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BACKGROUND: In Ethiopia, there is a growing concern about improving patients' safety in healthcare facilities. However, the lack of a valid and reliable instrument sensitive to the Ethiopian culture for measuring health professional practice environment leads to difficulty in constructing evaluations of safety climate and further linking organizational research to outcomes research. This research study examined the psychometric properties of the Safety Attitude Questionnaire (SAQ) in the Amharic language within an Ethiopian healthcare context. METHOD: A hospital-based cross-sectional study design was conducted. The SAQ was meticulously translated into Amharic using forward and backward translation methods. Content validity was evaluated with input from seven patient safety and healthcare quality experts. Face validity was established through feedback from healthcare professionals. Then, the Amharic SAQ (SAQ-A) was distributed to 648 participants working in 11 public hospitals, and a total of 611 valid questionnaires were completed and returned (95.2% response rate). Cronbach's alpha, McDonald's omega, composite reliability, correlation analysis, and average variance estimation were calculated, and confirmatory factor analysis was performed. Descriptive analyses were performed to describe socio-demographic characteristics. A P-value of ≤0.05 was considered statistically significant. Tables, figures, charts, and texts are used for data presentation. RESULT: The overall internal consistency (Cronbach's alpha) for the 31-item SAQ-A was 0.903, indicating excellent reliability. Confirmatory factor analyses demonstrated a good model fit for each dimension and the entire construct (χ2=1086.675, df=412, p<0.001, comparative fit index (CFI)=0.923, Tucker Lewis index (TLI)=0.913, and root mean square error of approximation (RMSEA)=0.052). The positive response rate of healthcare workers in hospitals was 32.1%. The positive response rates of the six dimensions were teamwork climate (59.7%), safety climate (41.9%), job satisfaction (57.1%), working conditions (37.5%), perception of management (37.6%), and stress recognition (46.2%). CONCLUSION: The Amharic translation of the SAQ showed good psychometric properties, making it a valuable tool for assessing safety attitudes among Amharic-speaking Ethiopian healthcare practitioners.

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Patient safety research has focused mostly on the hospital and acute care setting whereas assessments of patient safety climate in primary health care settings are warranted. Valid questionnaires as e.g., the Safety Attitudes Questionnaire (SAQ) may capture staff perceptions of patient safety climate but until now, an overview of the use of SAQ in primary care has not been systematically presented. Thus, the aim of this systematic review is to present an overview of SAQ used in primary care.Methods The electronic databases: PubMed, Embase, Cinahl, PsycInfo and Web of Science were used to find studies that used any version of SAQ in primary care. Studies were excluded if only abstract or poster was available, as the information in abstract and posters was deemed insufficient. Commentaries and nonempirical studies (e.g., study protocols) were excluded. Only English manuscripts were included.Results A total of 43 studies were included and 40 of them fell into four categories: 1) validation analysis, 2) descriptive analysis, 3) variance assessment and 4) intervention evaluation and were included in further analyses. Some studies fell into more than one of the four categories. Seventeen studies aimed to validate different versions of SAQ in a variety of settings and providers. Twenty-five studies from fourteen different countries reported descriptive findings of different versions of SAQ in a variety of settings. Most studies were conducted in primary health care centres, out-of-hours clinics, nursing homes and general practice focusing on greatly varying populations. One study was conducted in home care. Three studies investigated variance of SAQ scores. Only five studies used SAQ to assess the effects of interventions/events. These studies evaluated the effect of electronic medical record implementation, a comprehensive Unit-based Safety Program or COVID-19.Conclusion The synthesis demonstrated that SAQ is valid for use in primary care, but it is important to adapt and validate the questionnaire to the specific setting and participants under investigation. Moreover, differences in SAQ factor scores were related to a variety of descriptive factors, that should be considered in future studies More studies, especially variance and intervention studies, are warranted in primary care.Trial registration This systematic review was not registered in any register.

