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Learn more: PMC Disclaimer | PMC Copyright Notice BMC Health Serv Res . 2026 Mar 5;26:508. doi: 10.1186/s12913-026-14304-9 Search in PMC Search in PubMed View in NLM Catalog Add to search The Turkish version of the quality in psychiatric care–inpatient scale: translation, cross-cultural adaptation, and psychometric evaluation İrem Nur Öngü İrem Nur Öngü 1 Psychiatric Nursing Department, Institute of Health Sciences, Bursa Uludag University, Bursa, Turkey Find articles by İrem Nur Öngü 1 , Burcu Arkan Burcu Arkan 2 Psychiatric Nursing Department, Faculty of Health Sciences, Bursa Uludag University, Bursa, Turkey Find articles by Burcu Arkan 2, ✉ , Selçuk Kirli Selçuk Kirli 3 Department of Psychiatry, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey Find articles by Selçuk Kirli 3 Author information Article notes Copyright and License information 1 Psychiatric Nursing Department, Institute of Health Sciences, Bursa Uludag University, Bursa, Turkey 2 Psychiatric Nursing Department, Faculty of Health Sciences, Bursa Uludag University, Bursa, Turkey 3 Department of Psychiatry, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey ✉ Corresponding author. Received 2025 Oct 6; Accepted 2026 Feb 28; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13072464 PMID: 41787423 Abstract Background Effective mental health services require high-quality psychiatric inpatient care. To evaluate care from patients’ perspective, culturally validated tools are needed that also reflect local healthcare and psychiatric nursing services. This aim of this study was to validate the Turkish version of Quality in Psychiatric Care-Inpatient scale, to support its use by psychiatric nurses in assessing the quality of inpatient care. Methods This methodological study included 280 psychiatric inpatients from two hospitals. The scale was translated, back-translated and reviewed by experts following Beaton et al.’s adaptation framework and the Consensus-based Standards for Selecting Health Status Measurement Instruments guidelines. Content validity, construct validity, and internal consistency were assessed. Results The Turkish scale comprised 22 items across four sub-dimensions, explaining 53.5% of the total variance. The alpha coefficient was 0.86, demonstrating high internal consistency. Fit indices supported the four-factor model. Conclusions The scale demonstrated promising psychometric properties and is suitable for psychiatric inpatient nursing practice. Clinical trial number Not applicable. Keywords: Psychiatric nursing, Inpatient care, Scale adaptation, Validity, Reliability, Mental health quality Background Traditionally, the assessment of care quality in mental health services has been approached within the framework of clinical indicators, such as length of stay or symptom management [ 1 ]. However, more recent approaches suggest that quality may not be limited to clinical outcomes alone and that patients’ subjective experiences of the care process should also be considered an integral part of this structure [ 2 ]. Current literature emphasises that high-quality psychiatric care is shaped not only by technical competence, but also by respect for patients’ individual preferences and their interaction with the care environment [ 3 ]. In this context, quality is supported by a human rights-based service approach that respects individuals’ autonomy and focuses on protecting their dignity [ 4 ]. Therefore, measurement tools reflecting patients’ experiences can contribute to understanding care standards and developing patient-centred service models. In addition, evaluating care quality can support mental health nurses by encouraging reflective practice, improving clinical insight and contributing to professional development. Crucially, patient-centred care is not solely justified by its potential association with satisfaction, adherence, or clinical outcomes [ 5 ]. Rather, it represents an ethical commitment to respecting patients’ dignity, autonomy, and right to meaningful involvement in decisions affecting their care [ 4 , 6 ]. From this perspective, the central aim of patient-centred care is to align care processes with patients’ values, preferences and expressed needs. In inpatient psychiatric settings, collaborative and team-based approaches can facilitate more responsive and personalised care planning, bearing in mind that such practices are influenced by local organisational and cultural contexts. Systematic monitoring of care quality is considered to have the potential to support the professional development of nurses and contribute to clinical outcomes by integrating patient experiences into treatment