Development of a multicomponent intervention to improve medication error reporting among healthcare professionals: a theory-informed approach using the behaviour change wheel and the theoretical domains framework in China.

Introduction: Under-reporting of medication errors weakens reporting-and-learning systems and delays prevention efforts. Although medication error reporting is recognised as a core component of patient safety and organisational learning, reporting remains suboptimal in hospital practice. Healthcare professionals are central to the identification and reporting of medication errors and near misses; improving reporting therefore requires a change in the behaviour of clinical teams. In this paper, we describe the development of a theory- and evidence-informed multicomponent intervention, the Medication Error Reporting Enhancement Program (MERP), to promote medication error reporting in Chinese hospitals. Methods: A structured intervention development process guided by the Behaviour Change Wheel (BCW) was undertaken. It comprised three stages: (i) understanding the target behaviour by mapping determinants of medication error reporting identified in a Theoretical Domains Framework (TDF)-guided qualitative interview study to Capability-Opportunity-Motivation Behavior Model (COM-B) components; (ii) identifying intervention options by selecting BCW intervention functions and supporting policy categories using APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects and Equity); and (iii) specifying intervention content and delivery, including selecting behaviour change techniques (BCTs) using BCT Taxonomy v1 (BCTTv1), refining components through a stakeholder co-design workshop, and documenting the final programme using the Template for Intervention Description and Replication (TIDieR) checklist. Results: The behavioral diagnosis identified determinants of medication error reporting spanning all 14 TDF domains, with eight domains emerging as priority targets for change. Mapping these determinants to the BCW and applying the Affordability, Practicality, Effectiveness and Cost-Effectiveness, Acceptability, Side Effects/Safety, and Equality (APEASE) criteria resulted in an intervention architecture comprising seven intervention functions (education, training, persuasion, incentivisation, environmental restructuring, modelling and enablement) and four policy categories (communication/marketing, regulation, service provision and fiscal measures-conditional on resources). Intervention content was then specified using 14 BCTs, which were operationalised into the MERP and documented using the TIDieR checklist to enhance transparency and replicability. Conclusion: A TDF-to-BCW pipeline produced a theoretically grounded, system-aligned intervention blueprint that targets multi-level determinants of reporting behaviour. The resulting MERP offers a transparent basis for pilot testing and effectiveness-implementation evaluation. Its potential transferability to other safety-reporting behaviors is theoretical and mechanism-based, and should be empirically tested in other contexts.