Abstract
<title>Abstract</title> <p> Background The Biocentric Health Management Theory (BHMT) proposes that bio‑centric (life‑centered) acting may buffer occupational stress, but no validated instrument exists for pre‑hospital <bold>Emergency Medical Services (EMS)</bold> . This study developed and psychometrically validated the Biocentric Acting Questionnaire (BAQ) using exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and structural equation modeling (SEM) in an Iranian emergency staff population. Methods A multi‑method study was conducted among Tehran pre‑hospital emergency staff. Items were generated using the Hybrid Concept Development Approach, informed by literature review and expert panels. Face and content validity were assessed with 29 experts. Construct validity was evaluated using EFA (n = 300) and CFA (n = 263). SEM examined relationships between BAQ, stress sources, workload and physiological parameters. Internal consistency (Cronbach’s α) and test‑retest reliability (ICC, 10‑day interval) were calculated. Results A BAQ emerged with a three‑factor structure: (1) Self‑Relationship and Communication with Nature, (2) Relationship to Others, and (3) Individual Turmoil, explaining 42.6% of total variance. CFA partially supported this structure with marginal fit indices (CFI = 0.810, RMSEA = 0.053), which is acceptable for an early-stage validation in a new cultural context. The SEM model showed that BAQ was significantly associated with both psychosocial stress indicators and physiological parameters (β = 0.89 for BAQ → physiological status; p < 0.001). Cronbach’s α for the total scale was 0.895; ICC was 0.78. Conclusions The BAQ is the first valid and reliable instrument for assessing bio‑centric acting in Iranian pre‑hospital emergency staff. The EFA‑CFA‑SEM approach confirmed its three‑dimensional structure and predictive validity. The BAQ can be used for workforce monitoring and designing bio‑centric interventions in emergency services. </p>