Hospital survey on patient safety culture (HSOPSC): a multi-method approach for target-language instrument translation, adaptation, and validation to improve the equivalence of meaning for cross-cultural research

Table 6 Examples of Cultural Relevance Issues Identified from Cognitive Interviews

Cultural issue	Item content	Illustrative example
Definition of concepts or knowledge differ across cultures or nationalities	Problem: Different healthcare constructs in the provision of care between the United States and Peru	Description of issue: Temporary staff and professionals are not frequently utilized in Peruvian healthcare facilities. English Question: We use more agency/temporary staff than is best for patient care. Initial translation: Usamos más personal temporal o de agencia de lo conveniente para el cuidado del paciente. Final translation: Usamos más personal de reemplazo o temporal de lo que es mejor para el cuidado del paciente.
	Problem: Reference to errors and recording in personnel files	Description of issue: The concept of blame and recording of errors in a personal file is not clear in Peru. English question: Staff worry that mistakes they make are kept in their personnel file. Initial translation: Al personal le preocupaba que los errores cometidos permanezcan en sus expedientes personales. Final translation: Cuando se comete un error, el personal teme que eso quede en su expediente.

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