C O M P S A C D I G I - H E A LT H 2 0 2 3

Examining the Relationship

Between Stress Levels and
Cybersecurity Practices Among
Hospital Employees in Three
Countries: Ghana, Norway, and
Indonesia
Muhammad Ali Fauzi (NTNU Norway)
Prosper Yeng (NTNU Norway)
Bian Yang (NTNU Norway)
Dita Rachmayani (UB Indonesia)
Peter Nimbe (UENR Ghana)
Introduction
The Impact of Technology on
Healthcare

The rise of digitalization in healthcare has a huge potential to

improve patient care performance. However, it also carries a
hazardous side-effect: healthcare system vulnerabilities.
Verizon 82%
2 0 2 2 D ATA B R E A C H
I N V E S T I G AT I O N S R E P O RT

https://enterprise.verizon.com/
resources/reports/dbir 82% OF BREACHES
I N V O LV E D A H U M A N
FA C T O R
Humans are frequently
referred to as the weakest
link in cybersecurity

Recently, many studies focus on making a better understanding

of human behavior in using computers and the internet and the
factors that influence their cybersecurity practices.
 Related Work

1 2 3 4 5
2015 2016 2018 2019 2020
Whitty et al. Halevi et al. Gratian et al. Yeng et al. Kennison and
Chan-Tin
Studied the link Evaluated Investigated human Proposed a framework
between several the connection characteristics such as to analyze security Studied how
factors including between cultural, personality traits, risk- practices of hospital personality traits, risk-
impulsivity, self- personality, and taking preferences, employees that combine taking preferences,
monitoring, and demographic and decision-making demographic and and secure password
internal-external variables and styles with psycho-socio-cultural knowledge can be
control and password cybersecurity cybersecurity behavior factors correlated to risky
sharing behavior. practices intentions. cybersecurity
practices.
The Research
Stress also have a
significant effect
on human behavior
Method
A S U RV E Y C O N D U C T E D I N
T H R E E H O S P I TA L S I N
G H A N A , A H O S P I TA L I N
N O RWAY, A N D A H O S P I TA L
IN INDONESIA

• Healthcare staffs’ demographic information

• Healthcare staffs’ stress level in the last month
• Healthcare staffs’ cybersecurity practices in the last
month
Perceived Stress Hospital Staff’s Risky
Scale (PSS) Cybersecurity
• PSS is the most common psychological
Practices Scale
instrument to measure the perception of stress
• A scale to measure cybersecurity practices specifically
created by Cohen et al.
for hospital staff.
• A short and easy-to-use self-reported
• Developed partially based on the Human Aspects of
questionnaire established with acceptable
Information Security Questionnaire (HAIS-Q) and
psychometric properties
Security Behavior Intentions Scale (SeBIS)
• The 10-item PSS version in English,
• Refined based on some interviews with 36 people
Norwegian, and Indonesian language were
including hospital staff and cybersecurity experts from
used because it has better psychometric
several hospitals and universities in Indonesia, Ghana,
qualities than the 14-item and 4-item versions.
and Norway.
• The scale consists of 12 items with a possible total
score ranging from 0 to 48
Result
• General characteristics of
participants
• PSS Score
• Hospital Staffs’ Cybersecurity
Practices Score
• Correlation Between Stress Level
and Cybersecurity Practices
• Principal Finding and Practical
Application
• Limitation
Participant
Characteristics
PSS Score Distribution
 PSS Score
• Reliability testing: Cronbach 𝛼 in this study for the PSS in
English, Norwegian, and Indonesian versions were 0.750,
0.844, and 0.733, respectively.
• It indicates that the items in all three PSS versions had a good
level of internal consistency
• The figure depicts a left-skewed distribution, meaning that
more participants are in a lower level of stress.
HS-RCPS Score Distribution
 HS-RCPS Score
• Reliability testing: Cronbach 𝛼 in this study for the HS-RCPS
in English, Norwegian, and Indonesian versions were 0.595,
0.502, and 0.697, respectively.
• Overall, the HS-RCPS demonstrated acceptable internal
consistency across the surveyed populations
• The figure depicts a left-skewed distribution, meaning that
more participants are in a better level of cybersecurity
practices.
Correlation Between Stress
Level and Cybersecurity
Practices
G E N E R A L L Y, S T R E S S L E V E L H A D A
S I G N I F I C A N T C O R R E L AT I O N W I T H
S TA F F ’ S C Y B E R S E C U R I T Y P R A C T I C E S

