Theory of planned behavior applied to patient safety
a scoping review
Keywords:
Attitude of health personnel, Health services, Models, psychological, Nursing care, Safety managementAbstract
This study aimed to map the existing evidence on how the behavior of nursing professionals is associated with patient safety in hospital settings, based on the Theory of Planned Behavior. A scoping review was conducted across eight electronic databases, initially identifying 2,531 studies. After applying inclusion and exclusion criteria, 29 articles were selected for dataextraction and synthesis. The evidence indicates that the most frequently studied behaviors were general adherence to patient safety protocols, compliance with safe surgery routines, and hand hygiene practices. The determinants of behavior – according to the Theory of Planned Behavior – varied significantly depending on the specific conduct, underscoring the complexity of adhering to safety practices. Identifying the specific behavioral determinants of healthcare workers within care settings is a crucial step in developing effective interventions. Targeted strategies can enhance adherence to safety protocols, promote interprofessional collaboration to improve patient safety in the hospital setting, and help reduce team workload. While training strategies were frequently cited in the reviewed literature as a means to influence behavior, evidence indicates they have not been effective, highlighting the need for alternative interventions.
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Ab Malik, N., Mohamad Yatim, S., Lam, O. L. T., Jin, L., & McGrath, C. (2017). Factors influencing the provision of oral hygiene care following stroke: an application of the Theory of Planned Behaviour. Disability and Rehabilitation, 40(8), 889-893. https://doi.org/10.1080/09638288.2016.1277397
Abry, S., Mehrabian, F., Omidi, S., Karimy, M., Kasmaei, P., & Haryalchi, K. (2022). Investigation of factors related to the behavior of reporting clinical errors in nurses working in educational and medical centers in Rasht city, Iran. BMC Nursing, 21(1). https://doi.org/10.1186/s12912-022-01134-3
Ajzen I. (1985). From intentions to action: a theory of planned behavior. In J. Kuhl & J. Beckmann (Eds.), Action control: from cognition to behavior. Springer-Verlag.
Ajzen, I. (1991). The Theory of Planned Behavior. Organizational Behavior and Human Decision Processes, 50(2), 179-211. https://doi.org/10.1016/0749-5978(91)90020-T
Ajzen, I. (2002). Perceived behavioral control, self-efficacy, locus of control, and the Theory of Planned Behavior. Journal of Applied Social Psychology, 32(4), 665-683.
Alves, M. F. T., Carvalho, D. S., & Albuquerque, G. S. C. (2019). Barriers to patient safety incident reporting by Brazilian health professionals: an integrative review. Ciência & Saúde Coletiva, 24(8), 2895-2908. https://doi.org/10.1590/1413-81232018248.23912017
Angelis, A. D., Pancani, L., Steca, P., Colaceci, S., Giusti, A., Tibaldi, L., Alvaro, R., Ausili, D., & Vellone, E. (2017). Testing an explanatory model of nurses’ intention to report adverse drug reactions in hospital settings. Journal of Nursing Management, 25(4), 307-317. https://doi.org/10.1111/jonm.12467
Appleby, B. E. (2018). Implementing guideline-checklists: Evaluating health care providers intentional behaviour using an extended model of the theory of planned behaviour. Journal of Evaluation in Clinical Practice, 25(4), 664-675. https://doi.org/10.1111/jep.13075
Aromataris, E., & Munn, Z. (Eds.). (2020). JBI Manual for Evidence Synthesis. JBI.global. https://presencial.moodle.ufsc.br/pluginfile.php/1310067/mod_resource/content/0/JBI%20Manual%20for%20Evidence%20Synthesis%202024.pdf#page=12
Beatty, P. C. W., & Beatty, S. F. (2004). Anesthetists’ intentions to violate safety guidelines. Anaesthesia, 59(6), 528-40. https://doi.org/10.1111/j.1365-2044.2004.03741
Belela-Anacleto, A. S. C., Kusahara, D. M., Peterlini, M. A. S., & Pedreira, M. L. G. (2019). HM compliance and behavioural determinants in a paediatric intensive care unit: an observational study. Australian Critical Care, 32(1), 21–27. https://doi.org/10.1016/j.aucc.2018.02.010
Bi, J., Yin, X., Li, H., Gao, R., Zhang, Q., Zhong, T., Zan, T., Guan, B., & Li, Z. (2020). Effects of monitor alarm management training on nurses’ alarm fatigue: a randomized controlled trial. Journal of Clinical Nursing, 29(21-22), 4203-4216. https://doi.org/10.1111/jocn.15452
Blomgren, P.-O., Lytsy, B., Hjelm, K., & Swenne, C. L. (2021). Healthcare workers’ perceptions and acceptance of an electronic reminder system for hand hygiene. Journal of Hospital Infection, 108, 197-204. https://doi.org/10.1016/j.jhin.2020.12.005
Bravin, S. H. M. (2021). Higienização das mãos como precaução sinestésica, por ininteligibilidade humana e institucional para o não aparente [Dissertação de mestrado]. Universidade Estadual Paulista.
