Patient safety culture in Portuguese dentistry: Instrument validity and reliability

Abstract

Objectives: The purpose of this study was to adapt, validate, and analyze the reliability of the Medical Office Survey on Patient Safety Culture (MOSPSC) for Portuguese dental care. Methods: The Portuguese version of the MOSPSC of the Agency for Healthcare Research and Quality (AHRQ) was adapted for Portuguese dental care. Six specialists conducted the content validity and semantic analysis. The reliability analysis was performed using Cronbach's alpha and average inter-item correlation (AIIC). Confirmatory factor analysis (CFA) was conducted to assess the fit quality of the model associated with the theoretical model proposed by the AHRQ. The following goodness-of-fit indexes were used: the quotient between chi-square and the number of degrees of freedom (χ2/df), the goodness-of-fit index (GFI), the comparative fit index (CFI), the Tucker-Lewis index (TLI), Parsimony GFI, and the root mean square error of approximation index (RMSEA). Results: The initial sample (n=237) was subjected to an analysis of missing values, resulting in a final sample of 143 participants. The model proposed by the CFA corresponded to the joining of two pairs of dimensions (“communication about error” and “communication openness” dimensions; “office processes and standardization” and “work pressure and pace” dimensions). The proposed model obtained good overall consistency (Cronbach's α=0.93; AIIC=0.27) and moderate overall fit considering the study sample (χ2/df=5.63; GFI=0.90; CFI=0.90; TLI=0.88; PGFI=0.67; RMSEA=0.18; p<0.001; 90% CI RMSEA [0.175;0.186]). Conclusions: The proposed model structure resulted in eight dimensions, which achieved good reliability and moderate construct validity.