.rs-8360628/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-28T03:00:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-27T11:59:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"115130541510913778912097885503524768132","date":"2026-01-26T09:48:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"223192014203928477576532866609118644923","date":"2026-01-22T23:37:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-14T05:59:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-13T04:30:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-18T06:32:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-18T00:50:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-12-18T00:45:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"305d269b-1c44-42e7-9ddd-d47f1e248724","owner":[],"postedDate":"January 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T19:15:18+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-19 19:15:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8360628","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8360628","identity":"rs-8360628","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}