Cross-cultural adaptation and validation of hospital survey on patient safety culture in Bengali version (B-HSOPSC 2.0) among nurses in Bangladesh: a cross-sectional study

BMC Nursing https://doi.org/10.1186/s12912-026-04817-3 Article in Press Cross-cultural adaptation and validation of hospital survey on patient safety culture in Bengali version (B-HSOPSC 2.0) among nurses in Bangladesh: a cross-sectional study Md Abdul Khalek, K. A. T. M. Ehsanul Huq, Tomonori Hasegawa, Yosuke Hatakeyama, Abdulfatai Olamilekan Babaita & Michiko Moriyama Received: 22 January 2026 Accepted: 21 May 2026 Cite this article as: Khalek M.A., Huq K.A.T.M.E., Hasegawa T. et al. Cross-cultural adaptation and validation of hospital survey on patient safety culture in Bengali version (B-HSOPSC 2.0) among nurses in Bangladesh: a cross-sectional study. BMC Nurs (2026). https://doi.org/10.1186/ s12912-026-04817-3 A E R P S S We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply. IN If this paper is publishing under a Transparent Peer Review model then Peer Review reports will publish with the final article. I T R E L C © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. ACCEPTED ARTICLEMANUSCRIPT IN PRESS Original Article Cross-cultural adaptation and validation of Hospital Survey on Patient Safety Culture in Bengali version (B-HSOPSC 2.0) among nurses in Bangladesh: a cross-sectional study Md Abdul Khalek1*, K. A. T. M. Ehsanul Huq1, Tomonori Hasegawa2, Yosuke Hatakeyama2, Abdulfatai Olamilekan Babaita1 and Michiko Moriyama1* 1Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan 2 Department of Social Medicine, Faculty of Medicine, Toho University, Tokyo, Japan *Correspondence: Michiko Moriyama: Md Abdul Khalek: Abstract Background The Hospital Survey on Patient Safety Culture (HSOPSC 2.0) S S E R P was developed and updated by the Agency for Healthcare Research and Quality in 2019. It has now been widely adopted and translated into different languages worldwide. However, the validity and reliability of the Bengali E L C I T R A IN version of HSOPSC 2.0 (B-HSOPSC 2.0) have not been tested among healthcare professionals. This study aimed to determine the validity and reliability of the B-HSOPSC 2.0 with cross-cultural adaptations, among hospital nurses in Bangladesh. Methods The study was conducted among nurses in eight tertiary-level government medical college hospitals in Bangladesh. A two-step study design was employed, encompassing the translation, cultural adaptation, and psychometric evaluation of B-HSOPSC 2.0. The translation process included forward and backward translation by panel, expert consensus, review, and pretesting. Content validity, reliability, and test-retest reliability were assessed. Construct validity was evaluated through confirmatory factor ACCEPTED ARTICLEMANUSCRIPT IN PRESS analysis (CFA), and convergent validity was examined using average variance extraction and Spearman's correlation coefficient. Results Out of 7,170 eligible nurses, 4,982 were analyzed (valid response rate: 69.5%), and a subset (n=424) provided retest responses. The words “manager” and “clinical leader” were removed, and the word “units” was replaced with “wards,” as they were deemed inappropriate for the Bangladesh healthcare system. The content validity index provides strong evidence of adequacy for the instrument measurements (I-CVI=0.83-1.00, SCVI=0.98). B-HSOPSC 2.0 demonstrated a good internal consistency S S E R P (Cronbach’s α=0.70-0.76). The test-retest reliability was acceptable at the group level (ICC=0.65-0.76) and low in the single measure (0.071, 0.069). In IN the CFA model, the indices for the 10 and 9 dimensions were CFI=0.79, 0.83; E L C I T R A NFI=0.78, 0.82; TLI=0.74, 0.79; GFI=0.91, 0.92; RMSEA=0.06, 0.06; SRMR=0.07, 0.06, respectively. Conclusions The psychometric properties of the Bengali version were inconsistent and not sufficiently robust. However, content validity and testretest reliability were deemed acceptable. Since there is no validated tool to evaluate the patient safety culture in the Bengali version, these study findings may help further to evaluate future nurses' perceived patient safety culture interventions in hospital settings in Bangladesh. Further studies are required, as the psychometric properties of B-HSOPSC 2.0 among other healthcare professionals in Bangladesh remain to be confirmed. ACCEPTED ARTICLEMANUSCRIPT IN PRESS Clinical trial number Not applicable. Keywords Cross-cultural, Safety culture, Hospital survey, Patient safety, Reliability Introduction Patient safety is a fundamental pillar of high-quality healthcare, essential for preventing avoidable harm and ensuring safe healthcare worldwide [1]. Healthcare itself can cause harm that originates largely from unsafe systems and organizational factors, rather than individual errors [2, 3]. The World S S E R P Health Organization (WHO) convened international experts and policymakers for effective collaboration on patient safety action globally [4]. WHO defined IN patient safety as protecting patients from preventable harm and minimizing E L C I T R A the risk of unnecessary injury during healthcare to the lowest possible level [5]. The National Institute for Occupational Safety and Health (NIOSH) explained that safety culture is an organizational commitment to health and safety, reflected in shared values, attitudes, perceptions, and behaviors of individuals or groups characterized by mutual trust, open communication, and confidence in preventive measures [6]. The culture of patient safety is the sum of beliefs and practices that shape the way healthcare is provided [7]. Lack of a patient safety culture can cause adverse events due to inadequate medical management rather than underlying illness, such as medication ACCEPTED ARTICLEMANUSCRIPT IN PRESS errors, falls, infections, pressure ulcers, and equipment failures [8, 9]. It was estimated that 1 in every 10 patients in high-income countries (HICs) experiences adverse events, and 2.6 million people in low-and middle-income cou (...truncated)