Using the Theory of Planned Behavior as a Predictor of Radiologic Technologists' Use of Patient Radiation Protection Best Practices: a Regional Study
Authors:   ,   Andrews University, Boyd Brenda 
Published: April 2023

Problem. A growing concern exists that patients are receiving an increase in radiation exposure while undergoing medical imaging exams. According to a March 2009 report by the National Council on Radiation Protection and Measurements (NCRP), the U.S. population's total exposure to ionizing radiation has nearly doubled over the past two decades. With the introduction of new digital radiology equipment, patient dose is on the rise. Possible reasons for a radiologic technologist's behavior include: influence by availability or lack of equipment, policies, social pressure, attitudes, and a safety culture. Little research has been done in this area, specifically with applying a theoretical framework to a study. This study attempts to fill a gap to understand the attitudes, social pressures, behavioral control issues, impact of new digital technology, and the demographic factors that influence the demonstration of patient radiation protection best practices in order to reduce patient radiation exposure during radiography exams. Method. This study used ex post factor research design. The most sophisticated type of ex post facto research design was used, which is ex post facto with hypotheses and controls for viable alternative explanations of research outcomes. Statistical analysis was conducted on the data that were gathered using descriptive statistics of demographic factors of the study sample: scale descriptives for reliability of the variables and modified variables in the study; power analysis; correlations and analysis of variance between the components of Ajzen’s theory of planned behavior (intentions, past behaviors, attitudes, social pressures/norms, perceived behavioral control); and multiple regression analysis for controlling for demographics and the constructs of the theory of planned behavior. The development of an 80-item quantitative questionnaire and the design of this study were based on Ajzen’s theory of planned behavior. The purpose of the study was to predict the intentions and past behaviors of radiologic technologists in the area of patient radiation protection best practices and to predict the use of new digital equipment and digital techniques to lower patient dose. Experts in the field of radiologic technology were consulted using qualitative-type questions to develop the variables in the survey. Dr. Icek Ajzen, the developer of the theory of planned behavior, consulted on the questionnaire development. Participants from the Southwestern Region of the United States, but primarily in Southern California, were asked in an online questionnaire to self-report on their intentions and past behaviors regarding patient radiation protection best practices and the use of new digital technology and digital techniques, on the topics of attitude, social pressures/norms, and perceived behavioral control. The participants answered questions using a 7-point Likert scale. Results. The survey was sent to 365 participants with a return of 173 respondents, yielding a 47% response rate. Data were used to calculate descriptive statistics, correlations, and multiple linear regressions. Significant correlational findings include the following: intentions predict past behaviors; attitudes, social pressures/norms, and perceived behavioral control predict intentions and past behavior; intention scores are higher than past behaviour scores; attitudes have more significance to predicting intentions and past behaviorover social pressures/norms and perceived behavioral control; patients have more significant influence on radiologic technologists than do their co-workers; demographic variables of age, gender, and years in practice are significant in predicting intentions--specifically, females, more years in practice, and older radiologic technologists demonstrate higher intentions than past behaviors; demographic variables of age, gender, years in practice, primary roles (specifically students), and facility type are significant in predicting past behavior; a radiologic technologist's attitudes of reducing patient radiation exposure, being a positive role model, and doing something ethical/moral are significant in predicting intentions; and feeling rushed, trauma situation, lack of equipment in the department, policies, and a safety culture are predictive of intentions. Conclusions. The intent of this research has been to fill a gap in knowledge about how a radiologic technologist's attitudes, social pressures/subjective norms, perceived behavioral control, demographic factors, and certain organizational variables are correlated with the behavior that supports patient radiation protection best practices. The goal was to address the growing concern that patients are receiving an increase in radiation exposure while undergoing medical imaging exams. It is important to understand what drives a radiologic technologist to perform patient radiation protection best practice behavior. Based on Ajzen's theory of planned behavior that intentions and past behavior could predict future behavior, and the drivers of the best practice behavior can be identified, then hospital and education facilities could use this information to assess and develop organizational plans to instill and promote patient radiation protection best practice behavior in radiologic technologist staff and students. The major findings of this study provide data to predict the behaviors of radiologic technologists in the area of patient radiation protection best practices and the use of new digital technology and digital techniques. Further research is needed to understand the organizational issues that impact the use of patient radiation protection.