Unpacking the Implementation of the Universal Health Care Law: A Mixed-Methods Study on the Mediating Role of Nurses’ Readiness between Awareness and Training Exposure

Readiness significantly enhances the effectiveness with which nurses implement the Universal Health Care (UHC) Law, with training exposure playing a crucial supporting role. This mixed-methods study investigated how nurses’ readiness mediates the relationship between their awareness of the UHC Law, their training experiences, and their ability to effectively implement the law. Using an explanatory sequential design, the study first gathered quantitative data from 290 nurses across different healthcare settings in the Philippines to measure their levels of awareness, training exposure, readiness, and actual implementation of the UHC Law. This was complemented by in-depth qualitative interviews with frontline healthcare providers to gain deeper insight into their day-to-day experiences with UHC implementation. The quantitative findings revealed that nurses demonstrated very high levels of awareness, readiness, and training exposure; however, the implementation of the UHC Law remained comparatively lower. Readiness and training exposure significantly predicted implementation, with readiness emerging as a key mediating factor between awareness, training, and actual practice. Nurses who feel more prepared are better able to apply UHC principles in practice. The qualitative results supported and enriched the statistical findings, revealing four key themes: Expanding Access through System Integration, Broadening Roles and Holistic Service Delivery, Implementation Gaps and Resource Constraints, and Strengthening the Frontline for Sustainable Universal Health Coverage (UHC). Participants described enhanced patient access and evolving nursing roles but also highlighted challenges such as inadequate resources, inconsistent training, and fragmented systems. Despite these challenges, nurses expressed a strong commitment to the goals of UHC. While nurses are equipped and motivated to implement the UHC Law, structural barriers hinder complete execution. Strengthening institutional support, enhancing training programs, and engaging nurses in policy development are essential to achieving equitable and sustainable healthcare delivery.