Barriers and facilitators to personal protective equipment adherence among hospital nurses in Saudi Arabia: a qualitative study aligned with the Integrated Behavioral Model
Understanding why nurses fail to comply with personal protective equipment (PPE) guidelines requires investigating the specific cognitive, social, and organizational mechanisms that shape adherence decisions. While PPE compliance challenges in Saudi Arabia are well-documented, theory-informed qualitative research in this context remains scarce. This study aimed to identify and interpret the barriers and facilitators to PPE adherence among nurses in acute care hospitals in northern Saudi Arabia, using the Integrated Behavioral Model (IBM) as a theoretical framework. A qualitative study design was employed. A total of twelve nurses were intentionally recruited from two hospitals in the Tabuk Region, with data collection ceasing once saturation was attained, defined beforehand as the stage at which two consecutive interviews resulted in no additional codes or meaningful elaboration of existing themes. Data were collected through semi-structured, one-to-one interviews conducted via Skype during the COVID-19 pandemic. The interviews, lasting 60–90 min, were audio-recorded and transcribed verbatim. Data were analyzed using qualitative content analysis, with codes and themes organized around IBM constructs: attitudes, subjective norms, and perceived behavioral control. Trustworthiness was ensured through investigator triangulation, member checking, and researcher reflexivity. Five overarching themes emerged: (1) commitment to patient safety as a foundational motivator; (2) organizational cultures that inhibit best practices; (3) knowledge and confidence deficits; (4) personal safety concerns and psychological impacts; and (5) systemic resource gaps and time pressures. Facilitators were primarily internal, rooted in professional responsibility and care for patients. Conversely, barriers were predominantly external and systemic, including hierarchical blame cultures, locked PPE stores, medical staff non-compliance, infrequent education, staffing shortfalls, and ambiguous guidelines. Within this small, two-hospital sample, PPE adherence appeared to be driven more by organizational and systemic factors than by individual choice alone, and these findings should be interpreted as context specific rather than generalizable. Improving compliance requires a shift from blaming frontline nurses to addressing structural constraints. Healthcare organizations should prioritise accessible point-of-care supplies, foster blame-free reporting cultures, and provide regular competency-based training. Interventions must move beyond individual education to target the cultural and environmental barriers that impede safe practice. Not applicable.