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INTRODUCTION: This study aimed to translate and assess the psychometric properties of the Persian version of the "Safety Attitude Questionnaire" in the NICUs. METHODS: In this psychometric study, the "Safety Attitude Questionnaire" was translated into Persian. Then this version was used for psychometric evaluation. For this purpose, the qualitative face, content validity and construct validity were performed by confirmatory factor analysis. Internal consistency and stability reliability were calculated. Data were analyzed using SPSS and AMOS software. RESULTS: Face validity was also performed with a slight change in four items. The factor structure of the tool was determined by confirmatory factor analysis. Fit indices were appropriate. Internal consistency reliability in the whole questionnaire was 0.65 and the stability reliability was calculated to be 0.64. DISCUSSION AND CONCLUSION: "Safety Attitude Questionnaire" has appropriate psychometric properties and can be used in NICUs.

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Antecedentes y objetivo: La concepción actual de la discapacidad, donde las características físicas de una persona son contempladas en su interacción con el entorno, requiere de estudios actitudinales de la población que faciliten la identificación de las barreras que limitan el ejercicio de los derechos en igualdad de oportunidades para las personas con discapacidad en contextos profesionales. El objetivo principal del estudio ha sido el diseño, construcción y validación de un instrumento de evaluación de las actitudes hacia la discapacidad en personal militar.Método:En el estudio han participado 204 militares de diferentes empleos y escalas, donde un 11,76 % fueron mujeres y un 88,24 % hombres. El desarrollo del trabajo estuvo dividido en dos fases. En la primera fase, se construye la escala y se somete a juicio de expertos analizando la concordancia entre los mismos con el fin de valorar la validez de contenido del cuestionario. En la segunda fase, se valoran las cualidades psicométricas de fiabilidad y validez (constructo y concurrente) de la escala.Resultados:Los resultados obtenidos reflejan propiedades psicométricas adecuadas y ajustadas del instrumento. En el análisis de la fiabilidad se observa que, tanto la escala en su conjunto (.87), como las dos subescalas que la conforman (.88 y .89), presentan una adecuada consistencia interna. En los análisis exploratorio y confirmatorio realizados, se obtiene un modelo con una solución de dos factores cuyos datos de bondad de ajuste (NFI = 0.94, GFI = 0.94, CFI = .97, RMSEA = .06 (IC 90 % = .048 - .070), RMR estandarizado = .091) garantizan una adecuada validez de constructo. Asimismo, se observa una adecuada validez concurrente (.76; p< .01).Conclusiones:Se concluye el uso justificado y óptimo del instrumento para la evaluación de las actitudes hacia la discapacidad en personal militar. (AU)

Background and objective: Currently, the conception of disability considers the physical characteristics of the person in their interaction with the environment. This understanding makes it necessary for the development of attitudinal studies of the population that facilitate the identification of barriers that limit the exercise of people with disabilities’ rights in equal opportunities in the professional field. The main objective of the study was the design, construction, and validation of an instrument to assess attitudes towards disability in the Armed Forces.Method:204 soldiers of different positions and scales participated in the study, where 11.76 % were women and 88.24 % were men. The study was divided into two phases. In the first phase, the scale was constructed and evaluated by a group of experts. The concordance between them was also analyzed in order to evaluate the validity of the content of the questionnaire. In a second phase, the psychometric qualities of reliability and validity (construct and concurrent) of the scale were evaluated.Results:The results obtained reflect appropriate psychometric properties adjusted to the instrument. The reliability analysis, shows that both, the scale as a whole (.87), and the two subscales that make it up(.88 and .89), present adequate internal consistency. In the exploratory and confirmatory analyses performed, it is obtained a model with a two-factor solution. Its goodness-of-fit data (NFI = 0.94, GFI = 0.94, CFI = .97, RMSEA = .06 (90 % CI = .048 - .070), standardized RMR = .091) guarantee adequate construct validity. Likewise, an appropriate concurrent validity is observed (.76; p<.01).Conclusions:In conclusion, the use of the instrument for the evaluation of attitudes towards disability in the Armed Forces is justified and optimal. (AU)

