Beliefs Regarding Standard Precautions Among Nursing Students in Macao During the COVID-19 Pandemic: A Health Belief Model–Based Cross-Sectional Study

Background: Standard precautions (SPs) are critical safety competencies for nursing students, especially during health crises like COVID-19. Adherence is often governed by health beliefs rather than knowledge alone, and validated instruments tailored to specific cultural contexts are needed. Aim: To (1) adapt and evaluate the psychometric properties of a health belief model (HBM) scale on SPs among nursing students in Macao, and (2) identify demographic and clinical-training factors associated with these health beliefs. Methods: A descriptive cross-sectional study was conducted at two Macao nursing institutions (January–March 2022). An anonymous electronic survey using an adapted 39-item HBM scale measured six constructs: perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy. Psychometric evaluation included content validity index (CVI), Cronbach’s α, and exploratory factor analysis (EFA). Nonparametric tests and regression analysis were used to identify associated factors. Results: A total of 268 students participated (response rate, 90.5%). The scale demonstrated excellent content validity (S-CVI = 0.98) and reliability (Cronbach’s α = 0.837), with EFA supporting a six-factor structure and confirmatory factor analysis (CFA) providing partial support for the modified scale. The median total HBM score was 116 (IQR: 111–124). Students scored highest on perceived benefits (91.7%) and lowest on perceived barriers (66.3%). Higher belief scores were associated with older age (p = 0.004), year of study (p = 0.004), frequent infection-related worry (p = 0.017), and frequent care for infectious patients (p = 0.001). In the adjusted model, positive HBsAb status showed a higher but nonsignificant association with high health-belief status, while needle-stick injury history was associated with lower health beliefs in univariate analysis (p = 0.016). Conclusion: The adapted 39-item HBM scale showed acceptable psychometric properties for assessing SPs-related health beliefs among Macao nursing students. Perceived barriers and needle-stick injury history were associated with weaker health beliefs, whereas awareness of immune status may help reinforce preventive safety beliefs. Simulation-based training, serological testing, and psychological support should be integrated into nursing curricula to strengthen students’ readiness for SPs compliance.