Cross-Cultural Adaptation and Psychometric Validation of H-PEPSS in Indonesian Diploma-III Nursing Students

research
  • 21 Jul
  • 2026

Cross-Cultural Adaptation and Psychometric Validation of H-PEPSS in Indonesian Diploma-III Nursing Students

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.

REFERENSI

1. Kementerian Kesehatan Republik Indonesia. Profil kesehatan lansia Indonesia 2023. Jakarta: Kemenkes RI; 2023.
2. Suryani L, Letchmi S, Said FBM. Patient Safety Culture in Nurses in Karawang, Indonesia: A Cross- Sectional Study. KnE Life Sci. 2022;165–74.
3. Thistlethwaite JE, Forman D, Matthews LR, Rogers GD, Steketee C, Yassine T. Competencies and frameworks in interprofessional education: a comparative analysis. Acad Med. 2014;89(6):869–75.
4. Mansour M. Factor analysis of nursing students’ perception of patient safety education. Nurse Educ Today. 2015;35(1):32–7.
5. Bowman C, Neeman N, Sehgal NL. Enculturation of unsafe attitudes and behaviors: student perceptions of safety culture. Acad Med. 2013;88(6):802. 6. Ji Y, Lee H, Lee T, Choi M, Lee H, Kim S, et al. Developing an integrated curriculum for patient safety in an undergraduate nursing program: a case study. BMC Nurs. 2021;20(1):1–11.
7. Kulju S, Morrish W, King L, Bender J, Gunnar W. Patient misidentification events in the Veterans Health Administration: a comprehensive review in the context of high-reliability health care. J Patient Saf. 2022;18(1):e290–6.
8. Disch J, Barnsteiner J, Connor S, Brogren F. CE: original research: exploring how nursing schools handle student errors and near misses. Am J Nurs. 2017;117(10):24–31.
9. Leotsakos A, Ardolino A, Cheung R, Zheng H, Barraclough B, Walton M. Educating future leaders in patient safety. J Multidiscip Healthc. 2014;381–8.
10. Waterson P. Patient safety culture: theory, methods and application. Boca Raton: CRC Press; 2018.
11. Ginsburg L, Castel E, Tregunno D, Norton PG. The H-PEPSS: an instrument to measure health professionals’ perceptions of patient safety competence at entry into practice. BMJ Qual Saf.
2012;21(8):676–84.
12. Ginsburg LR, Tregunno D, Norton PG. Self-reported patient safety competence among new graduates in medicine, nursing and pharmacy. BMJ Qual Saf. 2013;22(2):147–54.
13. Stevanin S, Bressan V, Bulfone G, Zanini A, Dante A, Palese A. Knowledge and competence with patient safety as perceived by nursing students: The findings of a cross-sectional study. Nurse Educ Today. 2015;35(8):926–34.
14. Usher K, Woods C, Parmenter G, Hutchinson M, Mannix J, Power T, et al. Self-reported confidence in patient safety knowledge among Australian undergraduate nursing students: A multi-site cross-sectional survey study. Int J Nurs Stud. 2017;71:89–96.
15. Kalfoss M. Translation and adaption of questionnaires: a nursing challenge. SAGE Open Nurs.2019;5:2377960818816810.
16. Wolf EJ, Harrington KM, Clark SL, Miller MW. Sample size requirements for structural equation models: An evaluation of power, bias, and solution propriety. Educ Psychol Meas. 2013;73(6):913–34.
17. Furr RM. Psychometrics: an introduction. 3rd ed. Thousand Oaks: Sage; 2018.
18. Ginsburg LR, Tregunno D, Norton PG. Self-reported patient safety competence among new graduates in medicine, nursing and pharmacy. BMJ Qual Saf. 2013;22(2):147–54.
19. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25(24):3186–91.
20. Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.
21. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Modeling. 1999;6(1):1–55.
22. Calvache JA, Benavides E, Echeverry S, Agredo F, Stolker RJ, Klimek M. Psychometric properties of the Latin American Spanish version of the hospital survey on patient safety culture questionnaire in the surgical setting. J Patient Saf. 2021;17(8):e1806.
23. Hidayat AAA. Metode penelitian keperawatan dan teknik analisis data. Jakarta: Salemba Medika;2011.
24. Ginsburg L, Castel E, Tregunno D, Norton PG. The H-PEPSS: an instrument to measure health professionals’ perceptions of patient safety competence at entry into practice. BMJ Qual Saf.
2012;21(8):676–84.
25. Hwang JI, Yoon TY, Jin HJ, Park Y, Park JY, Lee BJ. Patient safety competence for final-year health professional students: Perceptions of effectiveness of an interprofessional education course. J Interprof Care. 2016;30(6):732–8.
26. Lee SE, Dahinten VS. Evaluating a patient safety course for undergraduate nursing students: A quasi-experimental study. Collegian. 2023;30(1):75–83.
27. Ahmed M, Arora S, Tiew S, Hayden J, Sevdalis N, Vincent C, et al. Building a safer foundation: the Lessons Learnt patient safety training programme. BMJ Qual Saf. 2014;23(1):78–86.28. Boloré S, Sovet L, Guirimand N. Health professionals’ perceptions of patient safety competencies: psychometric properties of the French version of the H-PEPSS in France and Switzerland. BMC Med Educ. 2023;23(1):905.
29. Chen L, Huang F, Yuan X, Song J. An assessment of the reliability and factorial validity of the Chinese version of the Health Professional Education in Patient Safety Survey (H-PEPSS). Front Psychol. 2019;10:478021.
30. Zakus D, Moussa M, Ezechiel M, Yimbesalu J, Orkar P, Damecour C, et al. Clinical evaluation of the use of an mHealth intervention on quality of care provided by Community Health Workers in southwest Niger. J Glob Health. 2019;9(1):010812.
31. Kahn R, Bangura S, Hann K, Salvi A, Gassimu J, Kabba A, et al. Strengthening provision of essential medicines to women and children in post-Ebola Sierra Leone. J Glob Health. 2019;9(1):010307