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Learn more: PMC Disclaimer | PMC Copyright Notice BMC Health Serv Res . 2026 Mar 4;26:503. doi: 10.1186/s12913-026-14289-5 Search in PMC Search in PubMed View in NLM Catalog Add to search Development and psychometric validation of the media-influenced healthcare violence perception scale in Türkiye Selman Kizilkaya Selman Kizilkaya 1 Department of Health Management, Faculty of Economics and Administrative Sciences, Dicle University, Diyarbakır, Turkey Find articles by Selman Kizilkaya 1, ✉ , Ahmet Fethi Gün Ahmet Fethi Gün 2 Institute of Social Sciences, Dicle University, Diyarbakır, Türkiye Find articles by Ahmet Fethi Gün 2 Author information Article notes Copyright and License information 1 Department of Health Management, Faculty of Economics and Administrative Sciences, Dicle University, Diyarbakır, Turkey 2 Institute of Social Sciences, Dicle University, Diyarbakır, Türkiye ✉ Corresponding author. Received 2026 Jan 12; Accepted 2026 Feb 26; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13069811 PMID: 41781958 Abstract Background Violence against healthcare professionals is a growing public health concern with significant implications for workforce sustainability, work-life integration, quality of care, and patient safety. Although the prevalence and consequences of violence in healthcare are well documented, the ways in which media exposure shapes public perceptions, emotional responses, and the psychosocial well-being of healthcare workers remain insufficiently measured. This study aimed to develop and psychometrically validate the Media-Influenced Healthcare Violence Perception Scale (MHVPS). Methods An item pool was generated from the literature and refined through expert review. The scale was administered to two independent adult samples in Türkiye. Exploratory factor analysis was conducted in the first sample ( n = 191), and confirmatory factor analysis was performed in the second sample ( n = 502). Construct validity and reliability were examined using factor loadings, internal consistency coefficients, and widely accepted model fit indices. Results A three-factor structure was identified, representing media-induced desensitization, mediated legitimization of healthcare violence, and media-driven fear of victimization. The model explained 62.8% of the total variance and demonstrated excellent fit (χ²/df = 2.73; Comparative Fit Index = 0.96; Tucker–Lewis Index = 0.95; Root Mean Square Error of Approximation = 0.06; Standardized Root Mean Square Residual = 0.05). Internal consistency was high for the overall scale (Cronbach’s alpha = 0.84; McDonald’s omega = 0.85). Conclusion The MHVPS is a valid and reliable instrument for measuring perceptions of violence toward healthcare professionals as influenced by media exposure. The scale offers valuable insights into how media narratives can shape psychosocial stress, emotional exhaustion, and fear responses that disrupt healthcare professionals’ well-being and work-life integration. Findings may support public health research, inform workforce resilience initiatives, and guide violence-prevention and media-regulation strategies aimed at improving healthcare working environments. MHVPS can also help stakeholders understand how media-derived perceptions contribute to challenges in work-life integration. Trial registration Not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-026-14289-5. Keywords: Healthcare violence, Media exposure, Desensitization, Fear of victimization, Legitimization, Well-being, Work-life integration Introduction In healthcare settings, violence against healthcare workers includes physical assault, verbal abuse, economic exploitation, and sexual aggression, making healthcare environments high-risk occupational contexts [ 1 ]. Violence toward healthcare professionals is widely recognized as a major global public health problem, as it undermines employee safety and compromises the quality and sustainability of healthcare services [ 2 ]. Exposure to workplace violence has been associated with burnout, turnover intention, fear of future victimization, and impaired physical and psychological well-being among healthcare workers [ 3 – 5 ]. At the system level, violence weakens patient safety, restricts access to care, and disrupts healthcare service delivery [ 6 , 7 ]. Evidence from Türkiye further indicates that violence against healthcare workers is driven by patient impatience, perceived inadequate care, and organizational deficiencies such as communication failures and insufficient security, underscoring its multidimensional and systemic nature [ 8 – 10 ]. Although the determinants of healthcare violence are multifactorial—spanning organizational, sociocultural, and systemic dimensions—media has emerged as a critical yet underexplored factor shaping societal perceptions and responses to healthcare violence [ 11 , 12 ]. Modern media ecosystems, including traditional journalism and digital platforms, do not merely reflect violent events but actively construct and frame them. These representations influence how violence is interpreted, justified, and emotionally processed by the public [ 13 , 14 ]. Contemporary media environments, particularly digital platforms, not only disseminate violent events but also intensify their perceived salience through repetitive and emotionally charged framing. Repeated exposure to such narratives has been shown to heighten perceived risk and