processes. Evaluating the interactional dimensions of care can therefore be seen as an integral part of clinical practice [ 7 – 10 ]. A literature review found that, despite various attempts to evaluate the quality of psychiatric care, most studies have to date had important methodological limitations. An early study by Elbeck and Fecteau aimed to determine the ideal characteristics of psychiatric services. Their work was a significant step in assessing the scope and quality of psychiatric healthcare. However, there was no psychometrical validation, and the majority of those sampled had schizophrenia, limiting the study’s methodological rigor and generalizability [ 11 ]. In a similar vein, Hannson et al. attempted to determine the ideal treatment. Their study was also not psychometrically tested, lacked precise measurement, and focused on only one dimension of psychiatric care; however, it helped shape early conceptualizations of quality [ 12 ]. Meehan et al. sought to determine the quality of psychiatric care but only looked at patient satisfaction [ 13 ]. Gigantesco et al. aimed to understand patients’ views, but limitations in the scale items meant that the content of the data was narrow. Scales that have only a restricted number of items make it harder for patients to fully express their perceptions and experiences. More comprehensive scales that can evaluate multiple different facets of psychiatric care and the patients’ various needs of patients should be used [ 14 ]. Molin et al. sought to evaluate care in the clinic, but only the quality of nursing care was measured, and the study had a very small sample size ( n = 16). Measuring the nurse’s care alone may not have accurately reflected other aspects of the clinical setting and the patients’ experiences, limiting the validity and reliability of their study [ 15 ]. In the Turkish healthcare context, psychiatric care evaluations often rely on general metrics, and there is a notable scarcity of tools focused on nursing care [ 16 ]. Although recent outpatient studies exist, these primarily address patient satisfaction rather than the quality of comprehensive care [ 17 ]. Consequently, research into the complex interactional dynamics of inpatient psychiatric wards is limited. Satisfaction-based tools in circulation may not fully capture the multifaceted nursing interventions that are integral to these units, underscoring the necessity of culturally adapted instruments that assess the nursing-led clinical environment from the patient’s viewpoint. Unlike traditional instruments which predominantly use patient satisfaction as a proxy for quality, The Quality in Psychiatric Care- Inpatient (QPC-IP) is based on a specific theoretical definition of quality of care, which involves interaction between patients and care providers. It uniquely captures the ‘dyadic’ nature of care, focusing on the encounter, participation and secure environment, rather than merely assessing amenities or general satisfaction [ 2 ]. This distinction is particularly important in psychiatric nursing, as it enables the measurement of relational aspects of care that are essential to the recovery process, but which are frequently overlooked by generic hospital survey tools. The Quality in Psychiatric Care (QPC) instrument family, developed by Schröder et al. [ 18 ], is designed to evaluate care quality in various psychiatric settings using a unified theoretical framework. This broader suite of tools comprises distinct scales tailored to different service levels, including inpatient, outpatient and forensic departments, and addresses both patient and staff perspectives to allow multidimensional assessment. QPC-IP evaluates patients’ overall perception of psychiatric care, with a particular focus on components of the therapeutic environment centred on nursing care. Conceptually, the instrument operationalises the quality of care through six distinct dimensions: Encounter, Participation, Discharge, Support, Secluded Environment and Secure Environment. By focusing on these relational aspects of care, the instrument contributes to a comprehensive understanding of psychiatric services, which is often linked to improved clinical outcomes. Therefore, the aim of this study was to translate the QPC-IP into Turkish and evaluate its psychometric properties in accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines [ 19 ], thereby providing a validated tool for use in psychiatric inpatient clinics. Method Step 1: Study design and setting A methodological research design which was guided by the COSMIN framework was adopted [ 19 ]. The aim was to adapt the QPC-IP scale into Turkish and evaluate its psychometric properties. Its intended use is