Carvalho, R. E. F. L., Arruda, L. P., Nascimento, N. K. P., Sampaio, R. L., Cavalcante, M. L. S. N., & Costa, A. C. P. (2017). Assessment of the culture of safety in public hospitals in Brazil. Revista Latino-Americana de Enfermagem, 25, e2849.
Cyrino, C. M. S., Dell’Acqua, M. C. Q., Castro, M. C. N., Oliveira, E. M., Deodato, S., & Almeida, P. M. V. (2017). Nursing Activities score by assistance sites in Intensive Care Units. Escola Anna Nery, 22(1), e20170145. https://doi.org/10.1590/2177-9465-EAN-2017-0145
Ekayani, N. P., Wardhani, V., & Rachmi, A. T. (2017). Nurses’ intention and behavior in reporting adverse event: application of Theory of Planned Behavior. Kesmas: National Public Health Journal, 11(3), e1091. https://doi.org/10.21109/kesmas.v11i3.1091
Fernandez, R., tenHam-Baloyi, W., Mathew, E., Secginli, S., Bahar, Z., Jans, C., Nahcivan, N., Torun, G., Lapkin, S., & Green, H. (2022). Predicting behavioural intentions towards medication safety among student and new graduate nurses across four countries. Journal of Clinical Nursing, 32(5-6), 789-798. https://doi.org/10.1111/jocn.16330
Fleming, M. L., Barner, J. C., Brown, C. M., Shepherd, M. D., Strassels, S., & Novak, S. (2014). Using the theory of planned behavior to examine pharmacists’ intention to utilize a prescription drug monitoring program database. Research in Social and Administrative Pharmacy, 10(2), 285-96. https://doi.org/10.1016/j.sapharm.2013.05.009
Gagnon, M.-P., Cassista, J., Payne-Gagnon, J., & Martel, B. (2015). Applying the Theory of Planned Behaviour to understand nurse intention to follow recommendations related to a preventive clinical practice. Journal of Research in Nursing, 20(7), 582-593. https://doi.org/10.1177/1744987115611715
Gavaza, P., Brown, C. M., Lawson, K. A., Rascati, K. L., Wilson, J. P., & Steinhardt, M. (2011). Examination of pharmacists’ intention to report serious adverse drug events (ADEs) to the FDA using the Theory of Planned Behavior. Research in Social and Administrative Pharmacy, 7(4), 369-82. https://doi.org/10.1016/j.sapharm.2010.09.001
Godin, G., & Kok, G. (1996). The Theory of Planned Behavior: a review of its applications to health-related behaviors. American Journal of Health Promotion, 11(2), 87-98.
Godin, G., & Vézina-In, L. A. (2019). Theory of prediction. In G. Godin (Org.), Health behaviors: understanding to better intervene. Editora Unicamp.
Gunawan, Y., Sukartiningsih, M. C. E., Landudjama, L., Kody, M. M., & Agustine, U. (2022). An overview of the theory of planned behavior approach in nursing care for dengue fever patients. Open Access Macedonian Journal of Medical Sciences, 10(G), 52-57.