amplify emotional reactions among audiences [ 13 ]. Recent empirical findings further indicate that media portrayals of aggression toward nurses may implicitly normalize violence by framing it as an expected or unavoidable aspect of professional practice [ 14 ]. In addition, exposure to violence-related news has been found to affect future healthcare professionals: qualitative evidence demonstrates that nursing students experience increased professional anxiety, secondary traumatic stress, and weakened occupational commitment when repeatedly confronted with media narratives of healthcare violence, particularly during critical stages of identity formation [ 15 , 16 ]. The role of media framing and emotional engagement in shaping public attitudes is supported by several theoretical perspectives. According to Social Cognitive Theory, individuals acquire attitudes and behavioral scripts through observational learning within their social environment, including symbolic communication conveyed through media representations [ 17 ]. Repeated exposure to emotionally charged media content can recalibrate normative expectations surrounding aggression and violence. Contemporary empirical research further supports this theoretical proposition, demonstrating that sustained exposure to violent media content is significantly associated with increased aggressive tendencies, behavioral imitation, and partial justification of violence across diverse populations [ 18 , 19 ]. Additional studies have emphasized the desensitizing effects of repeated exposure to media violence, linking it to diminished emotional responsiveness and greater acceptance of aggressive conduct [ 19 , 20 ]. Experimental and correlational evidence further indicates that exposure to verbally or physically aggressive media content can predict subsequent increases in real-world aggression and hostile behavioral patterns [ 21 ]. Collectively, these findings suggest that media narratives may simultaneously foster desensitization to violence, normalize hostile conduct, and amplify perceived threat, thereby shaping cognitive and emotional responses to violence within society [ 22 ]. Empirical findings reinforce these theoretical mechanisms. Exposure to violent media has been linked to reduced empathy and increased normalization of aggression [ 23 , 24 ]. Media coverage that depicts healthcare professionals as negligent or uncaring may justify aggression toward them [ 25 , 26 ], while emotionally manipulative or fear-based content can heighten anxiety, perceived threat, and avoidance behavior [ 22 ]. Within healthcare contexts, these effects have both societal (public distrust and aggression) and occupational (stress and burnout) implications. In Türkiye, social media narratives and sensational reporting have been shown to distort perceptions of healthcare risk and contribute to the erosion of professional credibility [ 11 , 27 ]. Despite this growing recognition, there remains a critical methodological gap in the literature: the absence of a validated, theory-based instrument capable of quantifying media-influenced perceptions of healthcare violence. Existing scales, such as the Workplace Violence in the Health Sector instruments and the Perceived Violence Scale for Healthcare Workers, assess direct experiences or general attitudes toward workplace violence but do not capture the perceptual and emotional dimensions shaped by media exposure [ 28 ]. Consequently, the field lacks tools for systematically examining how media representations influence both healthcare workers and the general public. In response to this gap, the present study introduces and validates the Media-Influenced Healthcare Violence Perception Scale (MHVPS), a newly developed instrument designed to assess how exposure to media content shapes perceptions of violence toward healthcare professionals in Türkiye. Unlike adaptation studies, this research represents a new scale development effort, initiated in Turkish to ensure cultural relevance and linguistic clarity, and subsequently translated into English to facilitate international accessibility. Grounded in Social Cognitive Theory, the MHVPS conceptualizes media influence as a multidimensional construct encompassing three interrelated domains: Media-Induced Desensitization (MID), Mediated Legitimization of Healthcare Violence (MLHV), and Media-Driven Fear of Victimization (MDFV). The aim of this study is therefore to develop and psychometrically validate the MHVPS, providing a reliable and valid tool to measure media-influenced perceptions of healthcare violence. This instrument is intended to contribute both to scholarly understanding and to practical applications in policy, media regulation, and healthcare workforce protection. By operationalizing this construct, the study seeks to advance interdisciplinary discourse on how mediated representations shape the psychological, social, and institutional dimensions of healthcare violence in contemporary societies. Methods Research model This study employed a methodological research design grounded in scale development principles [ 29 ], with the primary objective of developing and psychometrically validating a new instrument—the MHVPS—to measure how media exposure shapes perceptions of healthcare violence in Türkiye. Importantly, this research represents a de novo (original) scale development rather than an adaptation or modification of any pre-existing instrument. The initial item pool was generated