Cross-Cultural Adaptation and Psychometric Validation of H-PEPSS in Indonesian Diploma-III Nursing Students
Keywords:
Cross-cultural adaptation, Psychometric properties, Patient safety education, Nursing students, IndonesiaAbstract
In Indonesia, there is currently no standardized tool to evaluate patient safety competence among nursing students. This study aimed to culturally adapt and test the H-PEPSS for use with Indonesian nursing students. The participants were final-year diploma nursing students from Jakarta and West Java. The process included translation, expert validation, pilot testing, and cultural adaptation using cognitive interviews and student feedback. Items were developed through domain analysis and reviewed by experts to ensure relevance and clarity. The validity of the measurement model was examined using RMSEA, SRMR, and CFI indices, while internal consistency was tested to assess reliability. A total of 344 students from eight institutions in Jakarta and Bandung took part in the psychometric testing. The Content Validity Index (CVI) ranged from 0.73 to 1.00 across items. Pearson correlation coefficients varied by domain. The three-factor structure showed a good model fit, with standardized factor loadings above 0.4. All indicator variables exceeded the 0.30 significance threshold. The Indonesian version of H-PEPSS demonstrated a Cronbach’s alpha of 0.795, indicating acceptable reliability. The results suggest that H-PEPSS is a suitable instrument for assessing patient safety competencies among Indonesian nursing students and can be successfully adapted for use in different cultural settings.
Downloads
References
Ahmed, M., Arora, S., Tiew, S., Hayden, J., Sevdalis, N., Vincent, C., & Baker, P. (2014). Building a safer foundation: the Lessons Learnt patient safety training programme. BMJ Quality & Safety, 23(1), 78–86. DOI: https://doi.org/10.1136/bmjqs-2012-001740
Asensi-Vicente, J., Jiménez-Ruiz, I., & Vizcaya-Moreno, M. F. (2018). Medication errors involving nursing students: A systematic review. Nurse Educator, 43(5), E1–E5. DOI: https://doi.org/10.1097/NNE.0000000000000481
Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25(24), 3186–3191. https://doi.org/10.1097/00007632-200012150-00014 DOI: https://doi.org/10.1097/00007632-200012150-00014
Boloré, S., Sovet, L., & Guirimand, N. (2023). Health professionals’ perceptions of patient safety competencies: psychometric properties of the French version of the H-PEPSS in France and Switzerland. BMC Medical Education, 23(1), 905. DOI: https://doi.org/10.1186/s12909-023-04893-y
Bowman, C., Neeman, N., & Sehgal, N. L. (2013). Enculturation of unsafe attitudes and behaviors: student perceptions of safety culture. Academic Medicine: Journal of the Association of American Medical Colleges, 88(6), 802. DOI: https://doi.org/10.1097/ACM.0b013e31828fd4f4
Calvache, J. A., Benavides, E., Echeverry, S., Agredo, F., Stolker, R. J., & Klimek, M. (2021). Psychometric properties of the Latin American Spanish version of the hospital survey on patient safety culture questionnaire in the surgical setting. Journal of Patient Safety, 17(8), e1806. DOI: https://doi.org/10.1097/PTS.0000000000000644
Chen, L., Huang, F., Yuan, X., & Song, J. (2019). An assessment of the reliability and factorial validity of the Chinese version of the Health Professional Education in Patient Safety Survey (H-PEPSS). Frontiers in Psychology, 10, 478021. DOI: https://doi.org/10.3389/fpsyg.2019.02183
Denise F. Polite. (2020). Nursing Research.
Disch, J., Barnsteiner, J., Connor, S., & Brogren, F. (2017). CE: original research: exploring how nursing schools handle student errors and near misses. AJN The American Journal of Nursing, 117(10), 24–31. DOI: https://doi.org/10.1097/01.NAJ.0000525849.35536.74
Furr, R. M. (2018). Psychometrics: an introduction. 3rd ed. Sage.
Ginsburg, L., Castel, E., Tregunno, D., & Norton, P. G. (2012). The H-PEPSS: an instrument to measure health professionals’ perceptions of patient safety competence at entry into practice. BMJ Quality & Safety, 21(8), 676–684. DOI: https://doi.org/10.1136/bmjqs-2011-000601
Ginsburg, L. R., Tregunno, D., & Norton, P. G. (2013). Self-reported patient safety competence among new graduates in medicine, nursing and pharmacy. BMJ Quality & Safety, 22(2), 147–154. DOI: https://doi.org/10.1136/bmjqs-2012-001308
Hidayat, A. A. A. (2011). Metode penelitian keperawatan dan teknik analisis data.