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The Safety Attitude Questionnaire (SAQ) and Manchester Patient Safety Framework (MaPSaF) are known as effective tools to assess patient safety culture and climate and develop targeted strategies. However, they are seldom applied in an integrated way. The aim of this study was to conduct an implementation project through a novel use of both instruments to gain unique insights. The Italian version of MaPSaF and SAQ were administered to 1,759 healthcare workers from three Italian hospitals (response rate: MaPSaF 70.5%, SAQ 61.6%). MaPSaF evaluation proved an overall bureaucratic level of patient safety culture. SAQ scores showed a predominance of neutral scores (75.99%). The dimension perception of management gained the lowest mean score (53.32), while Stress recognition obtained the highest (75.17). Safety climate perception differed significantly among groups: working in a small hospital, in a medical department, and being a physician were associated with the most positive results. The majority (67.1%) of responders to both MaPSaF and SAQ considered the two instruments as providing with different and complementary information. Overall, results showed that an integrated approach in the evaluation of an organisation's safety culture may result useful for an in-depth analysis of the criticalities and the adoption of appropriate improvement strategies.

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BACKGROUND: Patient safety represents a global issue which leads to potentially avoidable morbidity and mortality. The healthcare providers perception and their role are utmost important in delivering quality care and patient safety. This study aimed to determine the interdisciplinary differences in patient safety culture in a tertiary university hospital. METHOD: A cross-sectional study using the Safety Attitude Questionnaire (SAQ) self-administered electronically in the English and Malay languages to evaluate safety culture domains. A positive percentage agreement scores of 60% was considered satisfactory. Comparisons were made between doctors, nurses, allied health professionals, nursing assistants and support staff. RESULTS: Of 6562 respondents, 5724 (80.4%) completed the questionnaire; 3930 (74.5%) women, 2263 (42.9%) nurses, and 1812 (34.2%) had 6-10 years of working experience. The mean overall positive percentage agreement scores were 66.2 (range = 31.1 to 84.7%), with job satisfaction (72.3% ± 21.9%) and stress recognition (58.3 ± 25.6%) representing the highest and lowest mean domain scores, respectively. Differences were observed between all five job categories. Linear regression analyses revealed that the other four job categories scored lower in teamwork, safety climate, job satisfaction and working conditions compared to nurses. CONCLUSIONS: The overall mean SAQ score was above the satisfactory level, with unsatisfactory percentage agreement scores in the stress recognition domain. Interventions to improve patient safety culture should be developed, focusing on stress management.

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BACKGROUND: Promoting drug-related knowledge and improving relevant attitudes among students are of crucial importance toward the prevention of drug misuse. Objective: This study aimed to assess the validity and reliability of the "drug-related knowledge and attitude questionnaire" among Iranian medical students. Methods: The participants of this cross-sectional study were students of Iran University of Medical Sciences. The "drug-related knowledge and attitude questionnaire" and a socio-demographic questionnaire were used to gather the data. Content validity was assessed by a panel of 11 experts, and face validity was evaluated by 10 participating students. Item-total correlation and Cronbach's alpha coefficients were used as internal consistency estimates. Results: The face and content validity of the questionnaire were satisfactory. The overall content validity index was .82. Cronbach's alpha was .679, indicating an acceptable degree of internal consistency and homogeneity between the items. Overall, most of the students had adequate knowledge about the harmful effects of addictive substances (48.11 ± 3.26). Conclusions: The "drug-related knowledge and attitude questionnaire" has favorable validity and reliability to assess the knowledge and attitude of Iranian students toward drug misuse and may be used in clinical and epidemiological studies. Besides, our findings can provide a suitable starting point for the implementation of effective psychoeducational interventions aimed at the improvement of the students' knowledge and attitudes toward drug misuse.