in Turkish, the native language of the target population, to ensure linguistic clarity and cultural appropriateness. The final version was subsequently translated into English following international guidelines to enable cross-cultural comparison and academic dissemination [ 30 , 31 ]. The development process followed four structured phases: item generation based on literature and theoretical foundations; expert panel evaluation for content validity and item reduction; pilot testing for clarity, readability, and comprehension; and psychometric validation through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Study group Data were collected from two independent samples drawn from the general population in Türkiye. Participants were adults aged 18 years and older who voluntarily completed the online survey. Inclusion criteria were: (a) being a resident of Türkiye, (b) having basic literacy in Turkish, and (c) following at least one media platform (social, digital, or traditional). The first sample ( n = 191) was used for EFA to identify the underlying factor structure. The second, independent sample ( n = 502) was used for CFA to validate the structure identified in the first phase. According to Table 1 , a significant majority of the participants were women, accounting for 70.7% ( n = 135), while men make up 29.3% ( n = 56). In terms of healthcare utilization, 79.1% of respondents ( n = 151) reported visiting a healthcare institution within the past 12 months, while only 20.9% ( n = 40) had not. Furthermore, a large portion (82.2%, n = 157) stated that they had witnessed violence directed at a healthcare worker, while 7.9% ( n = 15) had not, and 9.9% ( n = 19) could not recall. On the other hand, 89.5% ( n = 171) indicated that they had not been directly involved in a healthcare violence incident. Regarding media habits, the majority of participants (68.6%, n = 131) reported following media every day. An additional 23.6% ( n = 45) followed media several times a week, while smaller groups reported following it once a week (4.7%, n = 9) or a few times per month (3.1%, n = 6). In the analysis of participants’ preferred media types, social media emerged as the most frequently selected platform, with 42.4% of the respondents indicating it as their primary source of media consumption. This was followed by YouTube or podcasts at 30.4%, reflecting a strong preference for interactive and on-demand content formats. Traditional media sources such as television (14.7%) and newspapers (2.1%) were considerably less preferred, while internet news websites accounted for 10.5% of responses (Table 1 ). Table 1. Demographic characteristics of the EFA sample Variable f % Gender Female 135 70.7 Male 56 29.3 Healthcare use in the past 12 months Yes 151 79.1 No 40 20.9 Witnessed violence against healthcare worker Yes 157 82.2 No 15 7.9 I don’t remember 19 9.9 Direct involvement in a violence incident Yes 4 2.1 No 171 89.5 I don’t remember 16 8.4 Frequency of media consumption Every day 131 68.6 Several times a week 45 23.6 Once a week 9 4.7 A few times a month 6 3.1 Preferred media type Television 28 14.7 Social Media 81 42.4 Internet News Sites 20 10.5 Newspaper 4 2.1 YouTube/Podcast 58 30.4 Age (Mean ± SD) 25.7 ± 6.10 Open in a new tab According to Table 2 , the majority of participants in the CFA sample were women, representing 66.1% ( n = 332) of the sample, while men comprise 33.9% ( n = 170). The age of the participants was 25.6 years. Most participants (82.5%, n = 414) reported visiting a healthcare institution in the past 12 months. Regarding violence in healthcare settings, 81.5% ( n = 409) of the participants reported witnessing violence against a healthcare worker, whereas only 9.8% ( n = 49) reported not witnessing such an incident. A small portion (8.8%, n = 44) stated they could not remember. When asked about direct involvement in a violence incident, a significant majority (91.2%, n = 458) stated they had not been involved, while 2.4% ( n = 12) had been involved, and 6.4% ( n = 32) could not remember. In terms of media usage habits, 72.7% ( n = 365) reported consuming media daily. An additional 20.1% ( n = 101) consumed it several times a week, while only small proportions followed media weekly (4.4%, n = 22) or a few times a month (2.8%, n = 14). The majority of respondents reported that they primarily followed social media (52.2%), making it the most preferred media source. This was followed by YouTube or podcasts (24.7%) and internet news websites (10.0%). Traditional media sources such as television (7.6%) and newspapers (5.6%) were less frequently preferred (Table 2 ). Table 2. Demographic characteristics of the CFA sample Variable f % Gender Female 332 66.1 Male 170 33.9 Healthcare use in the past 12 months Yes 414 82.5 No 88 17.5 Witnessed violence against healthcare worker Yes 409 81.5 No 49 9.8 I don’t remember 44 8.8 Direct involvement in a violence incident Yes 12 2.4 No 458 91.2 I don’t remember 32 6.4 Frequency of media consumption A few times a month 14 2.8 Once a week 22 4.4 Several times a week 101 20.1 Every day 365 72.7 Preferred media type Social Media 262 52.2 YouTube/Podcast 124 24.7 Internet News Sites 50 10.0 Television 38 7.6 Newspaper 28 5.6 Age (Mean ± SD) 25.6 ± 5.62 Open in a new tab Measurement tools The data collection instrument consisted of two main sections. The first section included demographic questions designed to capture participants’ socio-demographic