Introduction
The prehospital emergency system is a crucial element of the health care delivery framework [1]. This community-oriented service supports injured or emergency patients outside medical facilities, ensuring they receive care until they reach the proper health care centers [2]. The prehospital emergency system’s accuracy, performance, and success depend on various factors, such as personnel’s ability, personnel training, equipment, coordination, and the communication system [3]. One of the factors that determines the ability and success of personnel is their intelligence level [4]. Intelligence has always been a crucial factor influencing an individual’s success and performance [5]. While it has traditionally been associated with cognitive abilities, recent developments have expanded this concept to encompass other areas, including spirituality [6]. Researchers now argue that, alongside general and emotional intelligence, humans have a unique form of spiritual intelligence [7]. 
Spiritual intelligence denotes a collection of personal capabilities linked to spiritual assets, enabling individuals to adjust effectively and resolve challenges [8]. It encompasses advanced stages of growth in cognitive, ethical, and social dimensions, helping individuals adapt to environmental changes while achieving both internal harmony and external integration [9]. This type of intelligence offers a broad and meaningful perspective, drawing from personal experiences and spiritual insights, and is essential for making significant decisions and overcoming everyday obstacles [10]. Spiritual intelligence empowers people to live with greater depth, purpose, and significance [11]. Spiritual intelligence refers to the human ability to explore and reflect on profound existential questions while experiencing a deep sense of interconnectedness between oneself and the surrounding world [8, 9]. George identifies key features of spiritual intelligence as self-confidence, effective communication, interpersonal understanding, the ability to manage change, and the capacity to navigate challenging situations [10]. Healthcare organizations require professional staff and nurses with strong spiritual intelligence to thrive and enhance their overall performance [12]. Developing spiritual intelligence can help individuals attain greater emotional stability and foster more meaningful communication by lowering levels of worry and anxiety [13]. Spiritual intelligence in health care workers and emergency response teams fosters a more integrated perspective, contributing to enhanced job performance [14]. Studies have shown that spiritual values improve work quality and help employees enhance their job performance [15]. Consequently, incorporating spirituality into the work environment can improve job performance, skill development, and overall organizational growth [16].
Recent studies have demonstrated that spirituality strongly influences personnel’s ability to adapt and perform in organizations, particularly in overcoming challenges [9].Talebi Ghadicolaei et al. demonstrated that spiritual intelligence significantly influences successful and effective career management [10]. Pinto et al. reported that nurses’ clinical competence was related to their spiritual intelligence [11]. Pinto et al. found that spiritual intelligence was linked to the performance quality of prehospital emergency personnel [12]. In their research, Arad et al. demonstrated that training in spiritual intelligence significantly enhanced interpersonal communication abilities [8]. Alpisarrin et al. indicated that factors like intellectual intelligence, emotional intelligence, and spiritual intelligence would influence employee performance. Furthermore, spiritual intelligence has the potential to act as a bridge between cognitive ability, emotional aptitude, and job performance [15]. In their research, Sapiee et al. demonstrated that spiritual intelligence was instrumental in managing challenges within organizational leadership. By enhancing spiritual intelligence among staff, managers can take proactive measures to mitigate various challenges within the organization [16]. 
The development of spiritual intelligence can help prehospital emergency personnel achieve more stability in their work by reducing worry and anxiety and facing fewer problems in their work relationships in providing clinical services [1, 9]. Spiritual intelligence in prehospital emergency responders promotes a holistic outlook, which can enhance job performance by positively influencing the staff’s work processes [2, 10]. Spiritual intelligence helps prehospital emergency personnel find deeper meaning in their work and activities. By tapping into this intelligence, they gain a greater understanding of the significance of their actions, which can lead to making more accurate diagnoses and enhancing performance in clinical settings [4, 12].
Since prehospital emergency workers are often the first to provide healthcare, their effectiveness is crucial in patient outcomes. However, research on how spiritual intelligence influences the performance of emergency response personnel is limited. This study examined spiritual intelligence’s role in enhancing prehospital emergency workers’ performance. By understanding its impact on job performance, the findings could offer insights that may contribute to better service delivery and overall efficiency of emergency teams. 

Materials and Methods
This study was cross-sectional descriptive research conducted from July 2023 to November 2023. A census sampling method was used to recruit 389 prehospital emergency personnel from Ardabil Province. The study participants were personnel working in the prehospital emergency department of Ardabil, including those stationed at road, urban, or administrative bases. After receiving approval from the Research Council of Ardabil University of Medical Sciences, the researchers identified eligible participants based on the personnel roster.
The criteria for inclusion were as follows: Consent to participate in the research, possession of at least an associate’s degree, and a minimum of six months of experience. 

