Cultural Adaptation and Evaluation of Selected Measurement Properties of Slovenian Version of Consumer Emergency Care Satisfaction Scale (CECSS-SLO).

AIM: The aim of this study was to translate and culturally adapt the Consumer Emergency Satisfaction Scale (CECSS) into Slovenian to evaluate selected measurement properties of the CECSS-SLO. BACKGROUND: Patient satisfaction with emergency department (ED) care represents an important quality indicator in healthcare provision. Instruments measuring satisfaction among older ED patients are scarce, and their cross-cultural adaptation and psychometric validation remain limited. CECSS assesses satisfaction with nursing care in the ED and has shown promising validity in international settings. METHODS: A methodological cross-sectional study was conducted in Slovenian EDs. The instrument was translated and culturally adapted using forward-backwards translation, and expert assessment of content validity, face validity, internal consistency reliability and cultural suitability, using principal component analysis. Reliability was estimated using Cronbach's alpha and McDonald's omega. Ethical approval was obtained. RESULTS: Content validity was assessed by 10 nursing experts with a PhD degree and demonstrated excellent item- and scale-level validity. Face validity and cultural adaptation were evaluated separately by 10 experienced emergency care nurses, who assessed the clarity, comprehensibility and contextual suitability of the translated items. The patient-based psychometric evaluation was conducted among 288 patients from Slovenian EDs. PCA identified a three-component solution whose item composition differed from the previously reported structure. Several items cross-loaded between components, indicating ambiguity in their component membership. The three components were identified as caring, information and dissatisfaction. Internal consistency reliability was high, with alpha and omega coefficients surpassing acceptable thresholds. CONCLUSION: The CECSS-SLO demonstrated satisfactory content validity and internal consistency for assessing patient satisfaction with nursing care in Slovenian EDs. Further studies should evaluate additional measurement properties including test-retest reliability, measurement error, cross-cultural validity/measurement invariance and responsiveness. Future studies should also formally test the proposed three-component structure using confirmatory factor analysis, including models that explicitly evaluate a possible method effect associated with the negatively worded dissatisfaction items. IMPACT: No validated questionnaire has yet been available in Slovenia to assess the quality of nursing care in the ED. CECSS enables systematic evaluation of patient experience, identification of areas for improvement and implementation of targeted quality initiatives. The CECSS-SLO provides a culturally adapted instrument with initial evidence supporting selected measurement properties. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The CECSS-SLO enables the structured assessment of patients' satisfaction with nursing care in Slovenian EDs. Its use may support the identification of areas for improvement and the development of targeted strategies to strengthen patient-centred nursing care and the overall quality of care in EDs. REPORTING METHOD: The cross-sectional component of the study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement, whereas reporting of the evaluation of measurement properties was guided by the COSMIN framework. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.