# Patient Safety Culture in Hospital Settings Across Continents: A Systematic Review
## 3 Result
### General Characteristics of the Reviewed Studies
#### 3.3.6 Descriptive Exploration of Strength and Weakness Areas in PSC across Continents
\begin{table}
\begin{tabular}{c c c c c c c c c c c c c c} \hline \hline  & & **D1** & **D2** & **D3** & **D4** & **D5** & **D6** & **D7** & **D8** & **D9** & **D10** & **D11** & **D12** \\ \hline \multirow{3}{*}{All (N = 70)} & \multirow{3}{*}{Strength Area} & 35 (50\%) * & 10 (14\%) & 35 (50\%) & 14 (20\%) & 3 (4\%) & 10 (14\%) & - & 2 & 4 & 1 & 4 & 5 \\  & & (7\%) & (7\%) & (36\%) & (83\%) & (29\%) & (51\%) & (49\%) & (39\%) & (84\%) & (40\%) & (30\%) \\ \hline \multirow{3}{*}{Europe (n = 16)} & \multirow{3}{*}{Strength Area} & 5 & 2 & 2 & 2 & - & 1 & - & 2 & - & - & - & 1 \\  & & (7\%) & (3\%) & (3\%) & (3\%) & & - & (1\%) & - & (3\%) & - & - & - & (1\%) \\ \cline{2-13}  & \multirow{3}{*}{Weakness Area} & \multirow{3}{*}{-} & 2 & 3 & 9 & 10 & 3 & 5 & 5 & 10 & 13 & 7 & 3 \\  & & (3\%) & (4\%) & (13\%) & (14\%) & (4\%) & (7\%) & (7\%) & (14\%) & (19\%) & (10\%) & (4\%) \\ \hline \multirow{3}{*}{South America (n = 9)} & \multirow{3}{*}{Strength Area} & 3 & - & 1 & 1 & - & - & - & - & - & - & - & - \\  & & (4\%) & & (1\%) & (1\%) & - & & - & - & - & - & - & - \\ \cline{2-13}  & \multirow{3}{*}{Weakness Area} & \multirow{3}{*}{-} & 1 & - & 3 & 9 & 6 & 4 & 6 & 6 & 8 & 6 & 6 \\  & & (1\%) & & (4\%) & (13\%) & (9\%) & (6\%) & (9\%) & (9\%) & (11\%) & (9\%) & (9\%) \\ \hline \multirow{3}{*}{Africa (n = 6)} & \multirow{3}{*}{Strength Area} & 1 & - & 1 & - & - & - & - & - & - & - & - & - \\  & & (1\%) & & (1\%) & - & - & - & - & - & - & - & - & - \\ \cline{2-13}  & \multirow{3}{*}{Weakness Area} & \multirow{3}{*}{-} & 4 & 4 & - & 5 & 6 & 5 & 5 & 4 & 6 & 5 & 6 & 6 \\  & & (6\%) & & & (7\%) & (9\%) & (7\%) & (7\%) & (6\%) & (9\%) & (7\%) & (9\%) & (9\%) \\ \hline \multirow{3}{*}{Asia (n = 39)} & \multirow{3}{*}{Strength Area} & 25 & 7 & 32 & 11 & 3 & 9 & - & 4 & 1 & 4 & 4 \\  & & (36\%) & (10\%) & (46\%) & (16\%) & (4\%) & (13\%) & - & - & (6\%) & (1\%) & (6\%) & (6\%) \\ \cline{1-1}  & & & & & & 32 & 6 & 22 & 15 & 5 & 32 & 8 & 6 \\ \cline{1-1}  & & & (6\%) & (7\%) & (3\%) & (6\%) & (46\%) & (9\%) & (31\%) & (21\%) & (7\%) & (46\%) & (11\%) & (9\%) \\ \hline \multirow{3}{*}{2010–2014 (n = 21)} & \multirow{3}{*}{Strength Area} & 9 & 2 & 10 & 2 & - & 1 & - & - & - & - & - & - \\ \cline{1-1}  & & (13\%) & (3\%) & (14\%) & (3\%) & - & (1\%) & - & - & - & - & - & - \\ \cline{1-1}  & & & & & & & & & & & & & \\ \cline{1-1}  & & & & & & & & & & & & & \\ \cline{1-1} \cline{2}  & & & & & & & & & & & & & & \\ \hline \multirow{3}{*}{2010–2014 (n = 21)} & \multirow{3}{*}{Weakness Area} & 2 & 5 & 2 & 9 & 19 & 7 & 10 & 14 & 10 & 17 & 9 & 6 \\ \cline{1-1}  & & (3\%) & (7\%) & (3\%) & (13\%) & (27\%) & (10\%) & (14\%) & (20\%) & (14\%) & (24\%) & (13\%) & (9\%) \\ \hline \end{tabular}
\end{table} 
Table 6: Summary of strengths and weaknesses dimensions across surveys. Regarding Table 6, across all surveys, 35 surveys consistently reported D1 and D3 as strength areas, with most of them from Asia. However, weakness areas ranging from 46% to 83% of surveys in D5 and D10 were identified as weaknesses, highlighted by 58% and 59%, respectively, reported from all continents. Following these, 36% and 34% of surveys also noted D7 and D8 weaknesses. Lastly, in the scope of opportunity for improvement within the previous two categories, D2 and D12 were identified as moderate areas needing improvement, with 48 and 44 surveys, respectively (see Table 4). Table 6 also summarizes weakness areas by continent and survey time period, highlighting weakness areas for each dimension of PSC. For continents, Europe (19%) in D10, South America (13%) in D5, all nine studies (9%) in Africa reported weakness in D9, and Asia (46%) in D5 and D10 have the highest percentages of participants reporting these areas as weakness. Looking at time periods, surveys conducted between 2010-2014 have the highest weakness in D5 (27%), followed by 2015-2019 with weakness in D5 and D10 (23%), and lastly, 2020-2023 with the highest weakness in D10 (36%). On the other hand, the dimensions of strengths are also emphasized.