Capability, opportunity, and motivation: a structural equation model of hand hygiene behavior based on the COM-B framework in a Chinese hospital setting

Background Healthcare-associated infections (HAIs) present a major threat to patient safety worldwide. While hand hygiene is the primary defense against HAIs, compliance among healthcare workers (HCWs) remains inadequate, highlighting a persistent “know-do” gap. The COM-B (capability, opportunity, motivation-behavior) model offers a robust theoretical framework for understanding this behavior, yet its complex mediating pathways—particularly through structural equation modeling—remain underexplor