in hospital-based psychiatric environments and its focus is on patients’ own experiences of care quality. Step 2: Data collection The study was conducted between October 12, 2023 and May 13, 2024. A purposive sampling strategy was employed to recruit participants who met the inclusion criteria: (1) receiving psychiatric treatment, (2) being aged 18 years or over, (3) having a diagnosed mental disorder, (4) being literate in Turkish language, and (5) giving informed consent. Participants were recruited using a convenience sample based on their availability and willingness to participate during the data collection period. A total of 280 patients took part in the study. This sample size was deemed sufficient, meeting the psychometric recommendation of approximately ten participants per item and ensuring adequate statistical power. Furthermore, this number aligns with the guidelines of Comrey and Lee [ 20 ] for achieving statistically rigorous factor analysis results. The study data were gathered through structured face-to-face interviews. An informed consent form containing information about the method and purpose of the study was presented to the patients before the interview. The voluntary participation of the subjects and their data protection followed the established ethical standards. Sociodemographic data collection form The researchers created a Sociodemographic Data Form to collect information on the participants’ demographic characteristics and psychiatric history. The form contained 20 items and was administered in face-to-face interviews. Quality in psychiatric care-inpatient (QPC-IP) scale The instrument consists of 30 items organised into six subscales. Items are rated on a 4-point Likert scale: 1 = ‘Totally Disagree’, 2 = ‘Partially Disagree’, 3 = ‘Partially Agree’ and 4 = ‘Totally Agree’. Additionally, respondents can select ‘Not Applicable’ for items that do not apply to their care experience. Total scores range from 30 to 120, with higher scores indicating a more positive perception of care quality [ 2 ]. Scale translation and validation processes The adaptation process followed Beaton et al.’s six-step framework and was fully in accordance with the COSMIN recommendations [ 19 , 21 ]. Step 1: Forward translation : Two independent bilingual translators who are native Turkish speakers translated the original QPC-IP scale into Turkish. One of the translators had a clinical background, while the other did not. To ensure objectivity, the translators worked independently of each other. Both versions were then reviewed by a translation panel comprising eight nursing faculty members (three professors, three associate professors and two assistant professors), each with expertise in scale development/adaptation and at least ten years’ experience in psychiatric nursing. Two faculty members specialising in foreign languages also participated in the review. The panel developed an initial Turkish draft of the scale. Step 2: Synthesis of translations : The translated items were evaluated by an expert panel for content validity. The experts scored each item on two separate 4-point Likert scales: one for relevance (1 = not relevant, 4 = highly relevant) and one for clarity (1 = not clear, 4 = very clear). Item Content Validity Index (I-CVI) and Scale Content Validity Index (S-CVI) were then calculated based on these scores. Step 3: Back translation : Two independent native English speakers who had not seen the original version back-translated the draft Turkish version to ensure semantic equivalence. The linguistic validity and accuracy of the translation were confirmed by the high level of similarity between the original and the back-translated version. Step 4: Expert committee review : Eight academic experts in psychiatric nursing, who were not part of the translation process but had the required experience, independently evaluated the content validity of the Turkish version. Each expert assessed the relevance and clarity of all items on a four-point Likert scale (1 = “not clear/relevant/important”, 2 = “somewhat clear/relevant/important”, 3 = “quite clear/relevant/important”, and 4 = “highly clear/relevant/important”) [ 22 ]. Additional recommendations were also gathered to improve the instrument. Step 5: Pre-testing : The Turkish version was pilot-tested with 30 patients not included in the main study to assess its clarity, comprehensibility, and cultural appropriateness. Patients rated the scale items using a four-point scale (1 = “not clear/understandable/appropriate”, 2 = “somewhat clear/understandable/appropriate”, 3 = “quite clear/understandable/appropriate”, and 4 = “highly clear/understandable/appropriate”). Over 90% of the patients indicated