Abstract
BACKGROUND: Effective communication is critical in healthcare for patient safety and teamwork. Assertiveness, often mistaken for aggressiveness, enables professionals to express concerns confidently while maintaining respect. Despite its importance, assertiveness training is not explicitly emphasized in medical and nursing guidelines. This systematic review evaluates the impact of assertiveness communication training, explores barriers to its implementation, and examines different training methods, particularly in the shift toward virtual learning. METHODS: A systematic review was conducted using Ovid MEDLINE, EMBASE, and Cochrane Library (2000-present). Studies were selected based on PICOS criteria: population (hospital-based healthcare professionals), intervention (assertiveness training), comparison (no training), outcomes (communication improvements, barriers identified), and study design (quantitative and qualitative). The Critical Appraisal Skills Programme (CASP) checklist was used for quality assessment. Due to heterogeneity in interventions, a narrative synthesis and thematic analysis were performed. RESULTS: Eight studies met inclusion criteria (two randomized control trials, one cohort, one case-control, two quasi-experimental, two cross-sectional). Most demonstrated that assertiveness training improves “speaking up” behaviors and confidence. Barriers included hierarchical structures, fear of repercussions, and cultural constraints. Simulation-based and face-to-face training were more effective than brief workshops or online modules. Risk of bias was assessed, revealing variations in study quality. CONCLUSION: Assertiveness training enhances communication and patient safety but faces barriers to implementation. Hierarchical structures and lack of standardized evaluation methods hinder broader adoption. Integrating assertiveness training into medical and nursing curricula and fostering open communication environments could improve outcomes. Future research should focus on standardizing training frameworks and assessing long-term impact.