Translation and validation of the Dari version of the hospital survey on patient safety culture for healthcare settings in Afghanistan

Patient safety culture (PSC) is a critical determinant of healthcare quality, as it influences error reduction and clinical outcomes. The hospital survey on patient safety culture (HSOPSC), a globally validated tool for assessing PSC, was translated and validated in Afghanistan a setting facing unique healthcare challenges, including resource constraints and a fragmented healthcare system. The translation adhered to WHO guidelines, involving forward-backward translation, expert review, and pilot testing with nurses and midwives at one of Afghanistan's largest hospitals, located in the capital city. Psychometric evaluations included face, content, and construct validity. Reliability was assessed through internal consistency (Cronbach's α, Omega coefficients) and test-retest reliability. The 42-item questionnaire demonstrated robust validity and reliability. Content Validity Index (CVI) scores ranged from 0.82 to 1.0, exceeding acceptable thresholds, while the Content Validity Ratio (CVR) ranged from 0.64 to 1.0, meeting required standards. Face validity was confirmed by an impact score > 1.5 (range 1.86-3.96). Two items from the Staffing dimension exhibited factor loadings below the recommended threshold of 0.4 and were removed, leading to the exclusion of this dimension (fewer than three retained items). Overall reliability was strong, with Cronbach's α = 0.848 and Omega = 0.841. The validated Dari version of the HSOPSC comprises 11 dimensions after removing Staffing. It demonstrates good validity and reliability, establishing its suitability for patient safety research in Afghanistan.