The criterion for exclusion was incomplete completion of the questionnaire. 
Out of 410 qualified personnel, 389 completed the questionnaires successfully.
The data collection tools included the standard spiritual intelligence and Paterson’s job performance questionnaire. A demographic also surveyed age, field of study, marital status, experience, type of shift, employment status, workplace, and level of education.
King and DeCicco [17] developed the spiritual intelligence self-assessment questionnaire to assess the mental abilities related to spiritual intelligence [17]. The questionnaire consists of four subscales: Critical existential thinking, with 7 items; personal meaning production, with 5 items; transcendental awareness, with 7 items; and conscious state expansion, which included 5 items. The participants rated the spiritual intelligence items on a 5-point Likert scale, from 0 (not at all true of me) to 4 (completely true of me). A higher score indicates a greater level of spiritual intelligence. King and DeCicco found the Cronbach α coefficient for the entire test to be 0.92 [17]. The current study’s Cronbach α coefficient for the spiritual intelligence questionnaire was 0.86.
Paterson’s job performance questionnaire, which contains 15 items, was used to assess job performance. The questionnaire employs a 4-point Likert scale, where responses range from “rarely” =1 to “always” =4. The total score can range from 15 to 60. Paterson’s original study reported the Cronbach α coefficient as 0.83. In this study, the Cronbach α for the questionnaire increased to 0.90, demonstrating an even higher level of internal consistency and reliability [18].
All necessary approvals have been documented and are available upon request. The use of these tools complies with ethical standards and contributes to the validity of the research findings. 
All procedures were conducted with the personnel’s consent and knowledge. Before the research commenced, the participants received detailed explanations and were assured that their data would be confidential. The study objectives were explained to the participants, and their confidentiality was assured before obtaining informed consent. 
Data were analyzed using SPSS software, version 22. Descriptive statistics were used to summarize the data. The t-test, analysis of variance (ANOVA), and multiple regression examined the relationships between variables. The Kolmogorov-Smirnov test assessed the normality of data distribution. A confidence level of 95% and a significance level 0.05 were applied.

Results
Of 389 personnel who participated in this study, 100% were male, with a mean age of 31.48±6.75 years. The majority of participants, 226(58.1%), were married; 242(62.2%) were officially employed, and 230(59.2%) held a bachelor’s degree. Additionally, 280 personnel (71.9%) worked 12-hour shifts, and 241(61.9%) were stationed at urban bases (Table 1).


The Mean±SD score of total spiritual intelligence was 49.12±12.28, which was moderate. Also, the Mean±SD scores of critical existential thinking, personal meaning production, transcendent awareness, and conscious state expansion were 15.32±4.11, 13.14±3.26, 14.32±3.41, and 9.12±3.66, respectively. The Mean±SD score of total job performance was 23.15±11.87, which was moderate. The results indicated a statistically significant relationship between age (P=0.03) and experience (P=0.001) with spiritual intelligence, as well as between age (P=0.001), work experience (P=0.001), and work shift type with job performance (Table 2).


The Mean±SD for spiritual intelligence and job performance were 49.12±12.28 and 23.15±11.87, respectively. The subgroup means for spiritual intelligence were critical existential thinking (20.15±4.12), personal meaning production (13.14±2.11), transcendental awareness (23.18±1.74), and conscious state expansion (14.44±2.02). The Pearson correlation test showed significant correlations between spiritual intelligence and job performance, as well as between various subgroups of spiritual intelligence (Table 3).


The results indicated that age and workplace were predictors of spiritual intelligence, while age and work shift type predicted job performance (Table 4).



