# 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  
In assessing the strengths and weaknesses of various dimensions across study surveys, a dimension was classified as strong when 75% or more of the average positive response rate percentage reflected positivity, indicating strength in that area and labeled with (\({}^{\text{th}}\)) in Tables 4 and 5. Conversely, dimensions were considered weak if less than 50%, suggesting weak areas that required improvement, and were labeled with (\({}^{\text{t}}\)). The range of less than 75% to 50% represented an acceptable level, but it underscores the need for continued refinement and enhancement efforts [98]. Figure 6: Continents and professional mean scores of PSC dimension compared to a mean of all. Figure 7: Boxplot for 12 dimensions of PSC across all responses. *: Indicates dimensions of patient safety culture where some studies reported significantly high or low PRR%, including potential outliers. Table 5 categorizes the mean PRR% of PCS dimensions across all surveys by continent and profession, classifying them as strengths, weaknesses, or moderate areas. According to continents, the areas considered weak in Europe were D4, D5, D9, and D10, with a range from 39.3% to 48.3%, resulting in 55.1% \(\pm\) 12.6 the overall perception of PSC. The total number of participants in surveys from Europe was 35,676. Furthermore, the surveys conducted in South America, which included 9954 participants, yielded an overall PSC score of 49% \(\pm\) 12.7. Weak areas were observed in D4-D6 and D8-D12, with response scores ranging from 27.5% to 49.5%. In addition, among the 2513 participants surveyed in Africa, weaknesses were noted in the D2 and D4-D12, ranging from 31% to 49.9%. The surveys yielded an overall PSC score of 44.5% \(\pm\) 9.1. Moreover, the surveys conducted in Asia, which involved the highest number of participants from several countries with a total of 279,750, revealed weaknesses in the D5, D7, and D8 ranges, with response rates ranging from 32.5% to 48.6%. Strengths were noted in D1 and D3, with PRR% of 76.4% and 80%, respectively. The overall PSC score was 58.4% \(\pm\) 13.5. According to professionals, some studies have been conducted to evaluate healthcare workers' perceptions regarding PSC. From the perspective of nurses, weak areas were identified in D5, D7, and D10, with mean PRR percentages of 31.4%, 49.4%, and 35.5%, respectively. However, surveys involving diverse professionals highlighted weaknesses, specifically in D5, D8, and D10, with mean PRR percentages of 36.9%, 47.6%, and 39.1%. According to Table 5, when closely analyzing the dimensions of PSC, distinct differences within the survey results have emerged. Some surveys indicate strong areas within certain dimensions, while others reveal weaknesses. Additionally, several dimensions fall between the two extremes, indicating potential areas for enhancement. Table 6 gives a comprehensive summary of the frequency of survey results that have reported dimensions as either strong, weak, or moderate.