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Traffic accident statistics have shown the necessity of risk assessment when driving in the dynamic traffic environment. If the risk associated with different traffic elements (i.e., road, environment and vehicles) could be evaluated accurately, potential accidents could be significantly avoided or mitigated. This paper proposes a driving risk assessment model that can quantitatively evaluate the driving risk associated with intelligent vehicles via the coupled analysis of different traffic elements. First, we present a concept of the internal field and external field for establishing the driving risk coupling model, through employing the internal field to define the risk range of driver's perspective and the external field to calculate the risk coefficients of those traffic elements. Then, the relative risk coefficients are computed by incorporating both naturalistic driving study (NDS) and driver attitude questionnaire (DAQ) using a multinomial logit model. Specifically, we perform a large-scale naturalistic driving study to investigate the objective driving risks. Typical driver behavior parameters, such as velocity, time headway, and acceleration, are analyzed. Besides, a self-reported survey of 364 drivers is conducted to subjectively evaluate the potential risks that drivers may face in various situations. Finally, validation of the model is conducted by comparing the accuracy with the typical risk assessment index, i.e., TTC and THW. Results demonstrate that the proposed approach is effective in evaluating the comprehensive driving risks by quantifying the influence factors of driving risks in dynamic environments.

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AIM: Perinatal death is often preceded by an end-of-life decision (ELD). Disparate hospital policies, complex legal frameworks and ethically difficult cases make attitudes important. This study investigated attitudes of neonatologists and nurses towards perinatal ELDs. METHODS: A survey was handed out to all neonatologists and neonatal nurses in all eight neonatal intensive care units in Flanders, Belgium in May 2017. Respondents indicated agreement with statements regarding perinatal ELDs on a Likert-scale and sent back questionnaires via mail. RESULTS: The response rate was 49.5% (302/610). Most neonatologists and nurses found nontreatment decisions such as withholding or withdrawing treatment acceptable (90-100%). Termination of pregnancy when the foetus is viable in cases of severe or lethal foetal problems was considered highly acceptable in both groups (80-98%). Physicians and nurses do not find different ELDs equally acceptable, e.g. nurses more often than physicians (74% vs 60%, p = 0.017) agree that it is acceptable in certain cases to administer medication with the explicit intention of hastening death. CONCLUSION: There was considerable support for both prenatal and neonatal ELDs, even for decisions that currently fall outside the Belgian legal framework. Differences between neonatologists' and nurses' attitudes indicate that both opinions should be heard during ELD-making.

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BACKGROUND: The objectives of this study are to test the psychometric properties of the safety attitudes and safety climate questionnaire Chinese simplified version (SAQ-CS), to test the safety attitudes of health professionals in tertiary hospitals in the Liaoning province and to explore the effects of demographic factors on safety attitudes. METHODS: The SAQ-CS was used to conduct a cross-sectional survey in nine tertiary hospitals in Liaoning province. RESULTS: Cronbach's alpha of each subscale of SAQ-CS were > 0.7, the values of GFI, TLI, and CFI were > 0.8, and RMSEA values ranged from 0.048-0.199. The mean of the safety attitudes of 2157 health professionals was 4.00, indicating a good safety attitude, with a positive response rate (% of items that scored ≥4) of 51.1%. The stress recognition subscale had the lowest score, with a mean of 2.73 and a positive response rate of 17.8%. A multiple linear regression equation revealed that demographic factors like gender, age, and training participation significantly affected the scores (ßgender > 0.06, ßage < - 0.08, ßtraining < - 0.07, p < 0.05). CONCLUSIONS: The psychometric properties of SAQ-CS are good and stable. Health professionals rate teamwork climate, safety climate, perception of management, and work conditions in Liaoning province are perceived as good; however, the stress of the health professionals is poor. To improve safety attitudes, it is necessary to not only reduce the stress of health professionals, but also to pay more attention to men, older health professionals, and health professionals who have not participated in safety training.

