Advisor(s)

Gregory Pavela

Committee Member(s)

Bradford Woodworth
Don Lein
Kevin Fontaine
Teneasha Washington

Document Type

Dissertation

Date of Award

1-27-2026

Degree Name

Doctor of Philosophy (PhD)

School

School of Public Health

Department

Public Health

Abstract

Work-related musculoskeletal disorders (WMSD) affect 77% of nurses and 60% of surgeons, exceeding rates in other occupational sectors and threatening healthcare workforce sustainability. Microbreaking is brief, strategic pause of 20 seconds to five minutes performed every 20 to 40 minutes during medical procedures. It has demonstrated effectiveness in reducing fatigue, improving accuracy, and lowering physiological stress markers without extending medical procedure duration. Despite this evidence, adoption remains limited, and no theoretically informed instruments exist to measure the behavioral determinants of microbreaking intentions among procedural healthcare workers. Investigators of this three-manuscript dissertation developed and established content and construct validity as well as internal consistency of the Instrument to Measure Antecedents of Microbreaking Intentions (I-MAMI) using the Integrated Behavior Model (IBM) framework. The first manuscript established content validity through systematic item development and a two-round Delphi process with nine expert panelists, resulting in a 56-item instrument with scale content validity indices ranging from 0.82 – 0.96 across six IBM constructs: Experiential Attitude, Instrumental Attitude, Injunctive Norm, Descriptive Norm, Perceived Control, and Self-Efficacy. The second manuscript described psychometric evaluation using data from 95 surgeons (62 complete cases). Despite an underpowered sample, confirmatory factor analysis supported the IBM driven six-factor structure over a four-factor model derived from parallel analysis and exploratory factor analysis, with the final 17-item instrument demonstrating acceptable fit (CFI = 0.95, TLI = 0.93, RMSEA = 0.08, SRMR = 0.08) and excellent internal consistency (Cronbach’s α range: 0.82 – 0.93). The third manuscript provided descriptive analysis revealing distinct patterns across IBM constructs. Surgeons reported high perceived control over microbreaking and high attitudes (both experiential and instrumental), high injunctive norms, and high self-efficacy. However, descriptive norms were low, indicating a disconnect between surgeons’ high individual readiness and their perception of minimal colleague implementation. Microbreaking intention showed wide variability (M = 4.21, SD = 1.84 on a 7-point scale). Missing data increased systematically from 7% to 30% across survey progression, highlighting methodological challenges. The I-MAMI provides researchers with a preliminarily content and construct validated, theory-based tool for assessing behavioral determinants of microbreaking adoption. By identifying specific barriers such as low perceived colleague implementation, the instrument enables targeted intervention development to reduce WMSD and maintain healthcare workforce sustainability.

Keywords

Healthcare Workers;Instrument Validation;Integrated Behavior Model;Microbreaking;Occupational Health;Work Related Musculoskeletal Disorders

ProQuest Publication Number

32283338

ISBN

9798273379886

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