Cross-cultural adaptation and validation of the Chinese version of the revised surveys on patient safety culture™ (SOPS®) hospital survey 2.0

Background: Surveys on Patient Safety Culture (TM) (SOPS (R)) Hospital Survey (HSOPS 1.0), developed by the U.S. Agency for Healthcare Research and Quality in 2004, has been widely adopted in the United States and internationally. An updated version, the SOPS Hospital Survey 2.0 (HSOPS 2.0), released in 2019, has not yet been applied in China. The aim of the present study was to translate HSOPS 2.0 into Chinese version with cross-cultural adaptations and test its psychometric properties. Methods: A convenience sample was used. Hospital nurses (N = 1013) and a sub-set (n = 200) was invited for the re-test. A three-stage study was conducted. Firstly, the HSOPS 2.0 was translated by a panel. Secondly, the content validity was tested using the two-round Delphi method and cognitive interview. Next, the construct validity was tested by the confirmatory factor analysis and further demonstrated by the convergent validity, discriminant validity, and correlations with the outcome of patient safety. Thirdly, the reliability was tested by internal consistency reliability and re-test reliability. Results: The float or PRN and manager words were deleted as considered unfitted for the Chinese health care system. The content validity index provided evidence of strong content validity (I-CVI = 0.84 similar to 1.00, S-CVI = 0.98). Confirmatory factor analysis revealed a good model fit (chi(2)/df = 4.05, RMSEA = 0.06, CFI = 0.94) and acceptable factor loadings (0.41 similar to 0.97). Convergent validity, and discriminant validity supported the factorial structure of the Chinese version of HSOPS 2.0. Further evidence for the construct validity was derived from correlations with the outcome of patient safety (r = 0.10 similar to 0.41). A good internal consistency (Cronbach's alpha = 0.68 similar to 0.93, McDonald's omega = 0.84 similar to 0.96) and test-retest reliability (ICC = 0.78 similar to 0.95) showed acceptable reliability. Additionally, Chinese nurses reported markedly lower scores for three dimensions, including Response to Error , Communication Openness , and Reporting Patient Safety Events , when comparing the findings of this study with those from U.S. research utilizing the HSOPS 2.0. Conclusion: The Chinese version of HSOPS 2.0 demonstrated good validity and reliability in a Chinese sample of hospital nurses, which suggests that it can be used to measure nurse-perceived patient safety culture in future research and practice. Psychometric properties of the Chinese version of HSOPS 2.0 among other Chinese healthcare professionals remain to be confirmed.

Automated summary

The aim of this study was to translate and adapt HSOPS 2.0 into Chinese, and test its psychometric properties. The Chinese version of HSOPS 2.0 demonstrated good validity and reliability among hospital nurses in China. However, Chinese nurses reported lower scores in certain dimensions compared to U.S. research.