Hwang, J.-I., Yoon, T.-Y., Jin, H.-J., Park, Y., Park, J.-Y., & Lee, B.-J. (2016). Patient safety competence for final-year health professional students: Perceptions of effectiveness of an interprofessional education course. Journal of Interprofessional Care, 30(6), 732–738. DOI: https://doi.org/10.1080/13561820.2016.1218446
Ji, Y., Lee, H., Lee, T., Choi, M., Lee, H., Kim, S., Do, H. K., Kim, S., Chu, S. H., & Park, J. (2021). Developing an integrated curriculum for patient safety in an undergraduate nursing program: a case study. BMC Nursing, 20(1), 1–11. DOI: https://doi.org/10.1186/s12912-021-00694-0
Kahn, R., Bangura, S., Hann, K., Salvi, A., Gassimu, J., Kabba, A., Mesman, A. W., Dierberg, K. L., & Marsh, R. H. (2019). Strengthening provision of essential medicines to women and children in post-Ebola Sierra Leone. Journal of Global Health, 9(1), 10307. https://doi.org/10.7189/jogh.09.010307 DOI: https://doi.org/10.7189/jogh.09.010307
Kalfoss, M. (2019). Translation and adaption of questionnaires: a nursing challenge. SAGE Open Nursing, 5, 2377960818816810. DOI: https://doi.org/10.1177/2377960818816810
Kulju, S., Morrish, W., King, L., Bender, J., & Gunnar, W. (2022). Patient misidentification events in the Veterans Health Administration: a comprehensive review in the context of high-reliability health care. Journal of Patient Safety, 18(1), e290–e296. DOI: https://doi.org/10.1097/PTS.0000000000000767
Lee, S. E., & Dahinten, V. S. (2023). Evaluating a patient safety course for undergraduate nursing students: A quasi-experimental study. Collegian, 30(1), 75–83. DOI: https://doi.org/10.1016/j.colegn.2022.06.001
Leotsakos, A., Ardolino, A., Cheung, R., Zheng, H., Barraclough, B., & Walton, M. (2014). Educating future leaders in patient safety. Journal of Multidisciplinary Healthcare, 381–388. DOI: https://doi.org/10.2147/JMDH.S53792
Mansour, M. (2015). Factor analysis of nursing students’ perception of patient safety education. Nurse Education Today, 35(1), 32–37. DOI: https://doi.org/10.1016/j.nedt.2014.04.020
Stevanin, S., Bressan, V., Bulfone, G., Zanini, A., Dante, A., & Palese, A. (2015). Knowledge and competence with patient safety as perceived by nursing students: The findings of a cross-sectional study. Nurse Education Today, 35(8), 926–934. DOI: https://doi.org/10.1016/j.nedt.2015.04.002
Suryani, L., Letchmi, S., & Said, F. B. M. (2022). Patient Safety Culture in Nurses in Karawang, Indonesia: A Cross-Sectional Study. KnE Life Sciences, 165–174. DOI: https://doi.org/10.18502/kls.v7i2.10299
Thistlethwaite, J. E., Forman, D., Matthews, L. R., Rogers, G. D., Steketee, C., & Yassine, T. (2014). Competencies and frameworks in interprofessional education: a comparative analysis. Academic Medicine, 89(6), 869–875. DOI: https://doi.org/10.1097/ACM.0000000000000249
Usher, K., Woods, C., Parmenter, G., Hutchinson, M., Mannix, J., Power, T., Chaboyer, W., Latimer, S., Mills, J., & Siegloff, L. (2017). Self-reported confidence in patient safety knowledge among Australian undergraduate nursing students: A multi-site cross-sectional survey study. International Journal of Nursing Studies, 71, 89–96. DOI: https://doi.org/10.1016/j.ijnurstu.2017.03.006
Van Slambrouck, L., Verschueren, R., Seys, D., Bruyneel, L., Panella, M., & Vanhaecht, K. (2021). Second victims among baccalaureate nursing students in the aftermath of a patient safety incident: An exploratory cross-sectional study. Journal of Professional Nursing, 37(4), 765–770. DOI: https://doi.org/10.1016/j.profnurs.2021.04.010
Waterson, P. (2018). Patient safety culture: theory, methods and application. CRC Press. DOI: https://doi.org/10.1201/9781315599717
Wolf, E. J., Harrington, K. M., Clark, S. L., & Miller, M. W. (2013). Sample size requirements for structural equation models: An evaluation of power, bias, and solution propriety. Educational and Psychological Measurement, 73(6), 913–934. DOI: https://doi.org/10.1177/0013164413495237
Zakus, D., Moussa, M., Ezechiel, M., Yimbesalu, J., Orkar, P., Damecour, C., Ghee, A., MacFarlane, M., & Nganga, G. (2019). Clinical evaluation of the use of an mhealth intervention on quality of care provided by Community Health Workers in southwest Niger. Journal of Global Health, 9. https://doi.org/10.7189/jogh.09.010812 DOI: https://doi.org/10.7189/jogh.09.010812
Published
How to Cite
Issue
Section
Copyright (c) 2025 Silvana Evi Linda, Linlin Lindayani

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.









