Theory of planned behavior applied to patient safety: a scoping review

Andolhe, Rafaela; Goulart, Giulia dos Santos; Silva, Marculina da; Andrechuk, Carla Renata Silva; Gallani, Maria Cecília Bueno Jayme; Rodrigues, Roberta Cunha Matheus

doi:10.1590/1982-0275202643e10649

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Sumário

REVIEW ARTICLE | Social Psychology • Estud. psicol. 43 • 2026 • https://doi.org/10.1590/1982-0275202643e10649 linkcopy

Theory of planned behavior applied to patient safety: a scoping review

Teoria do comportamento planejado aplicada à segurança do paciente: uma revisão de escopo

Authorship SCIMAGO INSTITUTIONS RANKINGS

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 data extraction 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.

Keywords
Attitude of health personnel; Health services; Models, psychological; Nursing care; Safety management

Strategy
Population	Nursing professionals
Concept	Behaviors based on the Theory of Planned Behavior
Context	Hospital setting
Types of Study	Randomized trials; quasi-randomized trials; controlled trials; case-control studies; and case series

N	Author (Year), Location	Behavior	Approach	Behavior Determinants
1	O’Boyle et al. (2001), EUA	Adherence to hand hygiene	Prospective	The TPB determinants assessed the self-reported intention for hand hygiene. The intensity of the activity predicted the observed adherence to hand hygiene.
2	Vandenkerkhof et al. (2009), Canada	Adherence to safe care practices	Cross-sectional	Attitude was an indicator of behavior change prior to the implementation of the communication device. Perceived behavioral control was an indicator of device use after deployment in the unit.
3	Hassan et al. (2009), Jordania	Adherence to hand hygiene	Cross-sectional	Positive correlations were found between intention and subjective norms, normative beliefs, outcome beliefs, and perceived behavioral control.
4	Wakefield et al. (2010), Australia	Adherence to patient safety protocols	Cross-sectional	Belief in colleagues’ professional behavior and belief in preventive actions were motivating factors.
5	Strand & Lindgren (2010), Sweden	Adherence to safe care practices	Cross-sectional	Beliefs indicated that pressure injury prevention is important, but lack of time and high patient morbidity were seen as barriers.
6	Jenner et al. (2002), UK	Adherence to hand hygiene	Cross-sectional	Attitudes and personal responsibility were significant predictors of intention, while perceived behavioral control and intention were significant predictors of behavior.
7	Javadi et al. (2013), Iran	Adherence to safe care practices	Cross-sectional	Normative beliefs had the greatest influence on nurses’ intention to implement patient safety behaviors, followed by subjective norms.
8	Lee et al. (2015), New Zealand	Reporting of adverse events	Cross-sectional	Perceived behavioral control played an important role in the intention to report incidents when the individual possessed the necessary skills.
9	Omura et al. (2015), Japan	Adherence to safe medication protocols	Quasi-experimental	Nurses showed greater intention to adopt the behavior when they had higher scores in perceived behavioral control and subjective norms.
10	White, Jimmieson, et al. (2015), Australia	Adherence to hand hygiene	Prospective	Perceived behavioral control was an indicator of behavior adherence.
11	Gagnon et al. (2015), Canada	Adherence to safe medication protocols	Quantitative	Perceived behavioral control and attitude were determinants of behavior adherence.
12	White, Starfelt, et al. (2015), Australia	Adherence to hand hygiene	Cross-sectional	All correlations with intention were significant for perceived behavioral control and group norms.
13	Hung et al. (2015), Taiwan	Reporting of medication administration errors	Cross-sectional	The attitudes of nurse managers and colleagues were decisive for the intention to report medication administration errors.
14	Hung et al. (2016), Taiwan	Reporting of medication administration errors	Cross-sectional	Attitudinal beliefs were determinants of intention among nurses.
15	Ekayani et al. (2017), Indonesia	Reporting of adverse events	Cross-sectional	Attitude and perceived behavioral control were determinants for reporting adverse events. Perceived control was an important variable in reporting adverse events within the statistical model.
16	Rogers et al. (2017), EUA	Use of automated dispensing cabinets	Cross-sectional	Attitude and subjective norms were independent factors associated with the use of automated dispensing cabinets.
17	Angelis et al. (2017), Italy	Reporting of adverse events	Cross-sectional	Attitude, perceived behavioral control, and subjective norms were determinants of intention among nurses.
18	Omura et al. (2018), Australia	Adherence to safe care practices	Qualitative	Normative and control beliefs were related to assertive communication.
19	Ab Malik et al. (2017)	Intention to provide oral hygiene care	Cross-sectional	Attitude and subjective norms had a positive association with the intention to provide oral hygiene care.
20	Piras et al. (2018), EUA	Adherence to hand hygiene	Cross-sectional	Subjective norms and perceived behavioral control determined hand hygiene behavior.
21	Appleby (2018), UK	Adherence to safe care practices	Quantitative	Nurses’ intention to implement checklists was predicted by different variables.
22	Belela-Anacleto et al. (2019), Brazil	Adherence to hand hygiene	Cross-sectional	Subjective norm was a determinant of the intention to perform the behavior.
23	Tanguay et al. (2019), Canada	Intention to provide oral hygiene care	Cross-sectional	Perceived behavioral control and attitude were the most important determinants of intention for engaging in oral care.
24	Bi et al. (2020), China	Adherence to safe care practices	Randomized study	Subjective norms were associated with alarm fatigue, which reduces the behavior.
25	Blomgren et al. (2021), Sweden	Adherence to hand hygiene	Qualitative	There was positive acceptance of the electronic reminder system.
26	Kim & Jeong (2021), Korea	Adherence to the surgical safety protocol	Cross-sectional	Work-related factors were negatively associated with perceived behavioral control. The patient safety management system was positively associated with attitude, subjective norm, and perceived behavioral control.
27	Sin & Rochelle (2022), China	Adherence to hand hygiene	Qualitative	The Theory of Planned Behavior provides a useful and effective framework for explaining nurses’ hand hygiene behavior during the COVID-19 outbreak.
28	Abry et al. (2022), Iran	Reporting of medication administration errors	Qualitative	Fear of consequences, social pressure, and lack of necessary knowledge/skills to identify medical errors are barriers to translating intention into behavior.
29	Lenggono et al. (2023), Indonesia	Adherence to hand hygiene	Quantitative	Nurses are expected to continuously improve their discipline independently or with the support of training activities facilitated by the hospital.

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Programa de Pós-Graduação em Psicologia, Pontifícia Universidade Católica de Campinas Editora Splendet, Pontifícia Universidade Católica de Campinas, Campus I, Rua Prof. Dr. Euryclides de Jesus Zerbini, 1516, Pq. Rural Fazenda Santa Cândida, Telefone: (55 19) 3343-7223. - Campinas - SP - Brazil
E-mail: psychologicalstudies@puc-campinas.edu.br

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