# Enhancing Patient Safety Education: Cross-Cultural Validation of the APSQ-III in Brazilian Healthcare Students

## TL;DR

This study adapted and validated a patient safety questionnaire for Brazilian healthcare students, finding it reliable for most factors and highlighting differences between medical and nursing students.

## Contribution

The study provides a cross-culturally validated version of the APSQ-III for Brazilian Portuguese and identifies reliability issues in specific factors.

## Key findings

- The nine-factor model of the APSQ-III showed acceptable fit after excluding four items.
- Medical and nursing students had significant differences in four factors of patient safety attitudes.
- Gender differences were observed in five items, indicating varied perceptions of patient safety.

## Abstract

Background: This study aimed to adapt and validate the Attitudes to Patient Safety Questionnaire (APSQ-III) for Brazilian Portuguese and to compare patient safety attitudes between medical and nursing students. Given the critical role of assessing safety attitudes in shaping future healthcare professionals, this research addresses a significant gap in the Brazilian educational context. Materials and Methods: The cross-cultural adaptation process adhered to the guidelines of for the Process of Cross-Cultural Adaptation of Self-Report Measures, encompassing translation, synthesis, back-translation, and expert committee evaluation. The adapted APSQ-III was administered to a sample of 423 undergraduate students from medicine and nursing courses. Confirmatory factor analysis (CFA) was conducted to verify the factor structure, while reliability was assessed using Cronbach’s alpha, McDonald’s omega, and composite reliability measures. Results: The CFA supported an acceptable fit for the nine-factor model with 26 items, following the exclusion of 4 items (χ2/df = 1.92; CFI = 0.90; TLI = 0.89; RMSEA = 0.05; SRMR = 0.07). Factor loadings ranged from 0.30 to 0.82, with satisfactory reliability indices, except for factors 4 (α = 0.47; ω = 0.48) and 9 (α = 0.54; ω = 0.54). Significant differences were discovered between medical and nursing students in four factors, and gender differences were noted in five items, highlighting the diverse perceptions of patient safety across these groups. Conclusions: The Brazilian version of the APSQ-III demonstrated adequate validity and reliability for seven out of the nine original factors. It is recommended to use the scale with modifications, such as developing a reduced version excluding factors with low reliability, to enhance its applicability. This study contributes to advancing patient safety research and education in Brazil, providing a robust tool for evaluating and improving safety attitudes among healthcare students. Future research should focus on refining the instrument and exploring its application in diverse healthcare educational settings across Brazil.