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Table 1 Evaluation form items and response modes

From: Implementing a survey for patients to provide safety experience feedback following a care transition: a feasibility study

Item number Item Response mode
1 I understood the purpose of the Safety Survey Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree)
2 I understood what was meant by ‘your recent transfer’ Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree)
3 I understood each of the questions Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree)
4 The questions asked accurately captured what made me feel safe or unsafe Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree)
5 There was nothing missing from the Safety Survey Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree)
6 I did not experience difficulties completing the Safety Survey Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree)
7 I felt that the colour scheme was useful Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree)
8 The size of the text was appropriate Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree)
9 The Safety Survey allows me to provide useful feedback about the healthcare I have received Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree)
10 By receiving this form I feel I am more educated about patient safety Likert scale, 1–5 (1 = Agree, 3 = Neither Agree or Disagree, 5 = Disagree)
11 Please use the space to expand on your answers or say anything about the survey that you think is relevant Free-text
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