that the items were clear, understandable and culturally appropriate. Step 6: Submission to developers and psychometric testing : The draft Turkish version and all relevant documents, including the first translation, synthesis, back-translation, expert panel’s comments, and pre-testing reports, were sent to the scale’s original developers. They confirmed that the adaptation was adequate and approved it without requesting any amendment. The next stage was to conduct a psychometric evaluation with the target population. Construct validity was assessed using exploratory and confirmatory factor analyses (EFA and CFA), and reliability was evaluated via internal consistency (Cronbach’s alpha (α)). This meticulous psychometric evaluation met the COSMIN criteria, demonstrating the adapted scale’s rigor, originality and practical significance for research and practice in the field of psychiatric nursing [ 19 ]. Step 3: Data evaluation The study data were analyzed using SPSS (Statistical Package for Social Sciences, version 28.0) and AMOS (Analysis of Moment Structures, version 28) software packages for Windows. To ensure a comprehensive evaluation of the scale’s internal consistency, both the Cronbach’s alpha coefficient and the split-half reliability method were used. This dual approach was adopted to verify the stability of the reliability estimates obtained using different calculation techniques. The Spearman-Brown and Guttman coefficients were used to evaluate the split-half method. Model fit was evaluated using a number of indices, including χ2 (Chi-Square Fit Test), RMSEA (Root Mean Square Error Approximation), GFI (Goodness of Fit Index), CFI (Comparative Fit Index), NFI (Normed Fit Index), and AGFI (Adjusted Goodness of Fit Index) [ 23 – 24 ]. Ethical principles Before the adaptation of the scale into Turkish, formal permission was obtained from the scale’s original developers through email. Ethical approval was granted by the Faculty of Medicine Clinical Research Ethics Committee of Bursa Uludağ University (Date: 2023-08 and Number: 16/5). Additionally, permission to collect data was obtained from the Chief Physician’s Office at Bursa City Hospital (Date: 21/12/2023; Document no.: 232309506). The data collection process followed the principles of the Declaration of Helsinki. Written informed consent was obtained from participants. Participation in the study was voluntary and participants were informed about the study before answering the questionnaire. The information included details of the purpose and implementation of the study and a statement that participants could stop answering the questionnaire at any stage. Results Sample A total of 280 inpatients receiving psychiatric care took part in the study. The participants’ detailed sociodemographic characteristic are presented in Table 1 . Table 1. Demographic Characteristics of the Patients Receiving Care in Psychiatric Clinics Demographic Variables Patients n % Age 18–29 68 24.3 30–39 75 26.8 40–55 103 36.8 56–76 34 12.1 Gender Female 144 51.5 Male 136 48.5 Nationality Citizen of the Republic of Türkiye 272 97.1 Citizen of Syria 6 2.2 Citizen of Germany 2 0.7 Marital Status Married 150 53.6 Single 130 46.4 Educational Status Illiterate 8 2.8 Primary school 29 10.3 Secondary school 45 16.1 High school 100 35.8 Undergraduate 84 30 Graduate 14 5 Open in a new tab Content validity The content validity of the scales was evaluated by calculating the content validity ratio (CVR) and content validity index (CVI) based on expert opinions. To ensure that the scale reflected core elements of psychiatric nursing, such as therapeutic communication, emotional support and patient-centered care, it was crucial to guarantee the participation of experienced psychiatric nursing faculty. The CVR was obtained by dividing the number of experts who stated that an item was “necessary” by half of the total number of experts who stated an opinion on that item and subtracting 1 from this number (CVR = [NG/(N/2)] – 1). The Content Validity Ratio (CVR) was determined based on assessments by the eight-person expert panel. According to Lawshe’s guidelines, the minimum critical value required for statistical significance with a panel of this size is 0.75. This value was consequently adopted as the cut-off for item retention. Analysis indicated that all 30 items met or exceeded this threshold. Additionally, the Scale Content Validity Index (S-CVI) was calculated as 0.88. As this surpasses the commonly accepted standard of 0.80, the Turkish version of the QPC-IP can be considered to demonstrate satisfactory content validity [ 22 ]. Construct validity To adapt the QPC-IP, the data obtained from a sample of 280 participants