The Social and Organisational Determinants of Protective Equipment Compliance Among Healthcare Workers: A Systematic Review

This study examines the social, organisational and cultural conditions that shape healthcare workers' compliance with personal protective equipment, a practice ordinarily treated as a technical rather than a social phenomenon. The review synthesises 117 peer-reviewed quantitative, qualitative and mixed-methods studies retrieved from Scopus, PubMed, Web of Science, ProQuest and ScienceDirect, screened and appraised following PRISMA 2020 procedures and analysed through a best-fit framework synthesis that combined the Theoretical Domains Framework, safety-climate theory and a work-system perspective. Reported compliance ranged from 13.5% to above 98%, with most studies falling below the 80% threshold conventionally treated as adequate. Compliance was associated less with individual knowledge than with organisational conditions, namely supply reliability, clarity and perceived legitimacy of policy, supervisory presence, workload and the credibility of monitoring. Occupational hierarchy, professional socialisation and the social construction of risk accounted for systematic differences between nursing, medical and support-staff groups, while emergency settings displayed the weakest adherence. Multi-component interventions that altered the work system outperformed education-only approaches, and monitoring mechanisms were effective where staff experienced them as supportive rather than punitive. The findings indicate that protective-equipment compliance operates as an institutional and cultural accomplishment, embedded in the normative order of the workplace rather than residing in individual decision-making alone.