For safety managers, personal protective equipment (PPE) is a cornerstone of workplace protection. Yet, every safety audit, near-miss, or injury report often highlights a familiar challenge—non-compliance. Why do workers skip, loosen, or remove PPE when the risks are clear?
A recent peer-reviewed study in BMC Public Health (2025) sheds new light on this enduring issue. The researchers designed and validated a short, plain-language survey based on behavioral science—specifically the COM-B model—to help employers better understand why blue-collar workers comply or don’t comply with PPE requirements.
Their findings offer evidence-based guidance for improving safety culture and interventions in high-risk industries. Below is a practical summary of what safety leaders can take away from this research.
Why PPE Still Matters—And Why It’s Often the Last Line of Defense
Across the globe, nearly 381,000 workers die each year from occupational injuries—about one every 11 seconds. The majority of these fatalities occur in sectors filled with manual labor: construction, manufacturing, transportation, and logistics.
Even in companies with strong engineering controls and administrative safety programs, PPE often remains the final barrier between a worker and serious injury. Helmets, gloves, face shields, respirators, harnesses—all are proven to reduce or prevent injury when used correctly.
Evidence for PPE effectiveness is overwhelming: studies across industries show significantly lower rates of head trauma, respiratory illness, and fall injuries when PPE is consistently worn. For instance, improved adherence to fall-protection programs alone can reduce incident rates by as much as 30 percent.
Yet compliance gaps persist. And those gaps are rarely due to lack of rules—they’re driven by human and environmental factors that traditional safety programs don’t always address.
Understanding PPE Non-Compliance: What Really Gets in the Way
The BMC Public Health review of previous research found at least 16 distinct factors influencing PPE use, which fall under several main themes:
- Design and comfort issues – Poor fit, heavy materials, restricted movement, and heat discomfort frequently cause workers to remove PPE mid-shift.
- Knowledge gaps – Workers may not fully understand what PPE to wear, how to wear it, or the specific hazard it mitigates.
- Language and literacy barriers – For multilingual, migrant, or low-literacy teams, training materials can miss the mark.
- Workplace safety climate – Supervisors’ enforcement, peer norms, and leadership commitment shape attitudes toward compliance.
- Physical and physiological burden – Fatigue, dehydration, or heat stress often override good intentions.
The researchers argue that understanding these barriers requires going beyond checklists and observation—it demands a behavioral diagnostic that links attitudes, capability, and opportunity to the likelihood of following PPE rules.
The New Tool: A Theory-Driven PPE Behavior Survey
Why It’s Different
Most existing PPE surveys are either too long, too technical, or disconnected from behavioral theory. The team behind this study sought to create something that safety professionals could actually use—an instrument that captures why workers behave a certain way, not just whether they do.
They based their framework on the COM-B model, a well-established behavioral science theory that says any behavior (B) depends on three things:
- Capability – Do workers have the knowledge and physical ability to comply?
- Opportunity – Do the environment and culture support PPE use?
- Motivation – Do workers value and intend to perform the behavior?
Each dimension can be measured and improved through targeted interventions.
How It Was Built
The researchers conducted iterative design workshops with over 160 blue-collar employees in a global logistics company. They rewrote technical questions into everyday language and trimmed the survey to just 14 items. For example, instead of asking about “proper PPE use,” the question was simplified to “I wear full PPE for my entire shift.”
They then tested the survey with 867 workers, primarily male migrant laborers, using robust statistical validation (Confirmatory Factor Analysis and Structural Equation Modeling).
The result: a reliable, validated diagnostic tool that safety teams can administer quickly to assess the behavioral health of their PPE program.
What the Data Revealed
Capability Is King
Among the COM-B factors, capability—both physical and psychological—was the strongest predictor of PPE intention:
- Workers who felt physically capable (comfortable, not overheated or fatigued) were more likely to comply.
- Workers who understood why and how to use PPE also showed stronger compliance intentions.
Motivation and opportunity—though important—showed weaker direct effects in this population.
For managers, this means most non-compliance isn’t defiance—it’s discomfort or confusion. When workers lack the energy, knowledge, or comfort to sustain full PPE use, even the best safety culture can’t compensate.