were examined by CFA. As a result of the analysis, the fit indices and significance levels of the items were evaluated to determine the model’s goodness of fit. In the proposed model, the χ2, RMSEA, GFI, CFI, NFI, and AGFI were used as fit indicators. Suitability was also evaluated using Kaiser-Meyer-Olkin (KMO) and Bartlett’s test. Items with factor loadings < 0.50 were excluded. When the goodness of 11 fit values of the model established for the construct validity of the QPC-IP were examined, it was found that χ2/sd: 2.785, GFI: 0.73, AGFI: 0.75, CFI: 0.77, NFI: 0.66; and RMSEA: 0.80 (Fig. 1 ). Fig. 1. Open in a new tab QPC-IP Second-Level Multifactorial CFA Findings (Six-Factor Structure) When the goodness of fit values obtained from the six sub-dimensional structures of the QPC-IP were examined (Table 2 ; Fig. 1 ), these values were found to be below the minimum acceptable goodness of fit values recommended. This indicated that the six sub-dimensional structure of the scales was not theoretically valid for Turkish culture, and the model did not adequately fit the data. Additional analyses were required to develop a structure that was more appropriate and culturally adapted, and that aligned with the typical care practices and interaction patterns in Turkish psychiatric nursing settings. When the contributions of QPC-IP sub-dimensions to the scale were examined, all sub-dimensions except the support sub-dimension were found to have made a statistically significant contribution to the scale. The contribution of the support sub-dimension to the scale was not statistically significant: this sub-dimension did not have a significant effect on the overall structure and validity of the scale ( p > 0.05; t = 1.804) (Table 3 ). Table 2. QPC-IP Goodness of Fit Values and Appropriate Ranges Recommended in the Literature Variable χ2/df RMSEA CFI GFI AGFI NFI Validity QCP-IP 2.785 0.80 0.77 0.73 0.75 0.66 Rejected *Good Fit χ2 < 2 0 < RMSEA < 0.05 0.95 ≤ CFI ≤ 1 0.95 ≤ GFI ≤ 1 AGFI > 0.95 0.95 ≤ GFI ≤ 1 *Acceptable Compatibility χ2 < 5 0.05 < RMSEA < 0.10 0.90 ≤ CFI ≤ 0.95 0.90 ≤ CFI ≤ 0.95 AGFI > 0.90 0.90 ≤ CFI ≤ 0.95 Open in a new tab RMSEA: Root Mean Square Error of Approximation; CFI: Comparative Fit Indices; GFI: Goodness-of-Fit Index; AGFI: Adjusted Goodness of Fit Index; NFI: Normed Fit Index Table 3. Contribution of the QPC-IP Sub-Dimensions to the Scale Sub-Dimensions QPC-IP Standardized Regression Load t p Encounter ←-- QPC-IP 0.985 7.663 0.000 Participation ←-- QPC-IP 0.528 5.863 0.000 Secluded Environment ←-- QPC-IP 0.516 4.533 0.000 Support ←-- QPC-IP 0.348 1.804 0.071 Secure Environment ←-- QPC-IP 0.759 7.367 0.000 Discharge ←-- QPC-IP 0.751 7.350 0.000 Open in a new tab Since the six sub-dimensional structure of the scale was rejected, EFA was performed to discover a new structure. The relationships between the scale items were analyzed, changed items were grouped, and these groups were defined as significant sub-dimensions. This enabled the development of a psychometrically sound and culturally sensitive structure that is better suited to clinical psychiatric nursing practice. Maximum Likelihood, Principal Component Analysis, Varimax Rotation, and CFA were evaluated over 30 items. Bartlett’s Sphericity test and the KMO test were employed to check sampling adequacy. The significance level of Bartlett’s test indicated a high-quality sample. In the KMO test, values greater than 0.50 were considered acceptable, while values higher than 0.90 were considered ideal. Eigenvalue and scree plot were used to determine the number of sub-dimensions. Significantly, no data were observed to be missing during the data collection process, and full sets of data were obtained from all the participants. Sampling adequacy was assessed using the KMO (0.835) and Bartlett’s tests and found to be significant (χ2 = 2413.547; df = 231; p < 0.001). It was seen that there was a structure of four sub-dimensions with an eigenvalue greater than 1. Some scale items had values below 0.50 (I-6, I-13, I-17, I-26, and I-28). These were excluded from the analysis, and it was repeated. As a result of repeated analysis, items I-9, I-12 and I-14 were found to have high loadings in more than one sub-dimension. These items were evaluated as overlapping and thus deleted from the study. In the new structure, the variance ratios explained by the sub-dimensions were as follows: Sub-Dimension 1: 28.6%, Sub-Dimension 2: 10.9%, Sub-Dimension 3: 7.6%, and Sub-Dimension 4: 6.5%. The total variance ratio explained by the four sub-dimensions together was 53.5%. The items in this structure contributed adequately to the scale. The factor loads of items ranged from 0.510 to 0.899 (Table 4 ). The four sub-dimensions were named as follows: Table 4. QPC-IP Sub-dimension structure and explained variance ratio No Item Sub-Dimension 1 Sub-Dimension 2 Sub-Dimension 3 Sub-Dimension 4 I-11 The staff treated me with warmth and consideration. 