Development and validation of the quiet quitting behavior scale: a mixed-methods study with primary healthcare workers in China

Background The growing prevalence of quiet quitting behavior (QQB) poses a significant challenge to workforce mental health and organizational sustainability. However, progress in this field has been hindered by the absence of culturally adapted and behaviorally anchored measurement instruments. This study aimed to develop a Quiet Quitting Behavior Scale (QQBS) tailored to the Chinese context and to validate the scale among primary healthcare workers. Method The QQBS was developed and validated using an exploratory sequential mixed-methods design. The development process included item generation through grounded-theory analysis, content validation via Delphi consultation, instrument refinement through a pilot survey, and psychometric evaluation in a formal survey. Results The final 15-item QQBS consists of two dimensions: Role Contraction and Behavioral Inertia (8 items) and Cognitive Collapse and Psychological Detachment (7 items). Content validity was established through expert review. Exploratory factor analysis identified a clear two-factor structure, which was subsequently confirmed by confirmatory factor analysis, indicating excellent model fit (CFI = 0.959, IFI = 0.960, RMSEA = 0.065). The scale showed excellent reliability, with high internal consistency (Cronbach’s α = 0.921 total; 0.874 and 0.900 subscales) and good split-half reliability (0.803). Evidence also supported robust convergent, discriminant, and criterion-related validity, the latter demonstrated by significant correlations with organizational citizenship behavior and turnover intention. Conclusion The QQBS is a theoretically grounded, reliable, and valid instrument. It serves as a critical instrument for identifying QQBs among primary healthcare workers in China and demonstrates strong potential for application in other high-stress sectors.