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Cited by 31Social Media in Health EducationInnovations in Medical EducationHealthcare Education and Workforce Issues

Development and validation of scale for measuring attitudes towards e-professionalism among medical and dental students: SMePROF-S scale

Open access
Marelić, Marko, Viskić, Joško, Poplašen, Lovela Machala, Relić, Danko, Jokić, Dražen, Rukavina, Tea Vukušić·2021·BMC Medical Education
DOI 10.1186/s12909-021-02879-2PMC PMC8381479
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Abstract

Background: Social media permeated everyday life and consequently it brought some changes to behaviour of health professionals. New form of professionalism emerged called e-professionalism depicting professional behaviour while using social media. There are a number of studies conducted in the past several years measuring behaviour of different populations of health professionals on social media and social media sites. Many studies have investigated aspects of e-professionalism of medical or dental students as future health professionals, but there are no validated instruments made for assessing attitude towards e-professionalism of those two populations. Objective of this paper is to validate a newly developed scale for measuring attitudes towards e-professionalism among medical and dental students. Methods: The original 32-item scale was developed and administered to 411 medical students (RR 69%), and 287 dental students (RR 49.7%). Exploratory factor analysis was used to investigate the existence of underlying factors. Principal component analysis was used as an extraction method with oblimin as selected oblique rotation method. Cronbach’s alpha was used to assess reliability. Results: Total of 698 student answers entered analysis. The final scale had 24 items that formed seven factors named: ethical aspects, dangers of social media, excluding physicians, freedom of choice, importance of professionalism, physicians in the digital age, negative consequences. Cronbach’s alpha indicating scale reliability was .72. Reliability conducted on each factor ranged from .570 to .877. Conclusions: The scale measures seven factors of attitude towards e-professionalism and exhibits satisfactory reliability. Based on insights from validation, some possible improvements are suggested.

AI snapshot

Written from the paper’s full text.

TL;DR

This paper develops and validates the SMePROF-S scale for measuring medical and dental students’ attitudes toward e-professionalism. The final 24-item scale has seven factors and acceptable overall reliability (Cronbach’s α = .72).

Key findings

  • The final scale contained 24 items forming seven factors: ethical aspects, dangers of social media, excluding physicians, freedom of choice, importance of professionalism, physicians in the digital age, and negative consequences; these explained 65.53% of cumulative variance.
  • Overall scale reliability was α = .72, while factor-level reliability ranged from .570 to .877.
  • The initial 32-item scale had nine factors explaining 62.8% of variance and α = .765; eight items were removed during validation.
  • Second-order factor analysis grouped the seven factors into four second-order factors, with “Excluding physicians” not grouping with the others.

Methods

  • Cross-sectional validation study within the SMePROF project, conducted at the University of Zagreb School of Medicine and School of Dental Medicine in academic year 2018/2019.
  • The instrument was administered to 714 students; 698 responses entered analysis: 411 medical students (RR 69%) and 287 dental students (RR 49.7%); mean age 22, range 18–30, 74% female.
  • Construct validity used exploratory factor analysis with principal component analysis and oblimin rotation; reliability used Cronbach’s alpha.

Limitations

  • The paper states that all items were taken from previous research, so some theoretical concepts may be omitted; “Excluding physicians” may not be a domain of e-professionalism; items used mixed four- and five-point scales; the questionnaire was in Croatian; and mandatory questions may have increased withdrawal.
  • The paper also notes that “Excluding physicians” requires further testing and that its items may have been better tailored to physicians than students.
  • Evident from the text: the sample was a convenience sample of two Zagreb schools, dental response rate was lower than medical, and the scale measures attitudes rather than observed e-professional behaviour.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12909-021-02879-2

Cites

30 of 30 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 21 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Reliability of the initial 32-item scale was α = .765.

    “Reliability of the initial 32-item scale was α = .765.”
    Quote in the paperSubstantial claim
  • Findingown data

    In the sample, using sanctions for misbehaviour, such as banning or restricting medical professionals from social networks, were items with the largest degree of disagreement.

    “and using sanctions for misbehaviour (like banning or restricting medical professionals from social networks) were items with the largest degree of disagreement.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Students in the sample clearly expressed rebuff about using sanctions for online behaviour.

    “and clearly expressed rebuff about using sanctions for online behaviour.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Seven factors from the SMePROF-S scale are grouped into four second-order factors.

    “Seven factors are grouped in four second-order factors, as it is shown in Table 4.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In our research, respondents were much more ambiguous about ethically acceptable interaction with patients on social media, as seen from average scoring of items 1 through 5 being closer to neutral values than agreement.

    “However, in our research respondents were much more ambiguous, which can be seen from average scoring of items 1 through 5 (Table 1) that are much closer to neutral values than agreement.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 19
  • Classified as probably not a substantial claim. 23

  • May combine two claims.