Hassan, Z. M., Wahsheh, M. A., & Hindawi, O. S. (2009). Understanding Hand Hygiene Behavior Among Jordanian Registered Nurses. Infectious Diseases in Clinical Practice, 17(3), 150-156. https://doi.org/10.1097/ipc.0b013e31818cd65f
Heidmann, A., Trindade, L. F., Schmidt, C. R., Loro, M. M., Fontana, R. T., & Kolankiewicz, A. C. B. (2020). Contributive factors for the consolidation of patient safety culture in the hospital environment. Escola Anna Nery, 24(1). https://doi.org/10.1590/2177-9465-ean-2019-0153
Hung, C.-C., Chu, T.-P., Lee, B.-O., & Hsiao, C.-C. (2015). Nurses’ attitude and intention of medication administration error reporting. Journal of Clinical Nursing, 25(3-4), 445-453. https://doi.org/10.1111/jocn.13071
Hung, C.-C., Lee, Bih-O., Liang, H.-F., & Chu, T.-P. (2016). Factors influencing nurses’ attitudes and intentions toward medication administration error reporting. Japan Journal of Nursing Science, 13(3), 345-354. https://doi.org/10.1111/jjns.12113
Javadi, M., Kadkhodaee, M., Yaghoubi, M., Maroufi, M., & Shams, A. (2013). Applying Theory of Planned Behavior in Predicting of Patient Safety Behaviors of Nurses. Materia Socio Medica, 25(1), 52. https://doi.org/10.5455/msm.2013.25.52-55
Jember, A., Hailu, M., Messele, A., Demeke, T., & Hassen, M. (2018). Proportion of medication error reporting and associated factors among nurses: a cross sectional study. BMC Nursing, 17(1). https://doi.org/10.1186/ s12912-018-0280-4
Jenner, E. A., Watson, P. W. B., Miller, L., Jones, F., & Scott, G. M. (2002). Explaining hand hygiene practice: An extended application of the Theory of Planned Behaviour. Psychology, Health & Medicine, 7(3), 311-326. https://doi.org/10.1080/13548500220139412
Kim, N. Y., & Jeong, S. Y. (2021). Perioperative patient safety management activities: A modified theory of planned behavior. Plos One, 16(6), e0252648. https://doi.org/10.1371/journal.pone.0252648
Lee, Y.-H., Yang, C.-C., & Chen, T.-T. (2015). Barriers to incident-reporting behavior among nursing staff: A study based on the theory of planned behavior. Journal of Management & Organization, 22(1), 1-18. https://doi.org/10.1017/jmo.2015.8
Lenggono, K. A., Qomariyatus, S., Gatot, C., Sri, A., Ahsan, null, Patria, D. K. A., & Adi, S. (2023). Discipline as complete mediation in the implementation of the Theory Planned Behaviour of nurse’s handwashing compliance. The Medical Journal of Malaysia, 78(3), 296-300. https://pubmed.ncbi.nlm.nih.gov/37271838/
Machen, S., Jani, Y., Turner, S., Marshall, M., & Fulop, N. J. (2019). The role of organizational and professional cultures in medication safety: a scoping review of the literature. International Journal for Quality in Health Care, 31(10), G146-G157. https://doi.org/10.1093/intqhc/mzz111
Mascherek, A. C., Gehring, K., Bezzola, P., & Schwappach, D. L. B. (2015). Using the theory of planned behavior to model antecedent of surgical checklist use: a cross-sectional study. BMC Health Services Research, 15, 462. https://doi.org/10.1186/s12913-015-1122-7
Mayer, B. L. D., Bernardo, M. S., Nascimento, E. R. P., Bertoncello, K. C. G., & Raulino, A. R. (2019). Nurses and patient advocacy: a theoretical reflection. Revista Mineira de Enfermagem, 23, e-1191.
McLaws, M.-L., Maharlouei, N., Yousefi, F., & Askarian, M. (2012). Predicting hand hygiene among Iranian health care workers using the theory of planned behavior. American Journal of Infection Control, 40(4), 336-339. https://doi.org/10.1016/j.ajic.2011.04.004
Mendez, R. D. R., Rodrigues, R. C. M., Cornélio, M. E., Gallani, M. C. B. J., & Godin, G. (2010). Development of an instrument to measure psychosocial factors determining physical activity behavior in coronary patients. Revista da Escola de Enfermagem da USP, 44(3), 584-596. https://doi.org/10.1590/s0080-62342010000300006
Mullan, B., Liddelow, C., Haywood, D., & Breare, H. (2022). Behaviour Change Training for Health Professionals: Evaluation of a Two-hour Workshop. JMIR Formative Research, 6(11), e42010. https://doi.org/10.2196/42010
O’Boyle, C. A., Henly, S. J., & Larson, E. (2001). Understanding adherence to hand hygiene recommendations: the theory of planned behavior. American Journal of Infection Control, 29(6), 352-360.
Oliveira, J. K. A., Llapa-Rodriguez, E. O., Lobo, I. M. F., Silva, L. S. L., Godoy, S., & Silva, G. G. (2018). Patient safety in nursing care during medication administration. Revista Latino-Americana de Enfermagem, 26, e3017. https://doi.org/10.1590/1518-8345.2350.3017
Omura, M., Levett-Jones, T., Stone, T. E., Maguire, J., & Lapkin, S. (2015). Measuring the impact of an interprofessional multimedia learning resource on Japanese nurses and nursing students using the Theory of Planned Behavior Medication Safety Questionnaire. Nursing & Health Sciences, 17(4), 500-506. https://doi.org/10.1111/nhs.12224
Omura, M., Stone, T. E., Maguire, J., & Levett-Jones, T. (2018). Exploring Japanese nurses’ perceptions of the relevance and use of assertive communication in healthcare: A qualitative study informed by the Theory of Planned Behaviour. Nurse Education Today, 67(67), 100-107. https://doi.org/10.1016/j.nedt.2018.05.004
Piras, S. E., Minnick, A., Lauderdale, J., Dietrich, M. S., & Vogus, T. J. (2018). The Effects of Social Influence on Nursesʼ Hand Hygiene Behaviors. JONA: The Journal of Nursing Administration, 48(4), 216-221. https://doi.org/10.1097/nna.0000000000000602
Porto, J. S., & Marziale, M. H. P. (2016). Reasons and consequences of low adherence to standard precautions by the nursing team. Revista Gaúcha de Enfermagem, 37(2), e57395.
