# Patient Safety Culture in Hospital Settings Across Continents: A Systematic Review
## 2 Methodology and Review Questions
### Eligibility Criteria  
The eligibility criteria are designed to guide the selection of papers relevant to this review. Studies will be included in this study if they meet the following criteria: (a) research must be peer-reviewed; (b) published between 2010 and 2024 inclusive; (c) research must be conducted in a hospital setting; and (d) articles must be in English. In contrast, articles were excluded based on the following exclusion criteria: they are (a) not available in full text or open access; (b) do not assess PSC; (c) do not take place in a hospital setting; (d) do not use the HSOPSC 1.0 or 2.0 survey as main instrument; (e) do not report measurements (e.g., Average Positive Response Rate (PRR%) or means) for PSC dimensions or most of them; and (f) include book chapters, views, reports, or opinions. Articles are chosen for full-text reading based on inclusion and exclusion criteria, starting with the titles and moving on to abstracts. In the next step, the quality of the papers should be checked and rated after thoroughly reading the articles, which constitutes the final step of the exclusion criteria, ensuring the papers are suitable for study and avoid bias.  
The selection of papers for this review went through several steps following the protocol of PRISMA 2020 [21], as illustrated in Figure 1. The flow diagram demonstrates the details in a structured and transparent manner. The initial studies were identified from databases searching 1154 sources, with the most entries coming from ProQuest 571, followed by PubMed 223, Web of Science 220, MEDLINE 64, CINAHL 59, and PsycINFO 17. The titles and article references were exported to Microsoft Excel so that the titles could be scanned, and duplicate references could be deleted, resulting in the removal of 488 records. The 666 titles and abstracts of papers were reviewed to ensure their relevance to the research question, and irrelevant titles and abstracts were removed, leaving 197 papers. After the scanning result sections, 99 papers were left for a full-text reading. Afterwards, 31 articles were excluded. The ancestry approach included seven studies, adding seven papers for the final number of included studies to be 75 research studies, as shown in Figure 1.  
Even the search of various databases yielded 1154 records; however, a total of 469 records were excluded for a variety of reasons, see Figure 1, including 185 that did not use HSOPSC; 140 that were not conducted in the hospital setting; 77 that did not assess PSC; 45 in non-English; 15 that were not peer-reviewed; and seven that did not have full-text availability. In addition, 98 reports were excluded for failing to report PSC dimension measurements for some reason, such as unclear reporting, using different instruments, and lacking required dimension details.  
\begin{table}
\begin{tabular}{c c} \hline
**Row** & **Step** \\ \hline Keywords 1 & “patient safety culture” OR “patient culture” OR “PSC” OR “patient safety” OR “safety” OR “hospital safety” OR “safety climate” OR “patient safety climate” \\ \hline Keywords 2 & “hospital” OR “government hospital” OR “private hospital” OR “teaching hospital” \\ \hline Keywords 3 & “hospital survey on patient safety culture” OR “HSOPSC” \\ \hline Search & \#1 AND \#2 AND \#3 \\ \hline \end{tabular}
\end{table}
Table 1: The keywords employed in this review.