    Findingown data

    The seventh factor, Negative consequences, is formed by three items and encompasses overall negative attitudes toward changes that social networks brought, namely in protection of physicians from public and inabilities to fully relax and maintain professional image.

    “The seventh factor called Negative consequences is formed by three items and encompasses overall negative attitudes toward changes that social networks brought; namely in protection of physicians from public and inabilities to fully relax and maintain professional image.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The sixth factor, Physicians in the digital age, measures attitude towards positive inclusion of social networks in the medical profession, making physicians and medical teachers responsible for education and guidance of patients and students in correct network usage.

    “The sixth factor, Physicians in the digital age, measures attitude towards positive inclusion of social networks in the medical profession, making physicians and medical teachers responsible for education and guidance of patients and students in tenants of “correct” type of network usage.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The third factor, Excluding physicians, measures attitude towards prohibiting or restricting usage of social networks to medical workers.

    “The third factor named Excluding physicians measures attitude towards prohibiting or restricting usage of social networks to medical workers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Item 10, sharing privileged patient information on social media without consent is inadmissible, saturated on factor Dangers of SM rather than Ethical aspects.

    “It’s interesting that item 10 – Sharing privileged patient information on social media without their consent is deemed to be inadmissible saturated on factor Dangers of SM rather than Ethical aspects.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    The fourth factor, Freedom of choice, is formed by three variables measuring independence of acting and posting on social media from college rules and social rules, suggesting that online activities do not affect professional performance.

    “The fourth factor named Freedom of choice is formed by three variables measuring independence of acting (and posting on social media) from college rules and social rules, suggesting that online activities do not affect their professional performance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    The factor Physicians in the digital age is formed by only two variables and has the lowest consistency with α = .570.

    “(factor Physicians in digital age is formed by only two variables and has lowest consistency with α = .570)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Item 25 was removed because it did not measure attitude and saturated equally on multiple factors.

    “One item (25 – People have the opportunity to post photos and document aspects of their professional life which would otherwise remain private) was removed because it did not measure attitude and it saturated equally on multiple factors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Kaiser-Meyer-Olkin measure was .771 and Bartlett's test of sampling adequacy was χ2 = 6873.78, df = 496, p = 0.000, showing dimension reduction is applicable.

    “Kaiser-Meyer-Olkin measure (.771) and Bartlett’s test of sampling adequacy (χ2 = 6873.78, df = 496, p = 0.000) shows that dimension reduction is applicable on this data.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The fifth factor, Importance of professionalism, connects e-professionalism to offline professionalism and is formed by items describing need for professional behaviour and self-assessment about what constitutes professional behaviour.

    “The fifth factor named Importance of professionalism is connecting e-professionalism to “offline” professionalism (or professional behaviour as already known concept). Factor is formed by items describing need for professional behaviour as well as self-assessment about what constitutes professional behaviour.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Values of Cronbach alpha between 0.7 and 0.9 are interpreted as acceptable reliability.

    “values between 0.7 and 0.9 are interpreted as acceptable reliability [30].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] Peacock J, Peacock P. Oxford Handbook of Medical Statistics. 2nd ed. Oxford: Oxford University Press; 2011.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Chisholm-Burns et al. instrument had 22 items forming five factors named honesty and integrity, respect for others, accountability, duty, and excellence.

    “After validation, instrument had 22 items that formed five factors named: honesty and integrity, respect for others, accountability, duty, and excellence.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Chisholm-Burns MA, Spivey CA, Jaeger MC, Williams J, George C. Development of an instrument to measure pharmacy student attitudes toward social media professionalism. Am J Pharm Educ. 2017;81(4):65. https://doi.org/10.5688/ajpe81465. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The original 32-item scale was administered to 411 medical students (response rate 69%) and 287 dental students (response rate 49.7%).

    “The original 32-item scale was developed and administered to 411 medical students (RR 69%), and 287 dental students (RR 49.7%).”
    • Also stated in: § Study sample · plain
      “Of the 714 collected students’ responses a total of 698 entered analysis, 411 from second and fifth-year medical students (RR 69%), and 287 from first to sixth year dental students (RR 49.7%); mean age of 22, range 18 to 30 years, 74% of the students were female and 26% were male.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The topic of the role of university in dealing with e-professionalism measured in the Chisholm-Burns et al. scale is consistent with the factor Freedom of choice in this instrument.

    “For example, topic that tackles role of university in dealing with e-professionalism measured in Chisholm-Burns et al. scale is consistent with factor Freedom of choice in this instrument.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Chisholm-Burns MA, Spivey CA, Jaeger MC, Williams J, George C. Development of an instrument to measure pharmacy student attitudes toward social media professionalism. Am J Pharm Educ. 2017;81(4):65. https://doi.org/10.5688/ajpe81465. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Dentistry is more market-oriented and has created a market based on wants rather than needs.