characteristics, including age, gender, frequency of media consumption, preferred media sources, and prior exposure to violence in healthcare settings—either as a witness or participant. The second section focused on the development of the MHVPS. Initially, a pool of 30 items was generated based on a comprehensive review of literature on media effects, healthcare violence, and social cognition frameworks [ 17 , 25 ]. Items were generated to reflect three theoretically grounded constructs: MID, MLHV, and MDFV. Each item was phrased as a declarative statement and rated on a 5-point Likert scale (1 = Strongly Disagree to 5 = Strongly Agree). Following an internal review by the research team, six items were excluded due to redundancy and semantic ambiguity, yielding a preliminary pool of 24 items. A multidisciplinary expert panel of 12 specialists—including professionals in psychology, communication studies, healthcare management, and psychometrics—evaluated the 24 items for clarity, content relevance, and representativeness using a 4-point relevance scale. Content Validity Index (CVI) scores were calculated for each item, and items scoring below the acceptable threshold (CVI < 0.78) were excluded [ 32 ]. As a result, eight items were removed: four due to insufficient conceptual clarity, two for linguistic overlap, and two for contextual misalignment with the theoretical framework. This process produced a final pool of 16 items for pilot testing. A pilot study ( n = 40) was conducted among master degree students in Dicle University to evaluate item clarity and readability. Participants provided qualitative feedback on language precision, comprehension, and item length. Minor wording modifications were made accordingly (e.g., replacing “acts of violence” with “violent incidents in healthcare” to enhance contextual relevance). Since the scale was originally developed in Turkish, a structured translation and back-translation process was conducted in alignment with World Health Organization (2016) and International Society for Pharmacoeconomics and Outcomes Research guidelines for linguistic and cultural validation [ 30 , 31 ]. The Turkish version was forward-translated into English by two independent bilingual translators. A back-translation was then performed by a third translator blinded to the original items. A reconciliation meeting with the expert panel ensured conceptual equivalence between Turkish and English versions. Cultural and linguistic appropriateness were further verified by three bilingual experts experienced in cross-cultural instrument development. The final Turkish version was used for data collection, while the English version is presented in Supplementary File for academic dissemination and potential international adaptation. The minimum possible score on the scale is 12, while the maximum possible score is 60. Higher scores reflect stronger endorsement of media-related perceptions of healthcare violence. Data collection The finalized survey was administered using an online platforms between September 15 and October 15, 2025, maintaining participant anonymity and ensuring confidentiality throughout the process. Ethical approval for the study was obtained from the Dicle University Human Research Ethics Committee (Approval No: 986675). All procedures were conducted in accordance with the principles of the Declaration of Helsinki (2013). Written electronic consent was obtained from all participants prior to participation. Participation was voluntary and anonymous. Participants were recruited via convenience sampling through healthcare-related social media groups and professional networks. Participants were informed about the purpose of the study, their rights, and data protection measures. Average completion time was approximately 5–10 min. No personally identifiable information was collected. Data analysis Statistical analyses were conducted using JAMOVI software [ 33 ]. Descriptive statistics were utilized to summarize the socio-demographic and media-related characteristics of the participants. EFA was applied to the first sample using maximum likelihood extraction and oblimin rotation in order to identify the underlying factor structure of the scale. prior to conducting EFA, the Kaiser-Meyer-Olkin measure and Bartlett’s Test of Sphericity were used to assess the adequacy of the sample and the suitability of the data for factor analysis. Criteria for item retention included factor loadings equal to or greater than 0.40, item–total correlations equal to or greater than 0.40, and item uniqueness values below 0.60 [ 34 , 35 ]. Items that failed to meet these psychometric thresholds were excluded from further analysis. Following EFA, CFA was conducted on the second sample to validate the factor structure identified in the first phase. Model fit was evaluated using multiple indices in line with widely accepted benchmarks. A chi-square to degrees of freedom ratio (χ²/df) value less than or equal to 5 was considered acceptable [ 36 ]. Comparative Fit Index (CFI) and Tucker–Lewis Index (TLI) values greater than or equal to 0.90 were considered acceptable, and values above 0.95 were interpreted as indicating good model fit [ 36 ]. The Root Mean Square Error of Approximation (RMSEA) was considered acceptable at 0.08 or lower, with values of 0.06 or lower reflecting good fit. The Standardized Root Mean Square Residual (SRMR) was considered acceptable at 0.08 or below [ 36 , 37 ]. Finally, internal consistency