PSYCHOMETRIC VALIDATION OF THE BRAZILIAN VERSION OF THE ATTITUDES TO PATIENT SAFETY QUESTIONNAIRE (APSQ-III) AMONG HEALTH STUDENTS

Abstract

This chapter details the cross-cultural adaptation and psychometric validation of the Attitudes to Patient Safety Questionnaire III (APSQ-III) for Brazilian Portuguese, aiming to assess the attitudes of health area students regarding patient safety. Driven by the growing importance of patient safety in education, the study sought to provide a reliable tool to identify training gaps and support pedagogical interventions. The methodology employed a quantitative, descriptive, and cross-sectional study involving 292 first-year Medicine, Nursing, and Psychology students from a Brazilian public university. The cross-cultural adaptation process followed rigorous guidelines, including multiple translations, back-translations, and evaluation by an expert committee, which resulted in high semantic, idiomatic, experiential, and cultural equivalence of the Brazilian version. A pre-test with 50 students allowed for minor adjustments to improve item clarity. In the validity analysis, a final model of 26 items and 9 factors of the APSQ-III showed a satisfactory fit to the data through confirmatory factor analysis (CFA). Factor loadings were mostly high, confirming the structure. However, the factors "Inevitability of error" (F4) and "Importance of patient safety in the curriculum" (F9) demonstrated low reliability, suggesting the need for future revisions of these constructs. Correlations between factors revealed significant associations, such as the strong link between team functioning and the valuing of safety in the curriculum, and the relationship between training and confidence in reporting errors. Comparison by sex indicated a statistically significant difference only in the "Confidence in reporting error" (F2) factor, with men showing slightly more confidence than women, albeit with a small effect size. In conclusion, the Brazilian version of the APSQ-III is a valid and reliable tool for most of its dimensions, useful for identifying strengths and weaknesses in training and for monitoring safety culture. Limitations include the convenience sample and the low reliability of two factors. Future research is recommended to diversify samples, revise less robust factors, and conduct longitudinal studies to monitor the evoluton of students' attitudes.