Safety culture was evaluated by 147 healthcare professionals working in primary and home care services. Most of them were female and worked as community health agents, with time of professional experience of one to two years. In Brazil, community health agents have an important role in establishing “the link” between families and the primary care providers. Their work is essential for the successful approach of the families as it provides essential elements to the understanding of the families' health problems and needs23.
The total score obtained in the present study considering both types of service was below the cutoff value that classifies a positive safety culture. Besides that, there was a significant difference showing that home care workers gave higher scores of safety culture in their workplace than primary care workers. Although no studies have been found in the literature comparing the perceptions of primary and home care workers about safety culture, SAQ scores given by primary care workers in another study were close to ours13.
A study conducted in a primary care setting at the southern region of Brazil found negative scores for safety culture in almost all SAQ domains13. An opposite result was identified in another study in which primary care providers and oral health workers evaluated safety culture using the Medical Office Survey on Patient Safety Culture (MOSPSC) questionnaire, and rated safety culture positively12.
It was also found that Job satisfaction achieved the highest value, while Working conditions and Management perception had the lowest scores, with significant differences related to type of service and time of experience. These findings indicate that the participants do what "they like to do". However, the low scores of management perception indicate that they do not approve (or partially approve) actions of their leaders regarding patient safety issues. These results agree with previous studies that used SAQ in Brazil and in other countries. A study conducted with professionals from five homes in Tonsberg, Norway, found high scores of Job satisfaction, followed by Teamwork climate and Safety climate24. In another study developed in home care services in Norway, Teamwork climate was the dimension with the highest score25.
A Brazilian study also found that health professionals working in primary care have difficulty in working relationships with their managers and avoid commenting on work-related problems because they do not feel safe. In relation to this issue, managers recognized that communication problems are real in their workplace8. These situations can weaken patient safety in primary care.
In the present study, men who work in home care with three to four years of experience attributed high scores for Safety Climate, Job Satisfaction, Teamwork Climate, and the total SAQ. This means that these professionals enjoy the work that they do and have a positive view of the relationships that occur in their workplace. Until the completion of this study, no research was identified that justifies the difference in perceptions of safety culture between men and women. However, a study conducted in China with 2,584 professionals identified that women gave higher scores than man to all SAQ domains, different from what was identified in our study26.
Positive scores in the SAQ domains may indicate that professionals are satisfied with their own performance at work in situations where patient care may not be ideal. For this reason, managers should interpret the results with caution and consider the need for quality improvement interventions24.
Regarding the type of service, a study identified a similar result when assessing safety culture in home care services27. In addition, according to a Brazilian study developed in the home care services, with users and providers, participants were satisfied with the health care program and this feeling would be the result of support provided by the family health teams, even in face of incidents28.
Regarding time of professional experience, a study shows that professionals with long time of experience tend to be more critical regarding management actions and work environment characteristics29, which may justify the lower scores of Working conditions and Management perception found in the present study among those with long time of professional experience. Management perception and Teamwork climate are domains that influence all the others SAQ domains, except Perception of stress21.
The statistically significant correlations do not necessarily indicate an underlying relationship between the variables. Our analyses measured how much independent variables explains the response variable, through multiple linear regression. The regression model showed that gender, type of service, and time of professional experience contributed (positively and negatively) to Safety climate, Job satisfaction, Perception of stress, Teamwork climate, Management perception, Working conditions, and Total SAQ. Other studies have similar results and report, from multiple linear regression equations, that demographic factors such as gender, age, and participation in training significantly affect SAQ26,30.
This study has some limitations. First, self-reported surveys like the SAQ depend on the respondents' recall and may be subject to reporting bias. However, the validity of the data gathered in the study is supported by their consistency and by the fact that the SAQ is widely used and has good psychometric qualities. Second, the cross-sectional approach limits our ability to establish assertions about change through time. Third, the convenience sample and the local level of the study limits the generalizability of the findings to other contexts.
In addition, there is a scarcity of studies evaluating safety culture in primary and home care settings, and the number of studies about the dimensions of SAQ and its relationship to demographic variables is small. We suggest that further studies are needed with a larger number of health units, in other regions of the country and in other countries, to determine which factors influence safety culture in different contexts. Such factors can be used in the formulation of public policies aimed at strengthening the safety culture in primary and home care settings.