reliability was evaluated using Cronbach’s alpha (α) and McDonald’s omega (ω) coefficients for each subscale and for the overall scale, ensuring the scale’s psychometric soundness. Results EFA results presented in Table 3 provide evidence for the construct validity and internal consistency of the MHVPS. During the initial phase of the analysis, four items (i1, i2, i3, i4) were removed from the scale due to psychometric inadequacy. Specifically, i3 was eliminated first because its item-total correlations were found to be below the accepted threshold of 0.40. A revised factor analysis was then conducted with the remaining items. As a result, item i2 was excluded due to its uniqueness value exceeding the acceptable limit, while item i4 was removed because of a persistently low item-total correlation, again below the 0.40 threshold. After these removals, a third round of factor analysis was performed. In this iteration, item i1 demonstrated a uniqueness value outside the recommended range, indicating that it did not adequately load on any of the latent factors. Consequently, i1 was also excluded from the scale. The analysis was conducted on data from 191 participants and yielded a three-factor solution explaining a total of 62.8% of the variance, which is considered satisfactory in social sciences for newly developed scales. The adequacy of the sample for factor analysis was confirmed by the Kaiser-Meyer-Olkin measure of sampling adequacy, which was 0.865, indicating meritorious adequacy. Additionally, Bartlett’s Test of Sphericity was statistically significant (X² = 1269, p < 0.001), supporting the factorability of the correlation matrix. Table 3. Exploratory factor analysis results Factors Item-rest correlation If item dropped Uniqueness Explained Variance 1 2 3 α ω i11 0.921 0.650 0.875 0.876 0.148 23.4 i9 0.856 0.553 0.881 0.882 0.316 i12 0.801 0.593 0.878 0.879 0.356 i10 0.549 0.646 0.875 0.876 0.497 i16 0.904 0.621 0.877 0.878 0.222 22.6 i15 0.874 0.633 0.876 0.877 0.255 i14 0.772 0.629 0.876 0.877 0.364 i13 0.544 0.625 0.877 0.878 0.524 i7 0.848 0.520 0.882 0.884 0.315 16.9 i5 0.708 0.436 0.887 0.887 0.517 i8 0.685 0.486 0.884 0.885 0.497 i6 0.426 0.691 0.873 0.874 0.451 Open in a new tab The first factor, MID, accounted for 23.40% of the total variance. Items under this factor (i11, i9, i12, i10) demonstrated strong item-total correlations, with i11 showing the highest correlation at 0.921, suggesting a strong relationship between the item and the overall construct. Uniqueness values for these items were generally low, particularly for i11 (0.148), indicating that a substantial portion of the variance in this item is explained by the factor. The second factor, MLHV, explained 22.6% of the variance. Items loading on this factor (i16, i15, i14, i13) also displayed high item-rest correlations, particularly i16 with a correlation of 0.904, highlighting its centrality in representing the construct. Uniqueness values remained within acceptable limits, confirming the contribution of these items to the underlying factor. The third factor, MDFV, accounted for 16.9% of the total variance. Items within this factor (i7, i5, i8, i6) exhibited acceptable item-rest correlations, with i7 scoring the highest (0.848). In terms of internal consistency, the overall α coefficient for the final 12-item scale was 0.887, and ω was 0.888, indicating excellent reliability (Table 3 ). Figure 1 presents the scree plot derived from EFA. This pattern suggests that a three-factor solution is most appropriate, as only the first three factors have eigenvalues substantially greater than 1 and demonstrate meaningful differentiation before the curve plateaus (Fig. 1 ). Fig. 1. Open in a new tab Scree plot CFA results presented in Table 4 confirm the three-factor structure identified during the exploratory phase, providing evidence for the construct validity of MHVPS. The three constructs—MID, MLHV, and MDFV—were all supported by statistically significant standardized factor loadings, all at p < 0.001. Within the MID factor, the highest standardized loading was observed for item i11 (0.851). The lowest, loading within this factor was for item i10 (0.678). For the MLHV dimension, factor loadings were consistently strong, ranging from 0.694 (i13) to 0.825 (i15). In the MDFV dimension, all four items loaded significantly, with estimates ranging from 0.611 to 0.653. The overall internal consistency of the scale, as measured by α (0.844) and ω (0.845), was high, confirming the reliability of the full 12-item scale (Table 4 ). Table 4. Confirmatory factor analysis results Factor Items Standard Estimate Standard Error Z p MID i11. Repeated exposure to news about violence in healthcare reduces my sensitivity to such incidents. 0.851 0.049 21.7 < 0.001 i9. Frequently watching violent news in healthcare makes me realize that my empathy toward healthcare workers has decreased. 0.702 0.049 16.9 < 0.001 i12. Violent media content about healthcare workers normalizes harsh or extreme reactions. 0.760 0.050 18.6 < 0.001 i10. The violent incidents I watch in the media sometimes make my reactions feel ordinary and normal. 0.678 0.049 15.9 < 0.001 MLHV i16. Media portrayals of problems in the healthcare system often frame violence as indirectly acceptable. 0.797 0.046 20.2 < 0.001 i15. Media content frequently presents patients’ anger as an understandable or justified reaction. 0.825 0.047 21.2 < 0.001 i14. Certain media reports depict violent acts in healthcare as expected or acceptable under specific conditions. 