Abstract
The aim of the study was to assess the reliability and construct validity of the Croatian translation of the Safety Attitudes Questionnaire—Ambulatory version (SAQ-AV) in the out-of-hours (OOH) primary care setting. A cross-sectional observational study using anonymous web-survey was carried out targeting a convenience sample of 358 health professionals working in the Croatian OOH primary care service. The final sample consisted of 185 questionnaires (response rate 51.7%). Psychometric properties were assessed using exploratory hierarchical factor analysis with Schmid-Leiman rotation to bifactor solution, McDonald’s ω, and Cronbach’s α. Five group factors were identified: Organization climate, Teamwork climate, Stress recognition, Ambulatory process of care, and Perceptions of workload. Items loading on the Stress recognition and Perceptions of workload factor had low loadings on the general factor. Cronbach’s α ranged between 0.79 and 0.93. All items had corrected item-total correlation above 0.5. McDonalds’ ω total for group factors ranged between 0.76 and 0.91. Values of ω general for factors Organization climate, Teamwork climate, and Ambulatory process of care ranged between 0.41 and 0.56. McDonalds’ ω general for Stress recognition and Perceptions of workload were 0.13 and 0.16, respectively. Even though SAQ-AV may not be a reliable tool for international comparisons, subsets of items may be reliable tools in several national settings, including Croatia. Results confirmed that Stress recognition is not a dimension of patient safety culture, while Ambulatory process of care might be. Future studies should investigate the relationship of patient safety culture to treatment outcome.
Highlights
Patient safety is a major concern of health care services
We have identified the Ambulatory process of Care factor as proposed in the original Safety Attitudes Questionnaire (SAQ)-A study [14] (USA)
Based on relatively high reliability of our factors, we believe that it would be possible to use the items loading on our factors Organization climate, Teamwork climate, and Ambulatory process as a reliable tool for measuring patient safety culture in Croatian OOH primary healthcare
Summary
Patient safety is a major concern of health care services. The World Health Organisation defines patient safety as "the absence of preventable harm to a patient during the process of health care" [1]. One of the most widely used instruments to measure safety culture of front line workers is the Safety Attitudes Questionnaire (SAQ) [2]. It has been validated in different languages and has shown good psychometric properties in different settings [4,5,6,7,8,9,10,11,12,13]. SAQ consists of 30 items arranged in six major patient safety subscales: Teamwork climate, Safety climate, Working condition, Job satisfaction, Perceptions of management, and Stress recognition [2]
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