Burnout syndrome is a work-related psychological syndrome included in the International Classification of Diseases 11th Revision (code QD85) [1]. Herbert Freudenberger described this syndrome in 1974 [2,3], and it is characterized by a chronic response to interpersonal stressors in the workplace that may be related to work organization and environment [4,5]. The protocol in our study will guide a scoping review to identify and map studies that used the Maslach Burnout Inventory (MBI) to identify burnout syndrome in health care professionals working in public health services. The results of this review may be useful to public health care professionals, managers, policymakers, and the general population since these findings will help understand the validated, translated, and adapted versions of MBI and domains, number of items, Likert scales, and cutoff points or the latent profile analysis most used in the literature. Furthermore, possible research gaps may be identified to guide future studies. All information regarding the stages of the scoping review favor its transparency and allow it to be methodologically replicated according to the principles of open science, thereby reducing the risk of bias and data duplication [3].

Different definitions of the burnout syndrome consider many etiological factors; thus, literature lacks a consensus about its definition and diagnostic criteria [6,7]. Some authors define burnout syndrome as fatigue and emotional exhaustion [8], whereas others consider it as emotional exhaustion and depersonalization [9]. Gil-Monte [10] defines burnout syndrome according to 4 dimensions: enthusiasm toward the job, psychological exhaustion, indolence, and guilt. Bakker et al [11] define the syndrome as mental distance from the job and emotional, physical, and cognitive exhaustion. One of the most used definitions of burnout syndrome was proposed by Maslach and Jackson who considered this syndrome as emotional exhaustion, depersonalization, and personal accomplishment associated with physical and psychological symptoms. Thus, this scoping review protocol used this definition to map the use of MBI [5].

The main characteristics of burnout syndrome are emotional exhaustion, resulting in fatigue; depersonalization, associated with negative behaviors and cynicism in work relationships; and low scores in personal accomplishment, with feelings of incompetence and low productivity [12-14]. Individuals with burnout syndrome see work as a source of misery and unpleasurable [3], leading to high employee turnover, work absenteeism, decreased quantity and quality of work, and increased occupational accidents, thereby representing institutional consequences [15,16]. People working with the general public are more prone to develop the burnout syndrome. Studies have shown burnout in several work fields; however, the most affected were teachers, police officers, and health care professionals (especially physicians and nurses) [6,17-19]. The burnout syndrome affects approximately 10%-70% of nurses and 30%-50% of physicians, nurse practitioners, and physician assistants [20] and is highly prevalent among health care professionals [21-24], especially among those working in public health services [25,26].

Many aspects of burnout syndrome have already been established, and more than 90% of the studies used MBI [27] to identify and implement preventive interventions and treatments [12,28]. MBI is a self-report questionnaire developed by Christina Maslach and Susan Jackson to obtain a multidimensional view of burnout and comprises 22 items divided into 3 sections: emotional exhaustion (9 items), depersonalization (5 items), and personal accomplishment (8 items). The original version uses a 7-point Likert scale (0 corresponds to “never” and 6 to “every day”) [5,29] that assesses burnout according to scores in each dimension: high levels of burnout are characterized by high scores in emotional exhaustion and depersonalization and low scores in personal accomplishment. According to studies, MBI must be used in a 3D approach to enhance the comprehension of the burnout syndrome, since all 3 dimensions are considered important for identifying burnout and the individual dimensions alone do not sufficiently define the construct [21,30-32].

MBI is also intended to investigate the syndrome in other work settings. The MBI-Educators Survey is intended for education professionals, and the MBI-General Survey measures the syndrome in any professional category. For health care professionals, there is a specific version called the MBI Human Services Survey [5,29]. The MBI-Student Survey is designed to identify burnout in students [33]. The literature shows different translated, validated, and adapted versions of MBI. This diversity constitutes a challenge for the development of research using the instrument, since it can impact the interpretation of data and make comparisons between studies impossible, as well as hinder the identification of workers at risk for developing the syndrome because there is no standardization in its use.

The choice of the setting in our study was due to evidence in the literature that professionals working in public health services are more exposed to stress, thereby causing burnout [34]. In these services, there is usually wage-related dissatisfaction on the part of professionals, the need for better planning of actions and work processes [35,36], the difficulty in operationalizing actions, underfunding, and poor infrastructure [35-37]. The evidence of the aforementioned factors in public health services should be considered and will help us in terms of understanding that the development of burnout syndrome in health care professionals may be related to the organization and development of the work process in these services, which reflects the importance of conducting this study in the current context. Considering the global importance of MBI for identifying burnout syndrome [38], we conducted a preliminary search in the Joanna Briggs Institute (JBI) evidence synthesis, the international Prospective Register of Systematic Reviews (PROSPERO), Cochrane Library, and PubMed/MEDLINE databases by using the descriptors “health care professionals,” “public health services,” “Maslach Burnout Inventory,” and “burnout syndrome.” We found only 1 integrative review synthesizing the use of MBI in Brazil; however, this study was not directed to public health care professionals [39]. No studies or protocols were found when expanding the search to other continents.

Therefore, this scoping review protocol will identify and map studies that used MBI to assess burnout syndrome in health care professionals working in public health services. It will allow us to map the evidence describing different translated and validated versions of MBI and assess the consistency in frequencies and cutoff points of the scale and its application in different countries, aiming to guide a possible standardization in its use. We will also evaluate possible research gaps regarding the use of MBI among health care professionals working in public health services.

This protocol will guide a scoping review to identify and map studies that used MBI to identify burnout syndrome in health care professionals working in public health services. The results of this review may be useful to public health care professionals, managers, policymakers, and the general population since the findings will help understand the validated, translated, and adapted versions of MBI and domains, number of items, Likert scales, and cutoff points or the latent profile analysis most used in the literature. Furthermore, possible research gaps may be identified to guide future studies. All information regarding the stages of the scoping review favor its transparency and allow it to be methodologically replicated according to the principles of open science, thereby reducing the risk of bias and data duplication.