0.746 0.047 18.4 < 0.001 i13. Some media portrayals present healthcare workers as largely responsible for violent incidents. 0.694 0.049 16.7 < 0.001 MDFV i7. Repeated exposure to news about violence in healthcare leads me to believe that violence is becoming increasingly widespread in society. 0.685 0.050 15.1 < 0.001 i5. Frequent exposure to violent incidents in healthcare through the media gives me the impression that such events are common and real in society. 0.611 0.048 13.2 < 0.001 i8. The more I watch news about violence in healthcare, the more I fear that I might become a victim one day. 0.664 0.052 14.5 < 0.001 i6. The violent news I watch makes me perceive healthcare environments as increasingly unsafe places. 0.653 0.056 14.1 < 0.001 Open in a new tab The fit indices and validity results presented in Table 5 indicate that the final model of MHVPS demonstrates an excellent overall fit to the data. The chi-square to degrees of freedom ratio (χ²/df = 2.73) falls well within the acceptable range (≤ 5), and approaches the threshold for excellent fit (≤ 3). CFI and TLI both exceed the commonly accepted cut-off value of 0.90, with values of 0.96 and 0.95, respectively, indicating strong model performance. Similarly, non-normed fit index also reached 0.95, reinforcing the evidence for a well-fitting model structure. In terms of error indices, RMSEA was 0.06, and SRMR was 0.05, both of which fall below the recommended thresholds (≤ 0.08), indicating minimal residual variance and good approximation of the model in the population. The RMSEA value specifically supports the adequacy of the model’s fit, while the low SRMR reflects consistency between the observed and predicted correlations (Table 5 ). Table 5. Fit Indices and validity results for the MHVPS Acceptable threshold obtained value χ²/df ≤ 5 139/51 = 2.73 CFI ≥ 0.90 0.96 TLI ≥ 0.90 0.95 RMSEA ≤ 0.08 0.06 SRMR ≤ 0.08 0.05 Open in a new tab Figure 2 displays the standardized path diagram obtained from the CFA, visually representing the structural validity of MHVPS. The model confirms a three-factor structure consisting of MID, MLHV, and MDFV, each indicated by their respective observed variables. All factor loadings are statistically significant, reflecting strong relationships between latent constructs and their observed indicators (Fig. 2 ). Fig. 2. Open in a new tab Confirmatory factor analysis path diagram As shown in Table 6 , the mean score for females (Mean = 37.0, SD = 9.01) was slightly lower than that of males (Mean = 37.4, SD = 7.54); however, this difference was not statistically significant, t(500) = − 0.540, p = 0.589). Similarly, participants aged 25 and older (Mean = 37.4, SD = 9.19) scored slightly higher than those aged 24 and younger (Mean = 36.9, SD = 7.88), but this difference was also not statistically significant, t(500) = − 0.748, p = 0.455). These results suggest that gender and age do not have a significant impact on individuals’ media-influenced perceptions of healthcare violence. In contrast, a significant difference was found in MHVPS scores based on participants’ healthcare utilization within the past 12 months. Participants who had visited a healthcare institution during the last year (Mean = 37.5, SD = 8.09) reported significantly higher scores than those who had not (Mean = 35.4, SD = 10.20), t(500) = − 2.16, p = 0.031) (Table 6 ). Table 6. Independent sample T-test results for MHVPS scores by gender, age and healthcare utilization Group N Mean SD t df p Female 332 37.0 9.01 -0.540 500 0.589 Male 170 37.4 7.54 Age Group N Mean SD t df p 24 and under 258 36.9 7.88 -0.748 500 0.455 25 and over 244 37.4 9.19 Healthcare Use (Past 12 Months) N Mean SD t df p Yes 414 37.5 8.09 -2.16 500 0.031 No 88 35.4 10.2 Open in a new tab Discussion The present study aimed to develop and psychometrically validate the MHVPS, a theory-based instrument designed to assess how media exposure shapes perceptions of violence toward healthcare professionals in Türkiye. The findings provide strong empirical support for a stable three-factor structure—MID, MLHV, and MDFV—thereby offering a multidimensional framework for understanding media-related perceptual processes in the context of healthcare violence. The three-factor solution identified through EFA and confirmed by CFA aligns closely with the theoretical foundations of Social Cognitive Theory and cultivation theory [ 17 ]. The MID dimension reflects the gradual attenuation of empathic and emotional responsiveness following repeated exposure to violent media content. Consistent with prior findings, exposure to media violence has been associated with reduced physiological reactivity and diminished empathy [ 23 , 34 ]. In healthcare contexts, such desensitization may reduce moral sensitivity toward aggression directed at healthcare professionals, contributing to the normalization of hostile attitudes. The MLHV dimension captures the moral and cognitive legitimization of violence through media framing. Media narratives that portray healthcare professionals as negligent or system failures as justification for aggression can recalibrate public norms [ 13 , 25 ]. Empirical evidence demonstrates that negative portrayals of healthcare workers increase dissatisfaction and may foster implicit justification of violence [ 11 , 26 ]. These findings support the conceptualization of “discursive violence,” whereby symbolic media narratives shape moral