0.753 I-15 The staff respected me. 0.723 I-18 The staff showed that they understood my feelings. 0.712 I-2 There was a high level of security at the ward. 0.709 I-10 The staff were involved and spent their time with the patients in the ward. 0.620 I-4 I was secure together with my fellow patients. 0.610 I-20 The staff had the time to listen to me. 0.610 I-7 I received support and I had the opportunity to talk when I needed to. 0.581 I-21 I received information about where I could go if I needed help following discharge. 0.565 I-25 The staff were concerned about my care and treatment. 0.530 I-29 I received information about my mental health problems in such a way that I could participate in my own care. 0.898 I-27 I was informed in an understandable way about my mental health problems/diagnosis. 0.862 I-30 I received information about different treatment alternatives so that I could decide which was best for me. 0.728 I-5 My opinion about what was the correct care and treatment for me was respected. 0.606 I-22 The staff prevented me from harming myself if I had such thoughts. 0.658 I-19 The staff prevented me from hurting those around me if I had such thoughts. 0.605 I-16 I was offered a follow-up after discharge. 0.542 I-3 I had access to a place that was private where I could withdraw when I wanted to be left in peace and quiet. 0.526 I-1 I could influence my own care and treatment. 0.520 I-8 Hospital and community services co-operated when planning my future care and activities. 0.510 I-23 The staff helped me to understand that it is not shameful to suffer from mental health problems. 0.899 I-24 The staff helped me to understand that feelings of guilt and shame must never prevent me from seeking care. 0.890 KMO: 0.835 Barlett’s: 2413.547; df:231; p < 0.001 Explained Variance 28.6 10.9 7.6 6.5 Total Variance 53.5 Open in a new tab Sub-Dimension 1: Interaction and Safety. Sub-Dimension 2: Participation. Sub-Dimension 3: Discharge and Secluded Environment. Sub-Dimension 4: Support. Reliability The findings, measured using Spearman-Brown and Guttman coefficients, demonstrated that there was a high, positive, and significant relationship between the two halves in the sub-dimensions and the total scale. While the minimum value for the Spearman-Brown Coefficient was 0.68, and the maximum value was 0.87, the minimum value for the Guttman Coefficient was 0.66, and the maximum value was 0.87. The Cronbach’s α values for the sub-dimensions of the scale were as follows: Interaction and Safety: 0.87; Participation: 0.83; Discharge and Secluded Environment: 0.74; Support: 0.86 (Table 5 ). Table 5. QPC-IP split-half test consistency and Cronbach’s α Variables Halves Number of Items Halves Cronbach α Spearman-Brown Gutman Cronbach α Interaction and Safety First Half 10 0.798 0.87 0.87 0.87 Second Half 0.735 Participation First Half 4 0.88 0.78 0.78 0.83 Second Half 0.62 Discharge and Secluded Environment First Half 6 0.66 0.68 0.66 0.74 Second Half 0.64 Support First Half 2 1.00 0.86 0.86 0.86 Second Half 1.00 QPC-IP First Half 22 0.842 0.71 0.71 0.86 Second Half 0.726 Open in a new tab The results showed that the Cronbach’s alpha value for the overall scale was 0.86, indicating high reliability. For both the total scale and its subscales, a coefficient of at least 0.70 was considered acceptable. Consequently, evaluating the split-half test consistency alongside Cronbach’s alpha coefficients concluded that the reliability of the four-subdimensional structure was sufficient. Discussion This study evaluated the psychometric properties of the Turkish version of the QPC-IP scale, which assesses the quality of inpatient psychiatric care from the patient’s perspective. The results suggest that the Turkish version of the QPC-IP demonstrates satisfactory validity and internal consistency, indicating its potential as a useful instrument in Turkish psychiatric clinical settings [ 19 ]. By providing a culturally adapted tool that reflects patients’ feelings and experiences, this study supports the psychiatric nursing process and could enhance mental health nursing practice in Turkey. The findings of the present study are discussed below in comparison with those of the original scale and of other adaptation studies. These methodological steps were conducted in accordance with COSMIN guidelines to ensure content validity [ 19 ]. The analysis showed that the content validity indices exceeded the critical threshold values. These results imply