Cross-cultural adaptation and psychometric evaluation of the Emergency Medical Services Safety Attitudes Questionnaire in the Brazilian context

Abstract

Background Ensuring patient safety is essential to prevent and minimize adverse events, and pre-hospital services play a vital role in the healthcare network, serving as the starting point for quality care. This study aimed to adapt the Emergency Medical Services Safety Attitudes Questionnaire to the Brazilian context and evaluate its psychometric properties. Methods Beaton and colleagues’ guidelines were used as a reference. Construct validity was evaluated by confirmatory factor analysis (CFA) based on the responses of 93 participants. Questions with reverse scoring were excluded in a further CFA. Results The content validity index was 0.99, and Cronbach's alpha was 0.90. The initial CFA resulted in a Tucker–Lewis index (TLI) of 0.95 and a comparative fit index (CFI) of 0.951. After the exclusion of reverse-coded questions (Q4 and Q9), TLI increased to 0.96 and CFI to 0.97. Conclusions The adapted instrument demonstrated good content, face, and construct validity, confirming its suitability for evaluating patient safety in prehospital services in Brazil. It can guide adjustments in care protocols, contributing to the safety and effectiveness of prehospital care while aligning with patient-centered best practices.