Understanding RTTs’ Intentions to Execute Best Practice Using the Theory of Planned Behaviour

Abstract

Purpose

Radiation Therapists (RTTs) acquire knowledge, skills, and understanding to perform best practice via initial training and ongoing professional development. However, adoption of best practice may not always be feasible given the nature of the clinical environment. The theory of planned behaviour (TPB) can help understand the impact of professional development on a healthcare professional’s intention to adopt best practices, measuring five main constructs: intention, social influence, beliefs about capabilities, moral norms, and beliefs about consequences. The purpose of this study is to use a generally acknowledged ‘best practice’ (bladder/rectum prep for prostate radiotherapy) as a specific clinical example to examine factors that may influence intention to adopt best practice in Canadian RTTs.

Methods

A four-part survey hosted on Redcap was shared via email amongst RTTs and Radiation Therapy students across Canada via CAMRT membership notification blasts from March to June 2025. Part 1 included general demographics, Part 2 included aspects of the practice environment, Part 3 included perceived ‘best practice’ for prostate prep, and Part 4 included the CPD-RQ. The CPD-RQ is a validated questionnaire, based on TPB, where questions are grouped to obtain a mean score reflective of the five main constructs. A high score (max 7) represents a positive assessment of the construct. Descriptive statistics and Pearson’s correlation coefficient were used to identify any relationship between RTT intention to adopt ‘best practice’ and other planned behaviour constructs.

Results

A total of 228 survey responses were received. The number of complete responses varied across the survey sections, with 133 respondents completing all four parts. Of these, 118 respondents identified as RTTs, mostly working in Canada, working in treatment delivery (78.0%), treatment planning (12.7%) and simulation (9.3%). 122 RTTs completed the CPD-RQ section. The majority of those respondents (97.6%) had an intention score of 5 or higher. The mean score for each construct is as follows (mean, SD): intention (6.54, 0.65), social influence (6.31, 0.74), beliefs about capabilities (5.94, 0.81), moral norms (6.51, 0.61), and beliefs about consequences (6.55, 0.65). Moral norms had a moderate to high linear association with intention (r = 0.57), followed by social influence (r = 0.47) and beliefs about consequence (r = 0.44), whereas beliefs about capabilities had a low association (r = 0.30), p < 0.05 for all correlations.

Conclusion

Responses to this questionnaire suggest that most RTTs intend to execute what they perceive to be best practice for prostate prep. The intention to adopt that best practice is most strongly influenced by one’s sense of professional or ethical obligation (moral norms). Consistent with TPB, the low association with ‘beliefs about capabilities’ may reflect the impact of extrinsic factors like practice environment or workload, which can diminish one’s perceived capability to adopt best practice. The results of these findings highlight the importance of ethically and contextually grounded best practices.