Furthermore, a significant correlation also

appears when we analyze only the data from
Ghana or only the data from Indonesia.
However, a significant correlation between stress
and risky cybersecurity practices was not found
in Norway.
Correlation Between Stress
Level and Cybersecurity
Practices
G E N E R A L L Y, S T R E S S L E V E L H A D A
S I G N I F I C A N T C O R R E L AT I O N W I T H
S TA F F ’ S C Y B E R S E C U R I T Y P R A C T I C E S

Hospital staff's tendency to click on links from

unknown sources (Item 4), had the highest
positive correlation with stress levels, indicating
that this is the riskiest cybersecurity behavior
that is most influenced by stress levels among
hospital staff.
Demographic and Risky Cybersecurity
Practices

The statistical analysis revealed no significant

differences in the levels of risky cybersecurity
practices across different groups of participants
based on gender, age, position, position level,
and work experience
Demographic and Risky Cybersecurity
Practices

A significant difference was observed in risky

cybersecurity practices scores across staff
groups based on the country of origin, with
hospital staff from Norway showing
significantly lower scores than those from
Ghana and Indonesia, suggesting that
Norwegian healthcare staff had safer
cybersecurity practices.
Practical Application

This study contributes an input for hospital management

to concern about stress prevention among hospital
workers as a factor in reducing risky cybersecurity
practices. Our findings highlight the need to prevent
stress to ensure appropriate cybersecurity practices and
avoid negative consequences for the hospital, such as
data breaches.
Limitation
Desirability bias
Participant may choose to answer in a way that they got low
risky cybersecurity practices score or low stress level.
S E V E R A L L I M I T AT I O N S
TO OUR WORK

Possible inaccurate answers

The respondents may give inaccurate answers because of
fatigue, failures to understand questions, or even random
clicking.

No causal relationships drawn

This study was cross-sectional so that no conclusions about
causal relationships can be formed.
Conclusion
CONCLUSION OF OUR WORK
Reliability of PSS and HS-RCPS
Both scales have acceptable Cronbach’s alpha
values for all English, Norwegian, and Indonesian
versions.
Stress and Cybersecurity Practices relationship
among hospital staff
Higher stress levels among
hospital employees are significantly associated
with riskier cybersecurity practices
Conclusion
CONCLUSION OF OUR WORK
Stress and Cybersecurity Practices
Specifically, the staff’s tendency to click on links
from unknown sources was found to be the risky
cybersecurity practice most heavily associated
with higher stress levels
Demographic & Cybersecurity Practices
• No significant differences were found in the
levels of risky cybersecurity practices between
male and female participants or among
different age groups, positions, position
levels, and work experience.
• A significant difference was observed in risky
cybersecurity practices scores across staff
groups based on the country of origin, with
hospital staff from Norway having safer
cybersecurity practices.
Future work
• A N A LY Z I N G T H E C A U S A L R E L AT I O N S H I P S
BETWEEN STRESS LEVELS AND
CYBERSECURITY PRACTICES
• E X P L O R E O T H E R FA C T O R S I N F L U E N C I N G
RISKY CYBERSECURITY PRACTICES
A M O N G H O S P I TA L S TA F F, S U C H A S
P E R S O N A L I T Y T R A I T S , M O T I VAT I O N , O R
J O B S AT I S FA C T I O N
• E X A M I N E T H E E F F E C T I V E N E S S O F VA R I O U S
I N T E RV E N T I O N S A I M E D AT P R O M O T I N G
SAFER CYBERSECURITY PRACTICES
A M O N G H O S P I TA L S TA F F
Do you have any
questions?
muhammad.a.fauzi@ntnu.no