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BACKGROUND: Physicians and nurses are core staff who are the first points of contact in care provision to patients. We aimed to examine physicians' and nurses' perceptions of patient safety in a case hospital by administering the Chinese Safety Attitude Questionnaire (CSAQ), developed from the Taiwan Joint Commission on Hospital Accreditation, in order to provide the patients with a safe environment and excellent medical service. METHODS: An intra-organizational online survey was conducted. Confirmatory factor analysis (CFA) was first performed on the assessment of the measures for patient safety culture and seven dimensions with 33 items were identified. Pearson correlation analysis was subsequently used to examine the strength and direction of the relationships between seven dimensions of patient safety culture. RESULTS: A total of 800 questionnaires were issued and 405 valid questionnaires were collected, the effective response rate being 50.6%. The findings highlighted that safety climate (SC) was positively and significantly related to teamwork climate (TC) and perception of management (PM), whereas stress recognition (SR) was negatively related to burnout (BUR). CONCLUSION: Patient safety culture in healthcare organizations has been considered a critical issue for improving the quality of healthcare. This study further focused on the contribution of a better patient safety culture for healthcare organizations in Taiwan.

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BACKGROUND AND AIM: The public opinion about the nursing profession can influence health service users, the work performance of nurses, health policies, and the choice to become a nurse. The aim of this study was to investigate the perception of nursing in modern society. METHODS: A cross-sectional study was conducted with a sample of 398 participants belonging to four population groups: Very Important Persons (VIPs), general population, upper-school students, and nursing students. This phenomenon was assessed through the Nursing Attitude Questionnaire (NAQ) and several additional items. RESULTS: The results highlighted that general population and nursing students showed a significantly better image of nurses than did VIPs and upper-school students. CONCLUSIONS: Overall, the sample acknowledged nurses fundamental connotations and functions, although secondary school students poorly recognized nurses' professional autonomy, and VIPs' judgements seemed to be more sensitive to the image of nurses given by mass media.

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OBJECTIVES: To measure and establish a baseline assessment of the patient safety culture in the Palestinian hospitals. DESIGN: A cross-sectional descriptive study using the Arabic version of the Safety Attitude Questionnaire (Short Form 2006). PARTICIPANTS: A total of 339 nurses and physicians returned the questionnaire out of 370 achieving a response rate of 91.6%. SETTING: Four public general hospitals in the Gaza Strip, Palestine. METHODS: Nurses and physicians were randomly selected using a proportionate random sampling. Data analysis performed using Statistical Package for the Social Sciences software version 20, and p value less than 0.05 was statistically significant. MAIN OUTCOMES MEASURES: Current status of patient safety culture among healthcare providers and percentage of positive attitudes. RESULTS: Male to female ratio was 2.16:1, and mean age was 36.5 ± 9.4 years. The mean score of Arabic Safety Attitude Questionnaire across the six dimensions on 100-point scale ranged between 68.5 for Job Satisfaction and 48.5 for Working Condition. The percentage of respondents holding a positive attitude was 34.5% for Teamwork Climate, 28.4% for Safety Climate, 40.7% for Stress Recognition, 48.8% for Job Satisfaction, 11.3% for Working Conditions and 42.8% for Perception of Management. Healthcare workers holding positive attitudes had better collaboration with co-workers than those without positive attitudes. CONCLUSION: Findings are useful to formulate a policy on patient safety culture and targeted a specific safety culture dimension to improve the safety of patients and improve the clinical outcomes within healthcare organisations.

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INTRODUCTION: The objective of this study was to analyse and model the safety culture with Markov chains, as well as predicting and/or prioritizing over time the evolutionary behaviour of the safety culture of the health's staff in one Mexican hospital. METHOD: The Markov chain theory has been employed in the analysis, and the input data has been obtained from a previous study based on the Safety Attitude Questionnaire (CAS-MX-II), by considering the following 6 dimensions: safety climate, teamwork, job satisfaction, recognition of stress, perception of management, and work environment. RESULTS: The results highlighted the predictions and/or prioritisation of the approximate time for the possible integration into the evolutionary behaviour of the safety culture as regards the "slightly agree" (Likert scale) for: safety climate (in 12 years; 24.13%); teamwork (8 years; 34.61%); job satisfaction (11 years; 52.41%); recognition of the level of stress (8 years; 19.35%); and perception of the direction (22 years; 27.87%). The work environment dimension was unable to determine the behaviour of staff information, i.e. no information cultural roots were obtained. CONCLUSION: In general, it has been shown that there are weaknesses in the safety culture of the hospital, which is an opportunity to suggest changes to the mandatory policies in order to strengthen it.