    “Dentistry is more market oriented, and coupled with different cosmetic treatment options such as bleaching, aesthetic crowns and orthodontics it has created a market based on want rather than needs [24].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Obree D, Trathen A. The special ethics of dentistry. In: Papanikitas A, Spicer J, editors. Handbook of primary care ethics. Boca Raton: FL CRC Press/Taylor & Francis Group; 2017. p. 385–92. https://doi.org/10.1201/9781315155487-46. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    The role of social media in future employability is a recurring topic that is unavoidable when assessing attitudes of students.

    “Also, the role of social media in future employability is occurring topic that is unavoidable when assessing attitudes of students.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The finding that negative aspects of social media are more emphasized than benefits is consistent with White et al. research.

    “This finding is consistent with White et al. research [28].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] White J, Kirwan P, Lai K, Walton J, Ross S. ‘Have you seen what is on Facebook?’ The use of social networking software by healthcare professions students. BMJ Open. 2013;3:e003013. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationcitation

    Protecting a patient's privacy and maintaining proper relationships with patients, as defined as tenets of professionalism, can be seen in the e-professionalism scale as factors Dangers of SM and Ethical aspects.

    “Protecting a patient’s privacy and maintaining proper relationships with patients defined as tenants of professionalism can be seen in e-professionalism scale as factors Dangers of SM and Ethical aspects.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] ABIM Foundation. American Board of Internal Medicine, ACP-ASIM Foundation. American College of Physicians-American Society of internal medicine, European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136:243–6. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Improving the quality of healthcare can be seen in the factor Physicians in the digital age.

    “Furthermore, improving the quality of healthcare can be seen in factor Physicians in the digital age.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Participation was voluntary and anonymous, and informed consent was obtained.

    “All participants were informed in guidelines statement that their participation is voluntary and anonymous. The first question of the questionnaire was informed consent about participation, allowing students that do not want to participate to opt out.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The researchers agreed that all items included in the scale reflected attitude towards e-professionalism.

    “The researchers agreed that all items included in this scale reflected attitude towards e-professionalism.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The study was approved by the Ethical board of University of Zagreb School of Medicine and the Ethical board of University of Zagreb School of Dental Medicine.

    “Both research and questionnaires were approved by the Ethical board of University of Zagreb School of Medicine, issued on March 22nd 2018 (641–01/18–02/01) and Ethical board of University of Zagreb School of Dental Medicine, issued on February 20th 2018 (05-PA-24-2/2018).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    Six researchers repeatedly checked whether items represented e-professionalism, whether item content was suitable for judging attitude towards e-professionalism of dental and medical students, and whether the concept was covered in the entire scale.

    “Following the example of Ichikawa et al., six researchers repeatedly checked whether items represented e-professionalism, whether item content was suitable for judging attitude towards e-professionalism of dental and medical students, and whether concept of e-professionalism was covered in the entire scale [29].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [29] Ichikawa N, Yamamoto-Mitani N, Takai Y, Tanaka M, Takemura Y. Understanding and measuring nurses’ professionalism: development and validation of the nurses’ professionalism inventory. J Nurs Manag. 2020;28(7):1607–18. https://doi.org/10.1111/jonm.13116. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    A total of 698 student answers entered analysis.

    “Total of 698 student answers entered analysis.”
    • Also stated in: § Subjects and methods · plain
      “After screening results, 698 answers entered the analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    Dental students tend to be more open towards patients on social media, making them prone to greater risk of e-professionalism violation.

    “Because of those reasons we believe dental students tend to be more open towards patients on SM, which makes them prone to bigger risk of e-professionalism violation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Some tenets of e-professionalism of medical and dental students are consistent with tenets found in the scale for measuring pharmacy student's attitudes towards social media professionalism.

    “Some tenants of e-professionalism of medical and dental students are consistent with tenants found in scale for measuring pharmacy student’s attitudes towards social media professionalism [17].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Chisholm-Burns MA, Spivey CA, Jaeger MC, Williams J, George C. Development of an instrument to measure pharmacy student attitudes toward social media professionalism. Am J Pharm Educ. 2017;81(4):65. https://doi.org/10.5688/ajpe81465. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Chisholm-Burns et al. instrument had a Cronbach's alpha of .72.

    “Cronbach’s alpha measuring reliability of instrument was .72.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Chisholm-Burns MA, Spivey CA, Jaeger MC, Williams J, George C. Development of an instrument to measure pharmacy student attitudes toward social media professionalism. Am J Pharm Educ. 2017;81(4):65. https://doi.org/10.5688/ajpe81465. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The SMePROF-S scale proved to be valid and reliable for measuring attitude towards e-professionalism among medical and dental students.

