title: The psychometric properties of the 'safety attitudes questionnaire' in out-of-hours primary care services in the Netherlands.
abstract: BACKGROUND
  The Safety Attitudes Questionnaire (SAQ) is one of the most widely used instruments to assess safety culture among healthcare providers. The ambulatory version of the SAQ (SAQ-AV) can be used in the primary care setting. Our study objective was to examine the underlying factors and psychometric properties of the Dutch translation of the SAQ-AV in out-of-hours primary care services.
  
  
  METHODS
  Cross-sectional observational study using a web-survey.
  
  
  METHODS
  Sixteen out-of-hours general practitioner cooperatives and two call centers in the Netherlands.
  
  
  METHODS
  Primary healthcare providers in out-of-hours services.
  
  
  METHODS
  Item-descriptive statistics, factor loadings, Cronbach's alpha scores, corrected item-total correlations, scale correlations.
  
  
  RESULTS
  The questionnaire was answered by 853 (43.2%) healthcare professionals. In the factor analyses, 784 respondents were included; mainly general practitioners (N = 470) and triage nurses (N = 189). Items were included in the analyses based on question type and results from previous studies. Five factors were drawn with reliability scores between .49 and .86 and a good construct validity. The five factors covered 27 of the 62 questionnaire items, with three to five items per factor.
  
  
  CONCLUSIONS
  The Dutch translation of the SAQ-AV, with five factors, seems to be a reliable tool for measuring patient safety culture and guide quality improvement interventions in out-of-hours primary care services. The Dutch factor structure differed from the original SAQ-AV and other translated versions. In future studies, the questionnaire should be validated further by examining if there is a relationship between the responses on the SAQ-AV, patient experiences, and the occurrence of adverse events.
authors.affiliation: Radboud Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Marleen
authors.identifier: http://orcid.org/0000-0001-9073-5382
authors.initials: M
authors.lastname: Smits
authors.affiliation: Radboud Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Ellen
authors.initials: E
authors.lastname: Keizer
authors.affiliation: Radboud Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Giesen
authors.affiliation: Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.|The Norwegian Directorate of Health, Oslo, Norway.
authors.forename: Ellen Catharina Tveter
authors.initials: EC
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.|Uni Research Health, National Centre for Emergency Primary Health Care, Bergen, Norway.
authors.forename: Gunnar Tschudi
authors.initials: GT
authors.lastname: Bondevik
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D008875:Middle Aged; D009426:Netherlands; D010348:Patient Care Team; D061214:Patient Safety; D011320:Primary Health Care / Q000592:standards*; D011594:Psychometrics / Q000295:instrumentation; D017751:Safety Management; D011795:Surveys and Questionnaires / Q000592:standards*