judgments that may precede behavioral aggression [ 12 ]. The MDFV dimension reflects heightened perceptions of threat and fear resulting from repeated exposure to violent healthcare narratives. Media coverage of violent events has been shown to increase anxiety, perceived vulnerability, and threat sensitivity [ 21 , 22 ]. Within healthcare settings, this mechanism may distort risk perception, increase mistrust, and negatively influence patient–provider interactions. Together, these three dimensions demonstrate that media influence operates simultaneously at affective (fear), cognitive (legitimization), and socio-emotional (desensitization) levels. In this study, the psychometric findings further reinforce the validity of the instrument. The three-factor structure explained 62.8% of the total variance, which is considered satisfactory for newly developed scales in social sciences [ 35 ]. Model fit indices obtained through CFA (CFI = 0.96; TLI = 0.95; RMSEA = 0.06; SRMR = 0.05) indicate excellent structural validity [ 36 , 37 ]. Internal consistency coefficients for both subscales and the total scale were high (α = 0.844–0.887; ω = 0.845–0.888), exceeding recommended thresholds [ 34 ]. No significant differences were observed across gender or age groups, suggesting that media-influenced perceptions of healthcare violence may operate relatively independently of basic demographic characteristics. This pattern aligns with reinforcement models of media effects, which propose that media influence often interacts with pre-existing beliefs rather than demographic categories alone [ 38 ]. However, participants who had visited healthcare institutions within the past 12 months reported significantly higher MHVPS scores. This finding suggests that personal contextual engagement may heighten the salience of violent media narratives. Media content may function as a cognitive amplifier when individuals have recent or relevant experiential anchors, intensifying perceived realism and emotional resonance [ 21 ]. By operationalizing media influence as a multidimensional construct, this study advances the literature beyond generalized “media effects” discussions. The differentiation of desensitization, legitimization, and fear provides conceptual precision and practical applicability. These findings support theoretical models suggesting that repeated symbolic exposure shapes cognitive schemas, emotional regulation, and normative perceptions [ 17 ]. Furthermore, MHVPS serves as a guide to examining how media narratives can impact work-life integration for healthcare professionals. Indeed, media-generated fear, emotional exhaustion, and the legitimization of aggression will lead to numerous challenges outside of work, such as constant hypervigilance, psychological detachment from work, and the need for restorative time outside of working hours. Therefore, MHVPS can help identify the psychosocial pathways through which repeated exposure to violent content undermines work-life integration and overall well-being. From a practical perspective, the MHVPS provides healthcare administrators, policymakers, and researchers with a standardized tool to assess media-driven perceptual climates. Given the documented association between violence exposure and burnout, turnover intention, and impaired physical and psychological well-being among healthcare workers [ 3 – 5 ], addressing perceptual mechanisms becomes essential. Media literacy programs, responsible journalism guidelines, and institutional communication strategies may benefit from integrating insights derived from MHVPS assessments. In sum, the MHVPS not only fills a methodological gap but also contributes to a deeper understanding of how mediated narratives shape the psychosocial ecology of healthcare violence. Conclusions This study developed and psychometrically validated the MHVPS, a newly constructed instrument designed to assess how media exposure shapes perceptions of violence toward healthcare professionals in Türkiye. The final validated form of the scale consists of 12 items structured under three subscales: MID, MLHV and MDFV, with each subscale comprising four items. All items are rated on a five-point Likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). Subscale scores are calculated by summing the four items within each respective dimension, allowing researchers and practitioners to evaluate desensitization, legitimization, and fear processes independently. The overall MHVPS score is obtained by summing all 12 items, yielding a total possible score between 12 and 60, where higher scores indicate stronger endorsement of media-influenced perceptions of healthcare violence. By clearly specifying the number of items, the three-factor structure, and the scoring procedure, this study ensures that the instrument can be readily implemented in empirical research, institutional assessments, and policy evaluations without requiring additional interpretation or recalculation procedures. The transparent scoring framework enables straightforward comparison across populations, facilitates monitoring of perceptual trends over time, and supports subscale-level analyses when more nuanced interpretation is needed. This explicit definition of the scale’s composition and scoring enhances its practical usability for readers by providing clear guidance for administration, scoring, and interpretation, thereby making the MHVPS directly applicable in both academic and applied healthcare