Knowledge, practice, and barriers to pressure ulcer prevention among nurses in Herat, Afghanistan: a multicenter cross-sectional study

OBJECTIVES: Pressure ulcers are a major yet preventable patient-safety problem and an indicator of care quality. In Afghanistan, evidence on pressure ulcer prevention is limited. This study assessed nurses' knowledge, practices, and perceived barriers to pressure ulcer prevention in Herat, Afghanistan. METHODS: A multicenter cross-sectional study was conducted from March 5 to December 30, 2024, in public and private hospitals in Herat. Data were collected using a structured Persian questionnaire adapted from validated tools and reviewed by ten experts; internal consistency was acceptable (Cronbach's α = 0.844). Data were analyzed in SPSS v27.0 (IBM Corp., Armonk, NY) using descriptive statistics, chi-square tests, and multivariable logistic regression (p < 0.05). RESULTS: Among 278 nurses (68.7% female), 57.2% had high knowledge and 52.5% had high preventive practice. Knowledge was higher among nurses working in regional hospital (60.7%) compared with private hospitals (46.1%) (p = 0.037), and among nurses who had read academic papers (62.7%) compared with those who had not (50.4%) (p = 0.039). Preventive practice was higher among nurses in private hospitals (60.5%) compared with regional hospital (44.1%) (p = 0.021), among nurses who had read academic papers (60.8%) compared with those who had not (42.4%) (p = 0.002), among those who attended pressure-ulcer conferences (64.8%) compared with those who did not (48.3%) (p = 0.016), and among nurses reporting university-based training (60.6%) compared with workplace training (44.3%) or workshops/papers (45.7%) (p = 0.029). In multivariable analysis, male nurses had lower odds of high knowledge than female nurses (AOR = 0.47; 95% CI: 0.24-0.94) (p = 0.033), while nurses at Public (regional) hospital had higher odds of high knowledge than those in private hospitals (AOR = 2.12; 95% CI: 1.04-4.33) (p = 0.039). Working 1-6 h/day was associated with lower odds of high practice compared with working 10-16 h/day (AOR = 0.36; 95% CI: 0.13-0.98) (p = 0.045). CONCLUSION: Despite moderate levels of knowledge and practice, important systemic and educational barriers remain. Targeted educational interventions, access to pressure-relieving equipment, and adequate staffing could improve pressure ulcer prevention outcomes in Afghanistan.