Knowledge, attitudes, and self-reported practices toward patient safety among nurses in selected health centers in Banadir, Puntland, and Somaliland: a multi-regional cross-sectional study.

backgroundPatient safety is a fundamental component of healthcare quality, yet it remains a major challenge in low- and middle-income and fragile settings. Nurses play a pivotal role in preventing harm through their continuous patient contact, but evidence of their preparedness for patient safety in Somalia is limited. This study aimed to assess nurses' knowledge, attitudes, and self-reported practices toward patient safety in selected primary and comprehensive health centers in Banadir, Puntland, and Somaliland.

methodsA facility-based cross-sectional study was conducted between May and September 2025 among nurses working in primary and comprehensive health centers in Banadir, Puntland, and Somaliland. Data were collected using a structured questionnaire adapted from previously published patient safety knowledge, attitude, and practice studies, particularly Wake et al., and informed by broader World Health Organization patient safety concepts. Descriptive statistics summarized participants' knowledge, attitudes, and practices, while Pearson's correlation and multiple linear regression analyses examined associations and predictors of attitude and practice scores.

resultsA total of 344 nurses participated. Overall, 60.5% demonstrated good knowledge, 63.7% reported positive attitudes, and 62.2% reported good patient safety practices. Knowledge was positively correlated with attitudes (r = 0.22, p < 0.01) and practices (r = 0.30, p < 0.01), while attitudes showed the strongest correlation with practices (r = 0.63, p < 0.01). Continuing patient safety education was significantly associated with higher attitude scores (B = 3.62, β = 0.21, p = 0.014) and better practice scores (B = 0.74, β = 0.20, p = 0.016). However, the regression models explained modest variance in attitudes and practices (R² = 0.071 and R² = 0.052, respectively). Only 25.0% of participants perceived a non-punitive response to errors.

conclusionNurses working in participating Somali health centers demonstrated generally favorable knowledge, attitudes, and self-reported practices toward patient safety. However, important gaps remain, especially in relation to blame-oriented perceptions and weak non-punitive responses to errors. Continuing patient safety education was associated with more positive attitudes and better reported practices, although the regression models explained only modest variance. These findings suggest that patient safety improvement in Somali health centers requires more than individual knowledge improvement; it also requires supportive supervision, non-punitive reporting systems, and stronger facility-level safety culture.