Prevalence and Determinants of Moral Injury and Its Association with General Self-Efficacy among Healthcare Professionals in a National Hospital in Sri Lanka: A Cross-sectional Study

Introduction: Healthcare professionals (HCPs) in low- and middle-income countries face resource constraints and ethical challenges that increase the risk of moral injury. Empirical evidence from South Asian healthcare settings, particularly outside acute crisis contexts, remains limited. This study aimed to determine the prevalence of moral injury, identify its sociodemographic and occupational determinants, and examine its association with general self-efficacy among HCPs at the National Hospital of Sri Lanka.
Methods: An analytical descriptive cross-sectional study was conducted among 391 HCPs at the National Hospital of Sri Lanka, using stratified random sampling. The Moral Injury Symptom Scale-Healthcare Professionals and the General Self-Efficacy Scale were adapted through forward-backward translation into Sinhala. Data were analyzed using descriptive statistics, Pearson correlation, independent-samples t-tests, one-way ANOVA, chi-square tests, and binary logistic regression.
Results: The sample comprised 391 HCPs (16.6% physicians, 38.9% nurses, 44.5% healthcare support workers) with a mean age of 34.53 ± 6.09 years. A total of 28.6% (n = 112) met criteria for clinically significant moral injury. The mean self-efficacy score for the full sample was 20.17 (SD ± 2.80). Occupational category was the only statistically significant predictor of moral injury: nurses (Odds Ratio; OR = 0.35, p = 0.001) and healthcare support workers (OR = 0.37, p = 0.001) had significantly lower odds of clinically significant moral injury compared to physician.
Conclusions: Clinically significant moral injury affected nearly one-third of HCPs, with physicians being disproportionately affected. Occupational category was associated with moral injury, suggesting that workplace and professional-context factors may contribute to variations in moral injury among HCPs.