    “SMePROF-student version (SMePROF-S) scale for measuring attitude towards e-professionalism among medical and dental students proved to be valid and reliable.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Unfinished questionnaires could not be collected in the online survey platform used (Google Forms).

    “Unfinished questionnaires could not be collected in online survey platform used (Google Forms).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Excluding physicians is an important theoretical part of e-professionalism because it covers students' autonomy and freedom to use social media regardless of profession.

    “Regardless, it’s an important theoretical part of e-professionalism because it covers students’ autonomy and freedom to use SM regardless the profession.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The SMePROF-S scale was part of a larger questionnaire and items were measured within different parts, resulting in difference in range of rating scale (four-point and five-point).

    “Third, this scale was part of a larger questionnaire and items were measured within different parts, resulting in difference in range of rating scale (four-point and five-point).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Although the questionnaire was translated by English language experts, some of the meaning can be lost or changed.

    “although questionnaire was translated by English language experts some of the meaning can be lost or changed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Mandatory questions could result in a larger degree of respondents withdrawing from research without completing the questionnaire.

    “That could result in larger degree of respondents withdrawing from research without completing questionnaire.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The questionnaire was conducted on Croatian language.

    “Fourth, the questionnaire was conducted on Croatian language”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    All questions were mandatory in order to avoid missing values.

    “Fifth, all questions were mandatory in order to avoid missing values.”
    Quote in the paperNot a substantial claim
34 of 34

  • The paper relies on this without support.

    The convenience sample of medical and dental students at UZSM and UZSDM is adequate for validating the SMePROF-S scale.

    “As a part of the project a quantitative cross-sectional study on the use of SM, attitudes and ethical values of students was carried out in the School of Medicine University of Zagreb, Croatia (UZSM) and the School of Dental Medicine University of Zagreb, Croatia (UZSDM) in the academic year 2018/2019.”
    “In order to provide a better picture about this convenience sample three variables were measured: active or passive type of usage, frequency of access and type of device most used.”

  • The paper relies on this without support.

    No previous scale measures attitudes towards e-professionalism among medical and dental students.

    “As far as authors know this is the first scale designed to investigate attitudes towards e-professionalism on student population of medicine and dental medicine.”
    “This is the first validated scale designed to measure attitude towards e-professionalism on this specific population”

  • The paper relies on this without support.

    Medical and dental students do not have regular and uniform contact with patients and lack practical experience and quantity of doctor-patient relations.

    “students don’t have regular and uniform contact with patients. They have some contact during practical classes, but they lack practical experiences and quantity of doctor-patient relations.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Item counts attributed to White et al. do not add up

    Minor

    The paper says 21 items were taken from White et al., but reports 18 retained and five excluded, which totals 23. The listed retained ranges (6-18 and 22-24) contain 16 items, not 18; 16 retained plus five excluded would total 21.

    Reported 21 · recomputed 23

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Australian and New Zealand Medical Associations. Social Media and Medical Professionalism: a guide to online professionalism for medical practitioners and medical students. 2010. https://ama.com.au/article/social-media-and-medical-profession. Accessed 22 Sep 2020.
  2. The British Medical Association. Social media : practical guidance and best practice. 2018. https://www.bma.org.uk/search?query=Social%20media%20Practical%20guidance. Accessed 22 Sept 2020.

Cited by

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Related

Authors
Marelić, M., Viskić, J., Poplašen, L. M., Relić, D., Jokić, D., & Rukavina, T. V.
Affiliations
University of Zagreb (HR)
Corresponding author
Marelić, Marko
ORCID
Venue
BMC Medical Education
Publisher
Springer Science and Business Media LLC
Published
2021-08-23
Volume
21
Issue
1
Pages
445-445
ISSN
1472-6920 (ISSN-L)
DOI
10.1186/s12909-021-02879-2
PMC
PMC8381479
OpenAlex
W3195611360
Semantic Scholar
508d697d012ed0177e5b3a5c5796ebfdb816e96e
Cited by
31
References
30
Citations by year
2026: 6 · 2025: 2 · 2024: 11 · 2023: 7 · 2022: 5
FWCI
3.17
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Medical Education (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Hrvatska Zaklada za Znanost
Topics
  • Social Sciences › Health › Social Media in Health Education
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
  • Health Sciences › Nursing › Leadership and Management › Healthcare Education and Workforce Issues
Keywords
e-professionalism, social media, medical students, dental students, attitudes, scale development, psychometric validation, professionalism, ethical considerations
MeSH terms
Professionalism, Attitude, Humans, Students, Dental, Students, Medical, Reproducibility of Results

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