Patient safety is crucial in healthcare, especially in home-based settings where unregulated environments and limited supervision pose unique challenges. With the expansion of home healthcare due to an ageing population and healthcare workforce shortages, there is a pressing need for tools to assess patient safety culture in this context. Current instruments, developed for hospitals, do not adequately address the specific dynamics of home healthcare, such as patient autonomy and caregiver involvement. This protocol outlines the development and validation of the Patient Safety Culture in Home Health Care Centers Instrument (PSCHCI), using a sequential exploratory mixed-methods approach.

This sequential exploratory mixed-methods protocol consists of three phases. Phase 1 fieldwork (semi-structured interviews with 15 participants, 3 participant observations and field notes) has been completed. Qualitative data are currently being analysed using conventional content analysis. The scoping review component of Phase 1 is planned but has not yet been conducted. Phase 2 (instrument development) is planned to include item generation from qualitative results followed by expert panel review. Phase 3 (psychometric evaluation), scheduled for late 2026, will employ a cross-sectional study to assess face, content and construct validity; reliability; interpretability; and feasibility. This phase features pilot testing (n=30–50), face and content validity assessment (n=10 each), test-retest reliability (n=15) and exploratory and confirmatory factor analyses (n=300–400).

Ethical approval was obtained from the Ethics Committee of Iran University of Medical Sciences. All participants will provide written informed consent. Confidentiality, voluntary participation and withdrawal rights are guaranteed. Findings will be published in peer-reviewed journals, presented at conferences and shared with participating home healthcare centres, policymakers and stakeholders.

This study was designed to investigate the mistreatment of women during childbirth and its determining factors in a selected maternity hospital in Mazandaran/Iran.

This cross-sectional study was designed in 2024.

Maternal and child clinics in the cities of Amol and Babol in Mazandaran/Iran.

The study population consisted of 215 women who were selected via convenience sampling and were at least 8 weeks postpartum.

All participants in the study reported experiencing at least one form of mistreatment. 42% of cases experienced three types of mistreatment. The highest reported level of mistreatment was related to the poor relationship between women and service providers (88.1%) and physical abuse (80.9%), respectively. The overall satisfaction score for care was 33.96±9.17. Multivariate logistic regression analysis demonstrated that higher maternal age was significantly associated with lower odds of physical mistreatment (OR=0.923, 95% CI 0.865 to 0.985, p=0.016). Women without doula accompaniment during childbirth had higher odds of experiencing a lack of privacy compared with those who had a doula (OR=2.77, 95% CI 1.41 to 5.42, p=0.003), and failure to meet needs (OR=2.2; 95% CI 1.13 to 4.28; p=0.020), but significantly lower odds of experiencing poor communication (OR=0.128; 95% CI 0.043 to 0.337; p

The results of this study indicated that the prevalence of mistreatment in participants in the selected hospitals was notable. The most reported mistreatment was the lack of effective communication between staff and the patient, followed by physical mistreatment and the lack of respect for privacy. Factors related to mistreatment included the mother’s age and the presence of a companion (doula) during delivery.