Abstract
This study utilised a mixed-method sequential exploratory approach to explore the radiation protection and monitoring practices of medical radiation workers (MRWs) in Malaysia and identify related issues in both practices. The study commenced with a pre-study phase, which consisted of a bibliometric study to review existing literature on MRWs and a pilot study to develop the interview guide. Subsequently, in the qualitative phase, face-to-face interviews (n=63) were performed to explore MRWs' perceptions towards the use of radioprotective garments and personal dosimeters and understand the underlying causes of non-adherence among workers. The interview transcripts were analysed using thematic analysis, and the results informed the subsequent quantitative stage. A validated questionnaire (Cronbach's Alpha=0.723, 0.963) was developed to evaluate MRWs' practices in relation to radiation protection and monitoring and to identify factors that influence their practices. The validated tool was administered to 411 MRWs, with 387 completing it online. The collected data were then analysed. Based on the qualitative phase results, MRWs consistently used radioprotective aprons despite facing various dilemmas in practicing radiation safety. There was less use of thyroid shields, and study respondents complained about the insufficient supply, 'inappropriate design,' and 'unsightly appearances.' The findings also revealed that the hefty penalty system imposed if the personal dosimeter was lost and the delayed supply of the devices hindered MRWs from committing to using them. Human factors, such as forgetfulness, attitude, and social influence, also contributed to non-adherence. Some MRWs felt that constant monitoring with personal dosimeters was unnecessary, as they perceived the radiation exposure at workplace to be low and safe. The quantitative findings showed that the vast majority of MRWs (88–99%) adhered to radiation protection principles. Corroborating results from the qualitative phase, adherence to personal dosimeters was low (65%), even when the devices were adequately available. Other possible factors, particularly behavioural factors, may influence the outcome, as sociodemographic factors, such as gender, the type of organisation, and working hours, explained only a small percentage of the variance in personal dosimeter use (R²=0.118). The structural equation model analysis from combining the Theory of Planned Behaviour (TPB) and Technology Acceptance Model (TAM) revealed that behavioural factors were strongly associated with actual personal dosimeter usage (R²=0.336). In fact, all three behavioural constructs, namely attitude (p<0.001), self-efficacy (p<0.001), and social factors (p<0.005), significantly influenced the actual device usage. MRWs with a negative attitude showed a high non-adherence rate to using dosimeters, while those with a higher self-efficacy showed more consistent usage. Notably, the social factor construct highlighted that workers who inconsistently use dosimeters would use the device in the presence of supervisors, subordinates, or auditors at the workplace. In conclusion, MRWs in Malaysia generally complied with the radiation protection practices by applying the ALARA principle, provided that the facilities are adequate and in acceptable conditions. The poor individual radiation monitoring practices were influenced by sociodemographic parameters to some extent but were more significantly influenced by behavioural factors.
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@phdthesis{phd-siti-farizwana,
title = {A Mixed Method Study on Use of Radioprotective Garments and Personal Dosimeters Among Malaysian Medical Radiation Workers},
author = {Siti Farizwana Mohd Ridzwan},
year = {2025},
date = {2025-02-12},
urldate = {2025-02-12},
abstract = {This study utilised a mixed-method sequential exploratory approach to explore the radiation protection and monitoring practices of medical radiation workers (MRWs) in Malaysia and identify related issues in both practices. The study commenced with a pre-study phase, which consisted of a bibliometric study to review existing literature on MRWs and a pilot study to develop the interview guide. Subsequently, in the qualitative phase, face-to-face interviews (n=63) were performed to explore MRWs\' perceptions towards the use of radioprotective garments and personal dosimeters and understand the underlying causes of non-adherence among workers. The interview transcripts were analysed using thematic analysis, and the results informed the subsequent quantitative stage. A validated questionnaire (Cronbach\'s Alpha=0.723, 0.963) was developed to evaluate MRWs\' practices in relation to radiation protection and monitoring and to identify factors that influence their practices. The validated tool was administered to 411 MRWs, with 387 completing it online. The collected data were then analysed. Based on the qualitative phase results, MRWs consistently used radioprotective aprons despite facing various dilemmas in practicing radiation safety. There was less use of thyroid shields, and study respondents complained about the insufficient supply, \'inappropriate design,\' and \'unsightly appearances.\' The findings also revealed that the hefty penalty system imposed if the personal dosimeter was lost and the delayed supply of the devices hindered MRWs from committing to using them. Human factors, such as forgetfulness, attitude, and social influence, also contributed to non-adherence. Some MRWs felt that constant monitoring with personal dosimeters was unnecessary, as they perceived the radiation exposure at workplace to be low and safe. The quantitative findings showed that the vast majority of MRWs (88\textendash99%) adhered to radiation protection principles. Corroborating results from the qualitative phase, adherence to personal dosimeters was low (65%), even when the devices were adequately available. Other possible factors, particularly behavioural factors, may influence the outcome, as sociodemographic factors, such as gender, the type of organisation, and working hours, explained only a small percentage of the variance in personal dosimeter use (R²=0.118). The structural equation model analysis from combining the Theory of Planned Behaviour (TPB) and Technology Acceptance Model (TAM) revealed that behavioural factors were strongly associated with actual personal dosimeter usage (R²=0.336). In fact, all three behavioural constructs, namely attitude (p\<0.001), self-efficacy (p\<0.001), and social factors (p\<0.005), significantly influenced the actual device usage. MRWs with a negative attitude showed a high non-adherence rate to using dosimeters, while those with a higher self-efficacy showed more consistent usage. Notably, the social factor construct highlighted that workers who inconsistently use dosimeters would use the device in the presence of supervisors, subordinates, or auditors at the workplace. In conclusion, MRWs in Malaysia generally complied with the radiation protection practices by applying the ALARA principle, provided that the facilities are adequate and in acceptable conditions. The poor individual radiation monitoring practices were influenced by sociodemographic parameters to some extent but were more significantly influenced by behavioural factors.},
note = {Doctor of Philosophy Thesis},
keywords = {},
pubstate = {published},
tppubtype = {phdthesis}
}
