An explorative approach of the InovSafeCare model for education in infection prevention and control: a cross-sectional study among undergraduate nursing students in sub-Saharan Africa

BACKGROUND: Adherence to healthcare-associated infection prevention and control best practices is essential to reducing morbidity and mortality in sub-Saharan Africa, where structural and educational challenges may affect adherence. Strengthening nursing education requires contextually appropriate frameworks and valid tools to evaluate them. OBJECTIVE: To evaluate the psychometric properties of the culturally adapted InovSafeCare Questionnaire and examine the structural relationships proposed by the InovSafeCare Model among undergraduate nursing students in sub-Saharan Africa. METHODS: A multiple-method approach was employed, involving the translation, cultural adaptation, and psychometric evaluation of the InovSafeCare Questionnaire. Data were collected from 486 undergraduate nursing students across four higher education institutions in two sub-Saharan African countries. Principal component analysis and reliability testing examined the questionnaire structure, followed by path analysis to evaluate the relationships among the model constructs. RESULTS: /df = 5.59; CFI = 0.88; GFI = 0.95; RMSEA = 0.097). No direct relationships were found between educational constructs and self-reported adherence. Instead, these associations operated through psychological and contextual mediators, including motivation, expectations, skepticism, environmental complexity, and overload and fatigue. The model explained 18.9% of the variance in adherence. CONCLUSIONS: The culturally adapted InovSafeCare Questionnaire demonstrated acceptable psychometric properties, and structural analysis provided preliminary support for the model's applicability in the sub-Saharan African sample. Further research should replicate the measurement and structural model across settings before considering its use to inform contextually adapted educational interventions.