Observational peer influence and institutional culture as predictors of preventive health compliance among Sudanese medical students

Adherence to preventive health behaviors among medical students is essential for both personal safety and professional practice. However, compliance is not solely determined by knowledge and may be influenced by social and institutional factors. This study aimed to examine the association between peer influence, perceived institutional culture and adherence to preventive health behaviors among Sudanese medical students. A multi-institutional cross-sectional study was conducted among 400 undergraduate medical students from five universities in Khartoum State, Sudan, between June and November 2025. Data were collected using a structured, self-administered online questionnaire based on established behavioral frameworks. Preventive behaviors, peer influence and institutional culture were measured using Likert-scale items and summarized into composite scores. Spearman correlation and multivariate linear regression analyses were performed to assess associations, adjusting for demographic and institutional variables. Overall adherence to preventive health behaviors was generally favorable with highest compliance observed in hand hygiene (66.4%) and lower consistency in mask use (46.0%). Significant positive correlations were found between preventive behaviors, peer influence, and perceived institutional culture ( p < 0.01). Observational peer influence, particularly role modeling, was strongly associated with adherence ( r = 0.32–0.49), while institutional culture variables showed moderate associations ( r = 0.43–0.52). In multivariate analysis, first-year students demonstrated lower adherence (β = -0.92, p = 0.010) whereas living with family was associated with higher compliance (β = 0.28, p = 0.019). Other demographic variables were not significant predictors. Preventive health behaviors among medical students are shaped primarily by social and institutional contexts rather than individual characteristics. Interventions that leverage peer influence, strengthen professional norms and promote supportive institutional cultures may be more effective than knowledge based approaches alone particularly in resource constrained settings.