The article by Dursun Engin and Seren İntepeler (2025) addresses the gap in existing measurement tools concerning patient participation specifically in safety-related practices during hospitalization. Although there are instruments like the Patient Activation Measure (PAM) or Patient Health Engagement Scale (PHE) that assess general engagement, none adequately capture safety-specific behaviors. The study presents the development and validation of the Patient Participation in Patient Safety Practices Scale (PPPSPS), designed to assess hospitalized patients’ involvement in four key safety domains: general safety, infection prevention, fall prevention, and medication safety.
Methodology:
This methodological study was conducted with 424 adult inpatients in a Turkish public hospital between June 2021 and February 2022. The development process included item generation through literature review, expert validation via Lawshe’s Content Validity Ratio (CVR), a pilot study, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). The initial 34-item draft was refined to a final 32-item version. The sample size followed best-practice psychometric guidelines, allowing for split datasets in EFA and CFA.
Scale Structure and Psychometrics:
The PPPSPS comprises 32 items grouped into four subscales:
- General Safety (11 items): Covers communication, support, and patient awareness.
- Infection (10 items): Centers on hand hygiene and patient-led infection control.
- Falls (6 items): Includes proactive behaviors to prevent falls.
- Drugs (5 items): Focuses on medication verification and communication with providers.
EFA revealed a four-factor structure explaining 70.61% of the total variance. CFA results confirmed good model fit with indices such as CFI = 1.000 and RMSEA = 0.079. Internal consistency was high, with Cronbach’s alpha ranging from 0.799 (Drugs) to 0.932 (Infection), and 0.922 for the total scale.
Discussion:
The PPPSPS is distinct from existing instruments by focusing solely on safety-specific participation behaviors rather than general engagement or disease management. The scale captures real-time behaviors relevant to inpatient care, such as checking medications, maintaining hand hygiene, and fall prevention strategies. The tool aligns with national (Turkey’s Health Quality Standards) and international patient safety initiatives (e.g., WHO’s Global Patient Safety Action Plan).
Items with lower CFA factor loadings were retained due to their theoretical importance, ensuring comprehensive construct representation. The authors recommend the scale for use in inpatient medical and surgical units to guide education, staff training, and institutional safety culture assessments.
Limitations:
The use of a convenience sample may limit generalizability. Interviews with low-literacy patients might introduce social desirability bias, despite procedural safeguards.
Conclusion:
The PPPSPS is a valid and reliable instrument for assessing patient participation in safety practices in hospital settings. It offers practical utility for clinical quality improvement, staff development, and cross-cultural adaptation in international health systems. Future research should explore its applicability in different clinical and cultural contexts and examine its predictive validity for safety outcomes.
APA Citation:
Dursun Engin, M., & Seren İntepeler, Ş. (2025). Patient participation in patient safety practices scale: Development and psychometric evaluation of a scale. Healthcare, 13(1387). https://doi.org/10.3390/healthcare13121387
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