**1. Introduction**

Sensory processing sensitivity (SPS) can be defined as a personality trait that includes the individual characteristics of sensitivity towards endogenous and exogenous stimuli [1]. It is colloquially called High Sensitivity, or Highly Sensitive Person (HSP), who are characterized by a high emotional and empathetic reactivity, and a greater depth in the processing of information [2], which makes them more vulnerable to external influences, more suggestible, and with a tendency towards sudden over-activation [3].

Sensory processing sensitivity is a non-pathological personality trait with a prevalence of 30% in the general population [4]. Initially, sensitivity was considered as a vulnerability [5]; however, recent studies have revealed adaptive traits of individuals with a high SPS, with more positive emotions in supporting environments [6,7]. In this sense, recent studies have proven that individuals with a high SPS have a greater ability to respond to positive and negative experiences [8,9]. This special sensitivity to the environment has implications on health, education, and work. Authors such as Costa-López et al. [10] and Aron et al. [3],

**Citation:** Ponce-Valencia, A.; Jiménez-Rodríguez, D.; Simonelli-Muñoz, A.J.; Gallego-Gómez, J.I.; Castro-Luna, G.; Echevarría Pérez, P. Adaptation of the Highly Sensitive Person Scale (HSP) and Psychometric Properties of Reduced Versions of the Highly Sensitive Person Scale (R-HSP Scale) in Spanish Nursing Students. *Healthcare* **2022**, *10*, 932. https:// doi.org/10.3390/healthcare10050932

Academic Editors: Athanassios Tselebis and Argyro Pachi

Received: 8 April 2022 Accepted: 17 May 2022 Published: 18 May 2022

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**Copyright:** © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

believe that SPS is an important factor that has an influence not only on the well-being or quality of life, but also at the functional or physiological level.

It is well known that university students experience diverse stressful events [11]. Studies with samples of university students have systematically provided information on the positive correlation between SPS and symptoms of depression [12]. In the last few years, interest has also grown for studies on stress and the psychosocial factors associated with a position at work, given the repercussions they could have on the health of workers [13]. One of the groups of people that is more exposed to stress due to the characteristics of their day-to-day work is healthcare workers, with special emphasis on nursing personnel. Nevertheless, this physical and emotional overload begins previously at university, where future healthcare professionals are trained [14,15]. The sources of stress for health sciences students include balancing academic and clinical demands [16].

The 27-item Highly Sensitive Persons scale (HSP scale) was composed by Aron and Aron [1], and is the most utilized as an instrument for measuring the environmental sensitivity of students and adults. Based on this scale, others were developed for children (HSC scale) [4], as well as parents [17]. The HSP/HSC scales have been translated into various languages and their psychometric properties have been validated, although with respect to the factor structure, they revealed different solutions. Most of the results ranged from one to several structures. These authors suggested that they were closely related to neuroticism, a propensity to experience negative effects and positive openness to stimuli [18].

Sensory processing sensitivity (SPS) is a biologically based temperament trait associated with a greater awareness and ability to respond to environmental and social stimuli [19]. These individuals are characterized by being good observers and having a high creativity. However, they are introverted and can easily suffer from high levels of stress. The period at university is characterized by a greater vulnerability for a great range of mental health (MH) challenges [20], so the education context could have an important impact on the personal and professional development of students. During their university period, nursing students spend a large amount of their time in the classroom, clinical simulation rooms, and university hospitals, where they face different life experiences that can be emotionally challenging, and which can modulate their development and future well-being. In this sense, many studies consider that stress is generalized in every aspect of nursing university education [8,21,22], and that SPS increases the risk of problems related with stress as a response to negative environments [23], although it also provides a greater benefit from positive and supportive environments [24]. Therefore, the differences in environmental sensitivity play an important role in the education context, on which interventions could be made [25] to prevent the negative effects associated with SPS, and to promote its positive potential to improve the well-being and mental health of future nurses [2].

Considering the health training and education characteristics described, the differences in environmental sensitivity can play a crucial role in the academic context of health professionals, and is therefore defined as a field of research that must be addressed. For this, an abbreviated, reliable, and valid self-report is needed, that could be swiftly applied and which allows the identification of Highly Sensitive Persons among nursing students.

The general objective of the present article is to adapt the Highly Sensitive Person Scale (HSP) and to study the psychometric properties of a reduced version of the Highly Sensitive Person scale, which is widely used in Spain by the Association of Persons with High Sensitivity in Spain (Aspase), in sample of nursing students. As specific objectives, we set out to find out whether the reduced scale can be used to efficiently distinguish nursing students with HSP from those who are not, to study the prevalence, and to analyze the influence of socio-familial variables, gender and age.

## **2. Materials and Methods**

#### *2.1. Design*

As this is an adaptation of a scale, a cross-sectional study was carried out including nursing students from the Catholic University of Murcia (UCAM, Murcia, Spain).

#### *2.2. Participants*

The study participants were enrolled in all four academic years in the Nursing Degree. The participants were informed about the characteristics of the study and aim of the data obtained from it. The participants provided their consent when completing the questionnaire. The final sample was composed of 284 students, enrolled in the 1st to 4th academic years within the Nursing Degree.

#### *2.3. Data Collection*

The study was conducted during the months of October and November, 2019. The data collection process took place during normal class hours, and the decision to participate was free and voluntary, without compensation, or disadvantages to the students who opted not to participate. Personal and academic variables were analyzed, such as gender, age, academic year, and previous healthcare education. The students were also asked whether their family, partner (if they had one at the time), and social relationships were satisfactory or unsatisfactory.

#### *2.4. The Instruments for Data Colletion*

Initially, the HSP scale developed by Aron and Aron (1997) was composed of 27 items. In Spain, the HSPS-S scale was validated in 2021 for an adult population, maintaining the 27 items from the original scale [26]. More recently, a reduced scale (HSC) was validated for an adolescent population [27]. Lastly, other authors at the international level also reduced the HSP scale for its use at the clinical level [28].

The values of the scale oscillate between 0 and 6 points. A higher score indicates a higher sensitivity. As a specific cut-off point does not exist for the questionnaire, the students who scored higher than the fourth quartile (4Q, ≥11 points) were defined as HSP.

#### *2.5. Adaptation and Initial Validation of Instruments*

For the process of translation and linguistic adaptation, the protocol suggested by Pluess [29] was followed. A committee of bilingual experts, who were educated in different disciplines, was convened. One was a physician, two were nurses, three were university professors, and two were clinical psychologists. A direct conceptual translation was made of the original in English to Spanish. Considering the cultural and university context, a provisional version was created of the reduced version of the highly sensitive person scale in Spanish, which was reviewed by a third expert. Of the 27 items from the original scale, 16 were kept in the r-HSP, as they had an item–total correlation coefficient > 0.30, considered useful for assessing the attribute under study, and a Cronbach's α value > 0.700. Items not fulfilling this condition were excluded. Lastly, cognitive interviews were given to 10 students. The interviewees did not have any difficulties with the answer alternatives, and their general assessment of the instrument was positive. None of the interviewees manifested having comprehension problems, or mentioned the need to include other elements. The transcultural adaptation of the original version of the HSP for a Spanish population (r-HSP) had a high degree of linguistic, cultural, and conceptual equivalence.
