Biological Risk Knowledge and Occupational Safety Training: Testing the Threat Appraisal Pathway of Protection Motivation Theory in Healthcare

Sharps injuries and biological exposures remain a leading occupational safety risk in healthcare training environments. Preventing such injuries requires not only trainees’ declarative knowledge of biological hazards, but their threat appraisal—the cognitive process through which individuals evaluate personal risk and that motivates consistent adherence to standard precautions in practice. This cross-sectional study (N = 581) examined whether biological risk knowledge predicts cognitive threat appraisal in Italian health professions students surveyed prior to their first supervised clinical internship, and whether this relationship varies by gender. Drawing on Protection Motivation Theory (PMT), a multiple linear regression showed that biological risk knowledge significantly predicted personalized threat appraisal (β = 0.214, p < 0.001). Gender was also associated with threat appraisal, with female students reporting higher levels than male peers at equivalent knowledge levels (β = 0.184, p = 0.035). The overall model explained 16% of variance in threat appraisal (adjusted R2 = 0.150), indicating that mandatory pre-placement occupational safety training is associated with risk appraisal activation, but only partially, and that a causal interpretation requires longitudinal confirmation. These findings suggest that knowledge transmission alone is insufficient to reduce biological risk exposure in clinical settings: appraisal-activating components—including scenario-based learning and near-miss incident review—should be integrated into occupational safety curricula for health professions students, with attention to gender differences in risk perception.