Perceived implementation climate and human trafficking screening intention among U.S. healthcare professionals: a cross-sectional parallel mediation analysis

Abstract Background Human trafficking (HT) is a global public health concern, and healthcare providers (HCPs) represent an underused point of identification for survivors. Despite expansion of training mandates, associations between perceived implementation climate and clinical screening intention remain unclear. Guided by the Theory of Planned Behavior (TPB), this study examined whether perceived implementation climate was associated with HT screening intention through subjective norms, competency-related perceived behavioral control (PBC), and job satisfaction. Methods A cross-sectional survey was administered to 1,019 licensed U.S. HCPs (registered nurses, advanced practice nurses, physicians, and physician assistants) recruited through the Centiment nonprobability online panel. Perceived implementation climate, subjective norms, competency-related PBC, job satisfaction, and HT screening intention were assessed using composite or single-item measures. A parallel mediation model was estimated with 5,000 bootstrap resamples to examine the three variables as simultaneous statistical mediators of the implementation climate-screening intention association. Because all variables were measured at one time point, estimates were interpreted as cross-sectional associations rather than causal effects. Results Perceived implementation climate was significantly associated with all three mediators. In the full model, subjective norms (standardized β = 0.38) and PBC (standardized β = 0.24) were significant positive correlates of screening intention, and job satisfaction had a small negative conditional association (standardized β = −0.09). The three indirect pathways jointly represented 71.0% of the total association. The largest indirect association was through subjective norms (0.121, 95% bootstrap CI [0.090, 0.153]), representing 51.0% of the total association, followed by PBC (0.065, 95% bootstrap CI [0.040, 0.091]; 27.2%). The indirect association through job satisfaction was small and negative (− 0.017, 95% bootstrap CI [− 0.029, − 0.007]; −7.2%). A direct association remained (c′ = 0.069, 95% CI [0.025, 0.115]). Conclusions Higher perceived implementation climate scores were associated with stronger HT screening intention primarily through subjective norms and, secondarily, competency-related PBC in the specified cross-sectional model. The findings support longitudinal and multilevel testing of organizational expectations and capability supports alongside provider education.