Adaptation and validation of the U.S. hospital survey on patient safety culture 2.0™(SOPS®) : the Saudi version

Abstract

Background: The U.S. Hospital Survey on Patient Safety Culture 2.0 (HSOPSC, 2.0), released by the Agency of Healthcare Research and Quality in 2019, is the most widely used instrument for measuring patient safety culture in healthcare organizations. However, it has not been cross-culturally adapted nor validated within the context of the Saudi healthcare system. This two-phased study aimed to adapt the U.S. HSOPSC 2.0 to be suitable for use by registered nurses working in Saudi hospital settings, and to assess the construct validity of the revised Saudi tool. My approach to psychometric testing was informed by Messick’s view of unified validity (1980, 1995), and guidelines provided by the International Test Commission (2017). Methods: Instrument adaptation was performed in Phase 1 using a committee-based approach, two focus-group interviews, and expert panel reviews. Construct validity of the adapted tool was assessed in Phase 2 using confirmatory factor analyses, reliability testing, and hierarchical logistic regression, drawing on cross-sectional data collected from 534 registered nurses working in a large tertiary hospital setting in Saudi Arabia. Results: Phase 1 resulted in a 33-item instrument that demonstrated excellent content validity. In Phase 2, confirmatory factor analysis yielded the 26-item Saudi-HSOPSC 2.0 with a 10-factor structure consistent with the U.S. HSOPSC 2.0. Reliability testing yielded acceptable reliability coefficients for eight subscales. Hierarchical logistic regression provided further evidence of the instrument’s construct validity, with seven of the 10 dimensions found to be uniquely predictive of at least one of the three patient safety outcomes. Conclusion: The findings provide initial evidence of the content and construct validity of the Saudi-HSOPSC 2.0. Together, the findings provide evidence supporting five aspects of Messick’s (1980) view of unified validity. Future research should assess the validity of the Saudi instrument within a broader validation context and investigate the potential impact of included negatively worded items. With additional evidence supporting the psychometric properties of the Saudi-HSOPSC 2.0, Saudi administrators and nurse leaders can use it to assess the status of patient safety culture in their hospitals and inform future interventions aimed at improving patient safety and quality of care in Saudi hospital settings.