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Latent class (LC) cluster analysis of a set of subscale lz person-fit statistics was proposed to explain person misfit on multiscale measures. The proposed explanatory LC person-fit analysis was used to analyze data of students (N = 91,648) on the nine-subscale School Attitude Questionnaire Internet (SAQI). Inspection of the class-specific lz mean and variance structure combined with explanatory analysis of class membership showed that the data included a poor-fit class, a class showing good fit combined with social desirability bias, a good-fit class, and two classes that were more difficult to interpret. A comparison of multinomial logistic regression predicting class membership and multiple regression predicting continuous person fit showed that LC cluster analysis provided information about aberrant responding unattainable by means of linear multiple regression. It was concluded that LC person-fit analysis has added value to common approaches to explaining aberrant responding to multiscale measures.

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RATIONALE, AIMS AND OBJECTIVE: Neonatal intensive care units (NICUs) are a high-risk setting. The Safety Attitude Questionnaire (SAQ) is a widely used tool to measure safety culture. The aims of the study are to verify the psychometric properties of the Italian version of SAQ, to evaluate safety culture in the NICUs and to identify improvement interventions. METHOD: A cross-sectional study was conducted in 6 level III NICUs. The SAQ was translated into Italian and adapted to the context, a confirmatory factor analysis (CFA) was performed to validate the questionnaire. RESULTS: 193 questionnaires were collected. The mean response rate was 59.7% (range 44.5%-95.7%). The answers were analysed according to six factors: f1 - teamwork climate, f2 - safety climate, f3 - job satisfaction, f4 - stress recognition, f5 - perception of management, f6 - working conditions. The CFA indexes were adequate (McDonald's omega indexes varied from 0.74 to 0.94, the SRMR index was equal to 0.79 and the RMSEA index was 0.070, 95% CI = 0.063-0.078). The mean composite score was 57.6 (SD 17.9), ranging between 42.3 and 69.7 on a standardized 100-point scale. We highlighted significant differences among units and professions (P < 0.05). CONCLUSIONS: The Italian version of the SAQ proved to be an effective tool to evaluate and compare the safety culture in the NICUs. The obtained scores significantly varied both within and among the NICUs. The organizational and structural characteristics of the involved hospitals probably affect the safety culture perception by the staff.

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This study examined directly the impact of various factors associated with driving on 'A-class' roads in the United Kingdom (specifically length of platoon, proportion of heavy goods vehicles (HGVs), speed and opportunities for overtaking) on self-reported frustration and overtaking intentions. The impact of situational variables (being under time pressure, and time behind a slower moving platoon) were also examined, as was the association between frustration and self-reported overtaking intentions. 183 members of the public from the areas around Perth and Inverness, Scotland took part in the study. Participants viewed simulated 'driver's viewpoint' clips representing all the combinations of the experimental variables (except time pressure, which was a between-groups variable, and time behind platoon, which was examined separately in four specific clips). After each clip, participants responded on a paper questionnaire as to the level of frustration they would feel for a given clip, and the likelihood that at some point during the clip they would have attempted an overtake manoeuvre. The findings show that the links between traffic variables such as speed and platoon length, and behaviourally-relevant variables such as frustration and overtaking intentions, are not simple. Although there are broad and predictable effects of speed and platoon length (lower speeds and longer platoons leading to greater frustration) these are mediated by other variables, and it is not always the case that more frustration leads to more intention to overtake. Analysis of driver attitudes identified three clusters (low, medium and high risk drivers) and suggests that higher risk drivers' levels of frustration are more affected by situational changes than those of lower risk drivers.

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