Protection motivation theory and infection-prevention behavior in nursing students across 26 Thai institutions: A cross-sectional study

Background While nursing students often possess strong theoretical knowledge of infection control, a gap exists between their understanding and actual preventive practices. This study explored the relationship between knowledge, preventive behaviors, and Protection Motivation Theory (PMT) components among nursing students, using COVID-19 as a representative model. Methods A national cross-sectional study was conducted among 463 nursing students from 26 educational institutions in Thailand. Data were collected via validated online questionnaires and analyzed using descriptive statistics, Spearman correlation coefficients, and binary logistic regression. Results Most participants were female (95.9%) with moderate-to-good knowledge (92.5%) and moderate protection motivation (81.6%). Despite this, 53.1% exhibited poor infection prevention behaviors. First-year students without clinical experience demonstrated significantly poorer behaviors compared to those with clinical exposure ( χ 2 = 4.690, df = 1, p = .030). Knowledge did not significantly correlate with behavior ( r = 0.026, p = .582). Protection motivation showed a weak correlation ( r = 0.181, p = .001). Logistic regression identified perceived fear as the only significant predictor of preventive behavior (OR = 1.049, 95% CI [1.010, 1.089], p = .013). Discussion Perceived fear, rather than knowledge, primarily drives preventive adherence. Nursing education should transition beyond knowledge-based curricula to focus on enhancing self-efficacy and positive motivation to mitigate fear and improve compliance with infection control protocols.