title: Assessing the Safety Attitudes Questionnaire (SAQ), German language version in Swiss university hospitals--a validation study.
abstract: BACKGROUND
  Improving patient safety has become a major focus of clinical care and research over the past two decades. An institution's patient safety climate represents an essential component of ensuring a safe environment and thereby can be vital to the prevention of adverse events. Covering six patient safety related factors, the Safety Attitudes Questionnaire (SAQ) is a validated and widely used instrument to measure the patient safety climate in clinical areas. The objective of this study was to assess the psychometric properties of the German language version of the SAQ.
  
  
  METHODS
  A survey was carried out in two University Hospitals in Switzerland in autumn 2009 where the SAQ was distributed to a sample of 406 nurses and physicians in medical and surgical wards. Following the American Educational Research Association guidelines, we tested the questionnaire validity by levels of evidence: content validity, internal structure and relations to other variables. Confirmatory factor analysis was used to examine factor structure. Cronbach's alphas and inter-item correlations were calculated to examine internal consistency reliability.
  
  
  RESULTS
  A total of 319 questionnaires were completed representing an overall response rate of 78.6%. For three items, the item content validity index was <0.75. Confirmatory factor analysis showed acceptable model fit (RMSEA = 0.045; CFI = 0.944) for the six-factor model. Additional exploratory factor analysis could not identify a better factor model. SAQ factor scores showed positive correlations with the Safety Organizing Scale (r = .56-.72). The SAQ German version showed moderate to strong internal consistency reliability indices (Cronbach alpha = .65-.83).
  
  
  CONCLUSIONS
  The German language version of the SAQ demonstrated acceptable to good psychometric properties and therefore shows promise to be a sound instrument to measure patient safety climate in Swiss hospital wards. However, the low item content validity and large number of missing responses for several items suggest that improvements and adaptations in translation are required for select items, especially within the perception of management scale. Following these revisions, psychometric properties should reassessed in a randomly selected sample and hospitals and departments prior to use in Swiss hospital settings.
authors.affiliation: Institute of Nursing Science, University of Basel, Bernoullistrasse 28, Basel 4056, Switzerland. Rene.Schwendimann@unibas.ch.
authors.forename: Natalie
authors.initials: N
authors.lastname: Zimmermann
authors.forename: Kaspar
authors.initials: K
authors.lastname: Küng
authors.forename: Susan M
authors.initials: SM
authors.lastname: Sereika
authors.forename: Sandra
authors.initials: S
authors.lastname: Engberg
authors.forename: Bryan
authors.initials: B
authors.lastname: Sexton
authors.forename: René
authors.initials: R
authors.lastname: Schwendimann
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data; D008297:Male; D009741:Nursing Staff, Hospital / Q000523:psychology / Q000706:statistics & numerical data; D061214:Patient Safety / Q000706:statistics & numerical data; D011594:Psychometrics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards; D013557:Switzerland / Q000453:epidemiology
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