Ribeiro, I. C. A., & Cunha, K. C. S. (2018). Avaliação do clima de segurança do paciente em um hospital cirúrgico oftalmológico. Enfermería Global, 21(52), 350-364. https://doi.org/10.6018/eglobal.17.4.310741
Rogers, J. W., Fleming, M., Tipton, J., Ward, A., Garey, K. W., & Pitman, E. P. (2017). Investigating inpatient medication administration using the theory of planned behavior. American Journal of Health-System Pharmacy, 74(24), 2065-2070. https://doi.org/10.2146/ajhp160502
Santos, P. R. A., Rocha, F. L. R., & Sampaio, C. S. J. C. (2019). Actions for safety in the prescription, use, and administration of medications in emergency care units. Revista Gaúcha de Enfermagem, 40, e20180347.
Sexton, J. B., Helmreich, R. L., Neilands, T. B., Rowan, K., Vella, K., Boyden, J., Roberts, P. R., & Thomas, E. J. (2006). The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Services Research, 6, 44. https://doi.org/10.1186/1472-6963-6-44
Sin, C. S., & Rochelle, T. L. (2022). Using the theory of planned behaviour to explain hand hygiene among nurses in Hong Kong during COVID-19. Journal of Hospital Infection, 123, 119-125. https://doi.org/10.1016/j.jhin.2022.01.018
Strand, T., & Lindgren, M. (2010). Knowledge, attitudes and barriers towards prevention of pressure ulcers in intensive care units: a descriptive cross-sectional study. Intensive & Critical Care Nursing, 26(6), 335-42. https://doi.org/10.1016/j.iccn.2010.08.006
Tanguay, A., LeMay, S., Reeves, I., Gosselin, É., & St-Cyr-Tribble, D. (2019). Factors influencing oral care in intubated intensive care patients. Nursing in Critical Care, 25(1), 53-60. https://doi.org/10.1111/nicc.12456
Vandenkerkhof, E. G., Hall, S., Wilson, R., Gay, A., & Duhn, L. (2009). Evaluation of an Innovative Communication Technology in an Acute Care Setting. CIN: Computers, Informatics, Nursing, 27(4), 254-262. https://doi.org/10.1097/ncn.0b013e3181a91bf6
Wakefield, J. G., McLaws, M.-L., Whitby, M., & Patton, L. (2010). Patient safety culture: factors that influence clinician involvement in patient safety behaviours. BMJ Quality & Safety, 19(6), 585-591. https://doi.org/10.1136/qshc.2008.030700
White, K. M., Jimmieson, N. L., Obst, P. L., Graves, N., Barnett, A., Cockshaw, W., Gee, P., Haneman, L., Page, K., Campbell, M., Martin, E., & Paterson, D. (2015). Using a theory of planned behaviour framework to explore hand hygiene beliefs at the “5 critical moments” among Australian hospital-based nurses. BMC Health Services Research, 15, 59. https://doi.org/10.1186/s12913-015-0718-2
White, K. M., Starfelt, L. C., Jimmieson, N. L., Campbell, M., Graves, N., Barnett, A. G., Cockshaw, W., Gee, P., Page, K., Martin, E., Brain, D., & Paterson, D. (2015). Understanding the determinants of Australian hospital nurses’ hand hygiene decisions following the implementation of a national hand hygiene initiative. Health Education Research, 30(6), 959-970. https://doi.org/10.1093/her/cyv057
Williams, S. D., Phipps, D. L., & Ashcroft, D. (2015). Examining the attitudes of hospital pharmacists to reporting medication safety incidents using the theory of planned behavior. International Journal for Quality in Health Care, 27(4), 297-304.
World Health Organization. (2009). The conceptual framework for the international classification for patient safety. www.who.int/publications/i/item/WHO-IER-PSP-2010.2
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Copyright (c) 2026 Rafaela Andolhe, GiuliaDos Santos Goulart, Marculina da Silva, Carla Renata Silva Andrechuk, Maria Cecília Bueno Jayme Gallani, Roberta Cunha Matheus Rodrigues
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