Investigation of medical waste segregation behaviours of healthcare workers: integration of the Theory of Planned Behaviour and Norm Activation Model

Proper segregation of medical waste is crucial for environmental safety, public health and preventing the spread of infectious diseases, making it a significant challenge to study health workers’ adherence. Since effective waste management depends on individual actions, this study uses environmental psychology principles to examine the cognitive and moral factors that influence medical waste management behaviour. Despite acknowledging the significance of these factors, the existing literature reveals a notable gap. It notably lacks a comprehensive framework that combines rational and moral drivers of behaviour. Specifically, the integrated use of the Theory of Planned Behaviour (TPB) and the Norm Activation Model (NAM) has been insufficiently explored among healthcare workers. Therefore, the primary objective of this study is to investigate the psychological factors – such as perceived behavioural control, subjective norms and personal moral norms – that influence the intentions and actual behaviours of healthcare workers regarding the segregation of medical waste. A quantitative, cross-sectional study was conducted using a structured questionnaire survey. The measurement tool used multiple-item scales adapted from validated sources to assess all variables, with responses recorded on a five-point Likert scale. Data were collected through an online survey using convenience sampling among healthcare workers in Bahrain over a 3-month period, resulting in 144 valid responses. Analysis was conducted using Partial Least Squares Structural Equation Modelling (PLS-SEM) with SmartPLS software. The results revealed that the integrated NAM-TPB model provides valuable insights into motivations, explaining 70% of the total variance in segregation intention. Also, Perceived Behavioural Control and Personal Norms are significant predictors of segregation intentions, and importantly, both personal norms and intention are key predictors of the final segregation action. In conclusion, this study confirms a strong, integrated behavioural model with significant theoretical and practical implications for developing theory-based interventions that focus on reinforcing personal norms and moral obligations rather than procedural compliance, thereby enhancing medical waste management practices.