Cross-culture adaptation and validation of
the Indonesian version of the Hospital
Survey on Patient Safety Culture
(HSOPSC 2.0)

Cross-culture adaptation and validation of
the Indonesian version of the Hospital
Survey on Patient Safety Culture
(HSOPSC 2.0)

factor analysis; hospitals; Indonesia; nursing; patient safety; psychometrics

Background: Hospital Survey on Patient Safety Culture (HSOPSC) is considered one of the
most scientifically rigorous tools available with excellent psychometric properties. However, it
is not yet available in an Indonesian version.
Objective: This study aimed to determine the validity of the content and psychometric
properties of HSOPSC 2.0 for use in Indonesian hospitals.
Methods: The study was divided into three stages: translation, adaptation, and validation.
Culture-adaptation was assessed using cognitive interviews with ten direct care nurses who
worked in the hospital to evaluate their perceptions and the coherence of the translated items,
response categories, and questionnaire directions. Content validity was also done by ten
experts from academic and clinical settings. Finally, Confirmatory Factor Analysis (CFA) and
reliability testing were conducted among 220 nurses from two Indonesian hospitals.
Results: The cognitive test results indicated that the language clarity was 87.8 % and 84.5%
for cultural relevance. The Content Validity Index (CVI) ranged between 0.73 to 1.00, while the
construct validity results indicated that each factor had factor loadings above 0.4, from 0.47 to
0.65. The fit indices showed an acceptable fit for the data provided by the 10-factor model,
with RMSEA = 0.052, SRMR = 0.089, and CFI = 0.87. The Pearson correlation coefficients
between the ten subscales ranged from 0.276 to 0.579 (p < 0.05). The Cronbach’s alpha for
all sub-scales was more than 0.70, except for organizational learning – continuous
improvement, response to error, and communication openness.
Conclusion: This study offers initial evidence of the psychometric properties of the
Indonesian-HSOPSC 2.0. Future studies are needed to examine its psychometric features to
improve generalizability. However, nurses and other healthcare professionals could use the
tool to measure hospital patient safety culture in Indonesia.

Lilis Suryani1,2* , Santhna Letchmi2
, and Faridah Binti Moch Said2

Original Research: Research Methodology Paper

30 March 2022

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