Behavioural predictors of personal protective equipment compliance intentions among nurses in Saudi Arabian...

Healthcare-associated infections (HAIs) remain a persistent patient safety problem in acute hospital settings globally, with suboptimal personal protective equipment (PPE) compliance among nursing staff identified as a modifiable contributing factor. In Saudi Arabia, compliance rates are reported as low as 65%, yet the psychological and behavioural determinants have not been systematically examined using validated theoretical frameworks. The Integrated Behavioural Model (IBM) offers a theoretically grounded approach to understanding the cognitive, normative, and control-related factors shaping health-related intentions. To identify and quantify the attitudinal, normative, and perceived control factors influencing nurses' intentions to comply with PPE guidelines in two acute care hospitals in northern Saudi Arabia, using a phased mixed-methods design informed by the IBM.

A sequential mixed-methods design was employed. Phase 1 comprised 14 semi-structured interviews with nurses; content analysis generated items for a purpose-built survey. Phase 2 involved administering the survey to a randomly selected sample of 289 nurses, with 279 completing it (response rate 96.5%). Internal consistency (Cronbach's alpha 0.92) and test-retest reliability (ICC > 0.80) were established. Multiple regression analyses identified significant predictors of compliance intention.

The overall IBM model accounted for 62.3% of variance in nurses' intentions to comply (R² =0.623, p < 0.001). Attitudes were the strongest predictor (indirect β = 0.405, p < 0.001; direct β = 0.229, p < 0.001), followed by subjective norms (direct β = 0.174, p < 0.001) and perceived behavioural control (indirect PBC β = 0.137, p = 0.002). Mean scores showed strong positive attitudes (5.7/7.0) and subjective norms (5.5/7.0), but notably lower perceived behavioural control (3.5/7.0), signaling a critical gap between intention and perceived ability.

These findings suggest that while nurses report strong foundational motivation, the institutional environment may substantially constrain their capacity to act on these intentions. Targeted interventions may benefit from addressing systemic barriers, such as supply chains and clinical guidance, alongside rather than instead of attitude-focused approaches.