Causes And Contributing Factors of Unsafe Radiation Safety Behavior Among Radiographers in Hospital Radiology Installations: A Qualitative Study

Abstract

Radiographers occupy a critical position in protecting themselves, patients, and colleagues from the hazards of ionizing radiation, yet unsafe radiation-related behavior persists in clinical practice. Existing literature has documented radiographers' knowledge, attitudes, and isolated barriers to specific protective behaviors, but has relied predominantly on single-round, questionnaire-based designs, leaving the underlying root causes and their interaction with contributing organizational factors insufficiently explored, particularly within Indonesian hospital settings. This study aimed to identify the root causes and contributing factors of unsafe radiation-related behavior among radiographers using a qualitative exploratory design. Five participants, comprising one head of the radiology room, one radiation protection officer, and three radiographers, were recruited through purposive sampling from two hospital radiology installations in Sleman and Bantul, Special Region of Yogyakarta. Data were collected through in-depth interviews and structured behavioral observation, and analyzed thematically. Findings identified root causes centered on procedural knowledge deficits, personal dosimeter non-adherence, incomplete door closure, and inconsistent hazard communication, as well as contributing factors related to infrastructure, supervision, peer influence, workload, and management commitment. These findings converged consistently across participants occupying different organizational roles, reinforcing their credibility as systemic rather than isolated concerns. Findings were synthesized within the Software-Hardware-Environment-Liveware (SHELL) human factors framework, indicating that unsafe behavior arises from interactions among procedural, physical, environmental, and interpersonal domains rather than from a single determinant. This study offers a preliminary premise for hospital radiology management to design domain-specific, rather than knowledge-only, occupational safety interventions in comparable hospital settings.