title: The safety attitudes questionnaire - ambulatory version: psychometric properties of the Slovenian version for the out-of-hours primary care setting.
abstract: Several tools have been developed to measure safety attitudes of health care providers, out of which the Safety Attitudes Questionnaire (SAQ) is regarded as one of the most appropriate ones. In 2007, it was adapted to outpatient (primary health care) settings and in 2014 it was tested in out-of-hours health care settings in Norway. The purpose of this study was to translate the English version of the SAQ-Ambulatory Version (SAQ-AV) to Slovenian language; to test its reliability; and to explore its factor structure.
  
  
  
  This was a cross-sectional study that took place in Slovenian out-of-hours primary care clinics in March-May 2015 as a part of an international study entitled Patient Safety Culture in European Out-of-hours services. The questionnaire consisted of the Slovenian version of the SAQ-AV. The link to the questionnaire was emailed to health care workers in the out-of-hours clinics. A total of 438 participants were invited. We performed exploratory factor analysis.
  
  
  
  Out of 438 invited participants, 250 answered the questionnaire (response rate 57.1%). Exploratory factor analysis put forward five factors: 1) Perceptions of management, 2) Job satisfaction, 3) Safety climate, 4) Teamwork climate, and 5) Communication. Cronbach's alpha of the whole SAQ-AV was 0.922. Cronbach's alpha of the five factors ranged from 0.587 to 0.791. Mean total score of the SAQ-AV was 56.6 ± 16.0 points. The factor with the highest average score was Teamwork climate and the factor with the lowest average was Job satisfaction.
  
  
  
  Based on the results in our study, we cannot state that the SAQ-AV is a reliable tool for measuring safety culture in the Slovenian out-of-hours care setting. Our study also showed that there might be other safety culture factors in out-of-hours care not recognised before. We therefore recommend larger studies aiming to identify an alternative factor structure.
authors.affiliation: Department of Family Medicine, Medical Faculty, University of Maribor, Taborska 8, 2000, Maribor, Slovenia. zalika.klemenc@um.si.|Department of Family Medicine, Medical Faculty, University of Ljubljana, Poljanski nasip 58, 1000, Ljubljana, Slovenia. zalika.klemenc@um.si.|Community Health Centre Ljubljana, Metelkova 9, 1000, Ljubljana, Slovenia. zalika.klemenc@um.si.
authors.forename: Zalika
authors.identifier: 0000-0002-0270-1754
authors.initials: Z
authors.lastname: Klemenc-Ketis
authors.affiliation: Faculty of Organisational Sciences, University of Maribor, Kidriceva cesta 55a, 4000, Kranj, Slovenia.
authors.forename: Matjaz
authors.initials: M
authors.lastname: Maletic
authors.affiliation: Health Centre Ravne na Koroskem, Ob Suhi 11, 2390, Ravne na Koroskem, Slovenia.
authors.forename: Vesna
authors.initials: V
authors.lastname: Stropnik
authors.affiliation: Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Ellen Tveter
authors.initials: ET
authors.lastname: Deilkås
authors.affiliation: Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Dag
authors.initials: D
authors.lastname: Hofoss
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.|National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway.
authors.forename: Gunnar Tschudi
authors.initials: GT
authors.lastname: Bondevik
mesh_terms: D000328:Adult; D039602:After-Hours Care; D000368:Aged; D000553:Ambulatory Care; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D015279:Organizational Culture; D061214:Patient Safety; D011320:Primary Health Care; D011594:Psychometrics; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results; D017524:Slovenia; D011795:Surveys and Questionnaires / Q000592:standards; D014175:Translating
keywords: Health care; Out-of-hours care; Patient safety; Quality assurance