Patient safety culture in UNRWA primary care centres in Gaza: a cross-sectional study

Abstract Background Patient safety culture is a core dimension of health care quality, yet evidence from refugee-serving primary care settings remains limited. This study assessed healthcare providers' perceptions of patient safety culture in United Nations Relief and Works Agency for Palestine Refugees in the Near East primary care centres in the Gaza Strip and examined differences by selected sociodemographic and work-related characteristics. Methods A cross-sectional survey was conducted among healthcare providers in nine UNRWA primary care centres selected by stratified multistage sampling from May to June 2022. Of 270 questionnaires, 259 were completed. Patient safety culture was assessed using an Arabic Safety Attitudes Questionnaire. Descriptive statistics, t tests and analysis of variance with eta-squared effect sizes were used. Multivariable linear regression examined independent predictors of the total SAQ score. Results The overall weighted positive-response score was 73.1%. Job satisfaction (79.2%) and teamwork climate (77.5%) were highest, while working conditions (61.9%) and perceptions of management (66.1%) were lowest. Although 93.4% rated patient safety as very good or excellent, 79.9% had submitted no formal incident or medical-error report in the preceding year. In adjusted analysis, more than 20 years of UNRWA service and middle-area location were associated with higher total scores, while allied health and pharmacy staff had lower scores than medical and dental staff. Conclusion Providers reported a generally favourable safety culture, but working conditions, management perceptions and formal incident reporting remain priorities. The findings provide a pre-war baseline and support non-punitive reporting, leadership engagement, workforce support and safety-focused learning in refugee-serving primary care.