Discussion
This study assessed the relationship between spiritual intelligence and job performance among prehospital emergency personnel in Ardabil Province. The findings revealed a positive and significant correlation, indicating that as spiritual intelligence increased, job performance also improved. These results align with Safarabadi et al., who found a similar significant relationship between spiritual intelligence and job performance among prehospital emergency personnel in Arak City, Iran [4]. The comparable results in the study may be due to the work being conducted under the same conditions and management systems used in prehospital emergency care in the country. Although the level of spiritual intelligence in the Safarabadi et al. study was slightly higher than in the present study, this difference could be attributed to cultural and religious influences and people’s attitudes toward spirituality. Amiri et al.’s study, consistent with the present study’s results, indicates that higher spiritual intelligence improves the quality of nursing care in nurses and can positively affect the job performance of personnel [19]. The results of Moradnezhad et al., consistent with the present study’s findings, indicate that higher spiritual intelligence can enhance the quality of nursing care and positively impact the job performance of personnel [20]. The results of the study by Talebi Ghadicolaei et al. show that with the improvement and increase of moral intelligence, the burnout score of employees decreases [10]. Higher spiritual intelligence in the workplace can positively impact performance and enhance patient care quality [5]. The possession of spiritual intelligence by the personnel gives them peace of mind and satisfaction. It shows increased creativity, optimism, self-confidence, and attention to high human values in the work environment, positively affecting their performance [7]. Thus, focusing on spiritual intelligence and efficiently managing personnel performance is the most reliable source of growth and is a fundamental requirement for the organization [20]. 
Results indicate that most prehospital emergency personnel have spiritual intelligence at a moderate level. Safarabadi et al.’s study also shows that the spiritual intelligence of Arak prehospital emergency personnel is at an average level [4]. This finding aligns with the findings of the present study. The results of the study by Moradnezhad et al. show that the level of spiritual intelligence of nurses is at an average level [20]. However, in the study by Parandeh et al., conducted on nursing managers at five army hospitals in Tehran City, Iran, the results show that most participants have high levels of spiritual intelligence, while the rest had moderate levels. None exhibited low levels of spiritual intelligence [21]. One possible reason for this difference is the selection of individuals with higher intellectual and mental abilities for managerial positions, which could lead to significantly different results. Additionally, the disparity in the results may stem from differences in the research populations. The previous study focused on nursing managers, while the current study involved operational personnel. It is essential to consider that those in managerial roles typically have more work experience and have participated in more training courses than other personnel, which may account for the differences observed between the two studies.
This study revealed a significant relationship between age, work experience, and spiritual intelligence. Similarly, Mohebbi et al. reported a significant relationship between spiritual intelligence and demographic variables such as age, sex, and field of study in nursing and midwifery students [22]. In contrast, Nouhi et al. identified a significant link between age and the average score of attitude toward spirituality and spiritual care. Still, they did not find a direct association with spiritual intelligence [23]. Safarabadi et al. found no significant correlation between demographic variables and spiritual intelligence [4], possibly due to differences in study populations or measurement tools.
Working in prehospital emergency settings and constantly stressful environments, the personnel encounter and handle critical situations, critically ill patients, as well as anxious or mourning relatives [4]. Therefore, it would be valuable to identify resources that can assist prehospital emergency personnel in effectively managing occupational challenges, maintaining their health, and preventing declines in performance and service quality [1, 11]. One such resource could be the development of high levels of spiritual intelligence, as it fosters greater adaptability and problem-solving skills. Spiritual intelligence encompasses a set of abilities that, by nurturing spiritual values and characteristics, can contribute to enhanced performance and well-being in both personal and professional aspects of life [6, 8]. Spiritual intelligence can improve the performance and the quality of prehospital emergency services. Therefore, including spiritual intelligence training during education and at the time of personnel employment can be effective.
Considering the current study’s limitations, such as its cross-sectional design and the use of self-report questionnaires, longitudinal studies are recommended to explore spiritual intelligence in prehospital emergency personnel over an extended period. Due to the nature of the study, it is challenging to establish definitive causal relationships between personality traits and spiritual intelligence. Longitudinal research could provide deeper insights into how spiritual intelligence develops and influences performance and well-being.

Conclusion
The results suggest that spiritual intelligence can enhance personnel performance, as developing spiritual skills positively affects patient care. Enhancing spiritual abilities can lead to significant improvements in professional performance. Therefore, prehospital managers must act to foster these qualities among their staff. Strategies such as training programs, mentorship, and workshops can effectively raise spiritual intelligence and improve service quality. Boosting spiritual intelligence improves individual performance, contributes to better patient care, and strengthens the overall prehospital emergency system. Given the impact of spiritual intelligence on job performance, future studies are encouraged to explore its presence in other prehospital emergency centers nationwide.

Ethical Considerations
Compliance with ethical guidelines
The study was approved by the Research Ethics Committee of the University of Ardabil Medical Sciences, Ardabil, Iran (Code: IR.ARUMS.REC.1402.164).

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
All authors equally contributed to preparing this article.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank everyone who contributed to this research.


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