title: Using the theory of planned behaviour to model antecedents of surgical checklist use: a cross-sectional study.
abstract: BACKGROUND
  Compliance with surgical checklist use remains an obstacle in the context of checklist implementation programs. The theory of planned behaviour was applied to analyse attitudes, perceived behaviour control, and norms as psychological antecedents of individuals' intentions to use the checklist.
  
  
  METHODS
  A cross-sectional survey study with staff (N = 866) of 10 Swiss hospitals was conducted in German and French. Group mean differences between individuals with and without managerial function were computed. Structural equation modelling and confirmatory factor analysis was applied to investigate the structural relation between attitudes, perceived behaviour control, norms, and intentions.
  
  
  RESULTS
  Significant mean differences in favour of individuals with managerial function emerged for norms, perceived behavioural control, and intentions, but not for attitudes. Attitudes and perceived behavioural control had a significant direct effect on intentions whereas norms had not.
  
  
  CONCLUSIONS
  Individuals with managerial function exhibit stronger perceived behavioural control, stronger norms, and stronger intentions. This could be applied in facilitating checklist implementation. The structural model of the theory of planned behaviour remains stable across groups, indicating a valid model to describe antecedents of intentions in the context of surgical checklist implementation.
authors.affiliation: Patient Safety Switzerland, Asylstrasse 77, 8032, Zurich, Switzerland. mascherek@patientensicherheit.ch.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Mascherek
authors.affiliation: Patient Safety Switzerland, Asylstrasse 77, 8032, Zurich, Switzerland. gehring@patientensicherheit.ch.
authors.forename: Katrin
authors.initials: K
authors.lastname: Gehring
authors.affiliation: Patient Safety Switzerland, Asylstrasse 77, 8032, Zurich, Switzerland. bezzola@patientensicherheit.ch.
authors.forename: Paula
authors.initials: P
authors.lastname: Bezzola
authors.affiliation: Patient Safety Switzerland, Asylstrasse 77, 8032, Zurich, Switzerland. schwappach@patientensicherheit.ch.|Institute of Social and Preventive Medicine (ISPM), University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland. schwappach@patientensicherheit.ch.
authors.forename: David L B
authors.initials: DL
authors.lastname: Schwappach
mesh_terms: D000328:Adult; D001290:Attitude; D057189:Checklist; D003430:Cross-Sectional Studies; D005260:Female; D013502:General Surgery; D006801:Humans; D033182:Intention; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008875:Middle Aged; D017146:Models, Organizational; D013503:Surgery Department, Hospital; D011795:Surveys and Questionnaires; D013557:Switzerland