Factors associated with sustainable biomedical waste management practices among healthcare workers in Bangladesh: a cross-sectional structural equation modelling study

Abstract Sustainable biomedical waste management protects healthcare workers, patients, communities and the environment. This cross-sectional, facility-based survey examined factors associated with sustainable biomedical waste-management practice among 420 healthcare workers from 5 public hospitals, 10 private hospitals and 13 specialised or diagnostic facilities in Dhaka, Bangladesh, between May and September 2026. Using an extended theory of planned behaviour framework, partial least squares structural equation modelling (SmartPLS 4.1.2.1) estimated associations among six antecedent constructs, behavioural intention and self-reported practice. The model explained 41% of the variance in intention and 47% in practice. All six antecedents were positively associated with intention; perceived behavioural control showed the strongest association (β = 0.28, p < 0.001), followed by training and organisational support (β = 0.23), regulatory awareness (β = 0.22), knowledge (β = 0.20), attitude (β = 0.16) and subjective norms (β = 0.09, p = 0.02). Behavioural intention was most strongly associated with practice (β = 0.47, p < 0.001), followed by perceived behavioural control (β = 0.25, p < 0.001) and training and organisational support (β = 0.12, p < 0.01). Regulatory awareness showed no significant direct association with practice (β = 0.06, p = 0.11). Out-of-sample predictive performance was meaningful, and no significant structural-path differences were detected across facility types. Because the design is cross-sectional, the findings indicate associations rather than causal or mediating effects. Interventions should combine knowledge-based training with supportive organisational systems, adequate resources and effective implementation of regulatory requirements.