## 8 Discussion  
The aim of this study was to analyse the psychometric properties of the MBI HSS scale and create a version best suitable for use in calculating burnout in the Gulf Cooperation Council Region. The critical ratios obtained from item analysis of the original version of the tool indicated that the  
Figure 1: MBI-HSS revised model for healthcare professional in Saudi Arabia.  
items were successfully able to measure differences among participants [21]. The item total correlation value was larger for three factors than for one factor. This finding is in accordance with previous studies [13; 15; 33], which have shown that the three-factor model of MBI-HSS is the best fit when assessing burnout [8]. On the other hand, our results contradict some of the previous studies which suggest that the use of a two-factor model fits better [3; 17]. Results from CFA of the original model were considered unsatisfactory in accordance with previous literature [13; 17]. This indicated that the model needed to be revised in order to be used in determining burnout in the Gulf Cooperation Council Region. EFA was then conducted on the 22 items MBI HSS and the factor number and items were retained using the following criteria (1) eigenvalues \(>\)1, (2) factor structure of at least four items, (3) factor loadings above 0.4, and (4) items that did not load to more than one factor [15; 22; 31]. In this study, MBI 22 showed a higher factor loading in the original dimension as compared to previous studies [15; 34; 35] in which the factor loading of item 22 was found to be less than 0.4. Factor loading of Item 14 produced a value less than 0.4 in a study conducted in China [34] which suggested its deletion, however in this study, a greater value was observed and, therefore, this factor was kept the same when constructing the new model. Confirmatory factor analysis was performed on the reconstructed model developed in this study. The chi square value generated could indicate lack of fit of model with the data, however, according to [PERSON] (2003), it is normal for the chi square to become significant as the sample size grows larger hence we also referred to other indices for evaluation of the model [31]. The model satisfied the criteria put forth in previous research and showed a GFI value \(>\)0.9, AGFI value of \(>\)0.8 and an RMSEA value \(<\)0.08. This also indicated that it is a better fit with the data as compared to the original version [13; 36; 37]. Results of the levels of burnout present in the sample used in this study indicate higher mean levels of emotional exhaustion and personal accomplishment and a lower mean level of depersonalization in the Gulf Cooperation Council Region, similar results have also been found in a recent study performed in Saudi Arabia and United Arab Emirates [20]. This study has many limitations, one of which is self-reported, the responses of the individuals are subjective and not backed up by clinical evidence. In addition to this, the study only includes private hospitals and hence health care professionals employed at public hospitals have not been represented in our study. This greatly affects the generalizability of the results generated. Therefore, we would encourage further studies of this nature to be performed within this region with public hospitals incorporated into the sample as well. The current study used a non-probability convenience sampling technique which might have limited the generalizability of the findings. It is also important to note that certain factors such as the unequal distribution of genders of the participants (more females than males), the differences in their nationalities (more non-Saudis than Saudis), and the fact that majority of individuals in the sample used are nurses could have also limited the generalizability of the results produced.