Reliability You Can Trust
All five survey subscales scored above 0.90 in reliability (Cronbach’s alpha), and model fit indices were excellent. In short, the tool works: it reliably captures distinct psychological and environmental drivers of PPE use.
Qualitative Insights
Feedback sessions revealed recurring themes:
- “Too hot to wear everything all day.”
- “Don’t know which PPE is right for each task.”
- “Some gear makes it hard to move or breathe.”
These comments mirror what many safety managers hear daily—and reinforce that compliance barriers are often design or communication problems, not motivation problems.
What This Means for Safety Managers
1. Start Measuring What Matters
If you can’t measure it, you can’t manage it. The COM-B PPE survey offers a structured way to identify which behavioral levers need attention—capability, opportunity, or motivation.
- Low psychological capability → Improve training, signage, or visual job aids.
- Low physical capability → Review PPE comfort, fit testing, and shift scheduling to reduce fatigue.
- Weak opportunity → Reassess workplace layout, PPE availability, and supervisor modeling.
- Lagging motivation → Reinforce positive safety norms through peer recognition or feedback loops.
2. Fix Capability Before Culture
Safety leaders often focus on “changing culture,” but this research suggests that practical barriers—heat stress, poor design, lack of understanding—must be solved first. Workers can’t comply with PPE rules if the equipment hurts, overheats them, or is confusing to use.
Invest in better-fitted gear, cooling options, or short rest breaks during hot conditions before launching motivational campaigns.
3. Simplify Safety Communication
The study found many workers misunderstood safety messages written in formal or technical English. Translating PPE rules into plain language, pictograms, or native-language briefings can close that gap fast.
Shorter, more focused toolbox talks—reinforced by supervisors who model correct behavior—remain one of the most effective compliance tools.
4. Track and Trend Behavioral Data
By using the COM-B survey periodically, safety teams can track improvement over time. Are workers reporting greater confidence and understanding? Has physical comfort improved after a PPE upgrade?
Turning survey results into a simple dashboard gives managers tangible metrics to discuss with leadership or auditors, much like lagging and leading indicators in safety performance.
5. Tailor Interventions by Group
Don’t assume every crew or department struggles with the same barriers. The survey can reveal that one team needs ergonomic adjustments while another needs communication support. Targeted, data-driven actions are more effective than one-size-fits-all mandates.
Practical Limitations to Keep in Mind
The authors note that their pilot study focused on male workers in a single logistics company—so results may differ across industries, genders, or cultures. Additionally, because participants reported very high compliance intentions (scores of 8.5–9/10), real-world variability might be greater in less mature safety environments.
Still, even with these caveats, the tool provides a valuable foundation for behavioral diagnostics—something the safety profession has long needed.
Turning Research into Action
The ultimate message for safety leaders is simple: PPE compliance is less about attitude and more about ability.
If you can diagnose and strengthen workers’ capability—their comfort, confidence, and clarity—compliance will follow naturally. This research gives managers a framework to identify those weak spots and fix them proactively.
Action checklist for safety managers:
- Introduce a short behavioral survey (like COM-B PPE) in your next safety review.
- Compare results by team or site to prioritize interventions.
- Partner with HR and procurement to address physical discomfort through better PPE design.
- Revisit training materials—make them visual, brief, and multilingual.
- Re-survey periodically to evaluate progress and adjust strategy.
Conclusion
For decades, the safety field has treated PPE non-compliance as a behavioral problem to be disciplined or retrained away. This new research reframes it as a capability challenge—a mismatch between human limits, equipment comfort, and environmental demands.
By adopting tools that measure those underlying factors, safety managers can shift from reactive enforcement to proactive design—making PPE compliance a natural outcome of smart systems, not just strict supervision.
The study’s accessible, validated COM-B-based survey represents a step forward: a simple, data-driven way to understand what drives worker behavior and how to strengthen it.
In short, if you want people to wear their PPE, start by asking not why they won’t—but what makes it hard for them to do so. The answers might surprise you, and they might just save lives.