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Measuring Barriers to Reporting Adverse Safety and Behavioural Events: Development and Psychometric Evaluation of the
Scott S Christensen1,2, Robert P Lubeznik-Warner3, S Duane Hansen4
1Department of Nursing, University of Utah Health Hospitals and Clinics, Salt Lake City, Utah, USA.
Aim:
To develop and psychometrically validate the Reasons Employees Perceive Obstacles to Reporting (REPORT) Scale, a self-report instrument designed to identify barriers to incident reporting.
Design:
Guided by the Theory of Planned Behaviour, this study used a descriptive, multiphase psychometric design.
Methods:
Phase one used literature review and expert input to create an initial pool of items. Nursing staff (n = 1288) completed the preliminary scale and exploratory factor analysis (EFA) results identified conceptual gaps to address in subsequent rounds of item development. Phase two used focus groups and content validity index testing to refine and generate items for the next iteration of the scale. Phase three recruited a new nursing sample from the same institution (n = 1105) to complete the revised scale. This sample was randomly divided into three independent subsets for EFA, confirmatory factor analysis (CFA) and validity testing (convergent, discriminant, predictive).
Results:
EFA factor loadings, together with theoretical and conceptual considerations, informed the development of six distinct factor groups representing the key barriers to reporting: reporting burden, leadership influence, personal and relational risks, reporting cynicism, knowledge and skill deficits, and normalization of events. The final 24-item scale (four items per factor group) demonstrated good model fit and strong validity. Findings were confirmed using the CFA sample subset and further validated with the remaining subset through convergent, discriminant and predictive validity testing.
Conclusion:
The REPORT Scale is a rigourously developed and validated instrument for identifying staff barriers to reporting adverse workplace events. Its sound psychometric properties support its use in research and practice settings to advance understanding of reporting behaviours.
Implications For The Profession:
This study helps to address the persistent problem of underreporting in healthcare by enabling leaders to measure and interpret the reasons why their employees do not report.
Impact:
By applying the REPORT Scale, organisations can target interventions to reduce barriers to reporting and strengthen safety cultures across healthcare settings.
Reporting Method:
STROBE Checklist for Cross-Sectional Studies.
Patient Or Public Contribution:
No patient or public involvement.
Contribution To Wider Global Clinical Community:
The underreporting of adverse workplace events is a global challenge and the REPORT Scale is a rigourously developed and validated instrument for identifying barriers to workplace incident reporting. The REPORT Scale is a practical resource for healthcare leaders across different care settings to identify attitudinal, organisational, cultural and procedural barriers to reporting, supporting targeted safety interventions.
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