contexts. However, by capturing media-induced fear, desensitization, and legitimization processes, and identifying the psychosocial burdens related to media that persist outside of working life, MHVPS can also contribute to healthcare professionals’ efforts to protect their work-life integrity. Policy implications The findings have important implications for public health policy, healthcare management, and media regulation. The MHVPS provides policymakers, administrators, and researchers with a standardized and contextually sensitive tool to assess societal perceptions of healthcare violence and to monitor the psychological effects of media narratives on healthcare professionals. Persistent exposure to violent or sensational media coverage can distort risk perception, amplify fear of victimization, and indirectly legitimize hostility toward healthcare workers—even when the actual risk remains stable. Recognizing this, the MHVPS can be used to inform the development of targeted prevention strategies, media literacy programs, and institutional communication frameworks that promote balanced reporting and foster trust in healthcare institutions. From an organizational perspective, integrating the MHVPS into workplace assessments and wellness initiatives can help identify media-related stressors and guide interventions to strengthen healthcare workers’ psychological resilience and work-life integration. In the context of post-pandemic healthcare systems and increasing digital media engagement, such tools are vital for evidence-based policy-making and for ensuring a sustainable, safe, and supportive environment for healthcare professionals. Limitations and recommendations for future research This study has several limitations. Data were collected exclusively from participants residing in Türkiye, which may limit the generalizability of the findings to other cultural and media contexts. Future studies should examine the cross-cultural validity of the MHVPS and test measurement invariance across diverse countries, healthcare systems, and sociocultural environments. The cross-sectional design also prevents causal inference regarding the relationship between media exposure and perceptions of healthcare violence. Longitudinal or experimental studies are recommended to explore temporal and causal dynamics, as well as the cumulative effects of media exposure. Although the MHVPS is concise and psychometrically robust, future research could expand it to incorporate related constructs such as perceived justice, empathy erosion, or trust in medical authority. Additionally, this study did not control for individual-level moderators such as political orientation, media trust, or preferred media platforms, all of which are known to influence media interpretation and emotional processing. Future research should explore these moderating factors alongside psychological mechanisms such as emotional regulation, third-person perception, and media literacy. In conclusion, the MHVPS represents an innovative contribution to public health and media psychology research. As societies increasingly rely on digital and visual media, this scale offers a timely and practical foundation for future inquiry and policy development aimed at mitigating the psychosocial and systemic consequences of healthcare violence and safeguarding the well-being of healthcare professionals. Supplementary Information Below is the link to the electronic supplementary material. Supplementary Material 1 (15.4KB, docx) Acknowledgements The authors would like to thank all participants who generously contributed their time and perspectives to this study. Abbreviations CFA Confirmatory Factor Analysis CFI Comparative Fit Index df Degrees of freedom EFA Exploratory Factor Analysis MDFV Media-Driven Fear of Victimization MID Media-Induced Desensitization MHVPS Media-Influenced Healthcare Violence Perception Scale MLHV Mediated Legitimization of Healthcare Violence p p value RMSEA Root Mean Square Error of Approximation SD Standard Deviation SRMR Standardized Root Mean Square Residual t t statistic TLI Tucker–Lewis Index WHO World Health Organization α Cronbach’s Alpha ω McDonald’s Omega Author contributions SK conceived and designed the study, led the methodology, conducted the formal analysis, supervised the project, and drafted the original manuscript. SK and AFG collected data, contributed to investigation, and participated in writing—review and editing. AFG contributed to data curation and visualization. All authors read and approved the final manuscript. Funding This research received no specific grant from any funding agency in the public, commercial, or not‑for‑profit sectors. Data availability The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Declarations Ethics approval and consent to participate This study was approved by the Human Research Ethics Committee of Dicle University (Approval No: 986675). All study procedures were performed in accordance with relevant guidelines and regulations, including the principles of the Declaration of Helsinki (2013). All participants were informed about the purpose of the study, assured of confidentiality, and provided written electronic consent prior to participation. Participation was voluntary, and respondents could withdraw at any time without consequence. Consent for publication Not applicable. Competing interests The authors declare no competing interests. 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