Freitas, ElsaSilva, CarinaEiras , Margarida2025-06-062025-06-062025-06Freitas E, Silva C, Eiras M. Portuguese cross-cultural adaptation and validation of the hospital survey on patient safety culture 2.0. BMC Health Serv Res. 2025;25(1):804.1472-6963http://hdl.handle.net/10400.21/21919Background: As patient safety continues to be a global priority, it is crucial to emphasize the assessment and development of Patient Safety Culture [PSC] to advance healthcare quality and safety initiatives worldwide. This study focused on the assessment of PSC in Portuguese hospitals, specifically through the translation and cultural adaptation of the Hospital Survey on Patient Safety Culture 2.0 [HSOPSC 2.0] for the Portuguese context. Methods: The study followed a two-phase design, encompassing the translation, cultural adaptation, and psychometric evaluation of HSOPSC 2.0. A total of 2,604 fully completed questionnaires were collected. The sample consisted of seven public hospitals from different regions of Portugal, ensuring broad representation within the Portuguese National Health System. The translation process includes four stages: forward translation, back translation, expert panel review, and pre-testing. Instrument reliability was assessed using Cronbach’s alpha coefficients and Exploratory Factor Analysis (EFA). Construct validity was evaluated through Confirmatory Factor Analysis (CFA), while convergent and discriminant validity were examined using Average Variance Extracted (AVE) and Pearson’s correlation coefficients, respectively. Results: The Portuguese translated version of the HSOPSC 2.0 [PT-HSOPSC 2.0] demonstrated good internal consistency, with Cronbach’s alpha values ranging from 0.63 to 0.88, and factor loadings above 0.80 indicating strong factor reliability. CFA results supported the adequacy of the model fit: χ²/df = 4.64, p < 0.01; RMSEA = 0.05; CFI = 0.93; GFI = 0.90; TLI = 0.91; PCFI = 0.78; PGFI = 0.71. The instrument demonstrated good convergent validity, with AVE values at or above 0.50. Strengths included “Teamwork” and “Management Support for Patient Safety”, whereas “Open Communication” and “Hospital Management” were identified as areas requiring improvement. Overall, the PT-HSOPSC 2.0 demonstrated robust psychometric properties, confirming its suitability for assessing PSC in Portuguese hospitals. Conclusion: This study contributes to enhancing PSC assessment in Portuguese healthcare settings by providing a translated and validated version of the HSOPSC 2.0 adapted to the Portuguese context. Findings support that PT-HSOPSC 2.0 is a reliable and valid tool for evaluating PSC in Portuguese healthcare settings.engHSOPSC 2.0Patient safety cultureReliabilityValidityjournal article10.1186/s12913-025-12960-x