that the scale’s language and content validity were successfully established in the Turkish sample, suggesting that the adapted scale effectively measures the intended construct and remains consistent with the original structure. The original study introducing the QPC-IP and the adaptation studies in Spain and Indonesia did not present specific content validity indices; however, the general validity and linguistic appropriateness of these adaptations have been reported. Construct validity was evaluated using CFA with maximum likelihood, principal component analysis and varimax rotation for the 30 items. The minimum acceptable factor loading for each item was determined based on established criteria [ 25 ]. It was observed that some items did not significantly contribute to the scale’s structure. The fit indices of the QPC-IP model were found to be outside the recommended limits. Although the chi-square/degrees of freedom ratio remained within acceptable limits, other key fit indices, including RMSEA, CFI, GFI, AGFI and NFI, did not reach the thresholds required for a good fit. These results indicated that the model did not fit the data sufficiently and was therefore rejected. The original study and subsequent adaptation studies also utilised CFA and EFA for construct validity. This analytical approach highlights the importance of adapting the scale to different cultural contexts to ensure robust measurement properties. In terms of structural validity, the initial confirmatory factor analysis revealed that the original six-factor model did not align perfectly with the data obtained from the Turkish sample. Specifically, the fit indices suggested that the original structure might not fully capture the nuances of psychiatric care in this cultural context. Consequently, an exploratory factor analysis was conducted to reveal a more appropriate latent structure. During this iterative process, items that showed low distinctiveness or cross-loaded onto multiple dimensions were removed to ensure clarity. This refinement suggests that Turkish patients perceive certain specific descriptors more holistically, necessitating a simplified structure. The final analysis yielded a four-factor structure, as shown in Table 2 : ‘Encounter’, ‘Participation’, ‘Discharge’ and ‘Secure Environment’. The prominence of the ‘Encounter’ dimension suggests that the relational aspect of care is still very important to the participants. Consolidating the scale into four dimensions suggests that participants in this study may perceive certain aspects of care as interrelated, despite them being distinct in the original scale. The refinement process resulted in a final model comprising four distinct sub-dimensions: Interaction and Safety; Participation; Discharge; and Secluded Environment; and Support. While the original scale featured six dimensions, reducing it to four in this study suggests that Turkish patients may perceive certain care concepts, particularly safety and interaction, as deeply intertwined rather than separate entities. This structural variation is consistent with findings from other cultural adaptations. For instance, the Indonesian version also required structural changes to fit the local context, whereas the Spanish adaptation retained the original six-factor model. These discrepancies emphasise that the concept of ‘quality of care’ is likely influenced by the specific clinical and cultural environment in which it is assessed, rather than being a rigid, universal structure. When evaluating the scale’s reliability, a notable distinction emerged between the dimensions. The ‘Interaction and Safety’ and ‘Participation’ dimensions demonstrated higher internal consistency than the ‘Discharge and Secluded Environment’ dimension. This suggests that patients perceive the direct relational aspects of care, such as feeling safe and being heard, as more consistent and coherent. In contrast, the slightly lower consistency in the discharge dimension may reflect the variability inherent in discharge planning processes, or the fact that patients often perceive discharge preparation as a multifaceted process. Nevertheless, the scale’s overall reliability confirms its ability to capture the core therapeutic elements of psychiatric nursing, particularly in the domains of interaction and patient empowerment. The Turkish version’s internal consistency coefficients appear to be consistent with those of the original scale and its international adaptations. In this regard, the results are similar to the reliability levels reported in the original study by Schröder et al. [ 2 ] and the Spanish adaptation [ 26 ]. Additionally, while the Indonesian version presented varying reliability ranges [ 3 ], the values obtained in this study can be considered satisfactory [ 20 ]. Taken together, these findings suggest that the Turkish version of the QPC-IP has psychometric stability that is comparable to that of the original instrument and its other translated versions. The patient-centred design of the QPC-IP provides a framework that supports evidence-based psychiatric nursing practice, which could lead to greater professional accountability and positive patient outcomes. Unlike traditional instruments, which often focus primarily on general satisfaction, the QPC-IP appears capable of capturing the complex relational and contextual nuances of care delivery. Consequently, it is particularly well-suited to evaluating the multidimensional role of psychiatric nurses, an area that is frequently underrepresented in conventional quality assessments. Ultimately, the findings suggest that the Turkish version of the QPC-IP is a valuable instrument for assessing the quality of inpatient care, providing a practical guide to improving psychiatric nursing services. Limitations This study has limitations in terms of generalisability, as data were collected from inpatients in only two psychiatric hospitals. Although this geographical focus provided depth, reliance on a convenience sampling strategy means the findings should be interpreted with caution in terms of their external validity, as the sample may not fully reflect the diverse characteristics of the wider psychiatric inpatient population in Turkey. Regarding the validation process, an expert panel of academic professionals assessed content validity to ensure theoretical, linguistic and cultural rigour. While ‘service users’ (individuals with lived experience) were not included in the technical expert committee, the patient perspective was incorporated during the pilot study phase. Feedback was actively sought to ensure item clarity and relevance prior to main data collection. The psychometric evaluation primarily focused on exploring the factor structure through exploratory factor analysis (EFA). While this analysis provided substantial evidence for the construct validity of the scale, the identified structure was not cross validated using confirmatory factor analysis (CFA) within the scope of this research. Conclusions This study involved adapting the QPC-IP scale for use in Turkish inpatient psychiatric settings, as well as evaluating its psychometric properties. The findings suggest that the Turkish version, comprising 22 items across four sub-dimensions, demonstrates construct, content and linguistic validity that is comparable to that of the original scale. These results indicate that the Turkish version of the QPC-IP has the potential to serve as a valuable patient-reported outcome measure (PROM) for evaluating the quality of psychiatric inpatient care. The scale’s patient-centred structure provides a systematic approach to assessing care quality, which could encourage continuous professional development and reflective practice. Consequently, it has the potential to contribute to enhancing patient satisfaction with mental health services in Turkey by providing a systematic basis for shaping evidence-based interventions. However, further research is needed to confirm the factor structure and investigate its applicability in different psychiatric settings, in order to reinforce its generalisability. Acknowledgements We express our thanks to all the participants in this study. Author contributions All authors contributed to the study conception and design. Material preparation and data collection were performed by İÖ. The full manuscript was written by İÖ & BA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Funding No funding was received for this study. Data availability The data that support the fndings of this study are available from the corresponding author upon reasonable request. Declarations Ethics approval and consent to participate Before the adaptation of the scale into Turkish, formal permission was obtained from the scale’s original developers through email. Ethical approval was granted by the Faculty of Medicine Clinical Research Ethics Committee of Bursa Uludağ University (Date: 2023-08 and Number: 16/5). Additionally, permission to collect data was obtained from the Chief Physician’s Office at Bursa City Hospital (Date: 21/12/2023; Document no.: 232309506). The data collection process followed the principles of the Declaration of Helsinki Written informed consent was obtained from participants. Participation in the study was voluntary and participants were informed about the study before answering the questionnaire. 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