Occupational Risk Perception and Utilization of Personal Protective Equipment Among Informal Auto‐Artisans in Ghana: A Cross‐Sectional Study

ABSTRACT

Background and Aims

Auto‐artisans are exposed to various occupational hazards, including physical, chemical, and mechanical risks, which necessitate the consistent use of personal protective equipment (PPE). Despite the critical role of PPE in mitigating these risks, adherence remains a challenge, particularly among artisans in informal sectors. This study examines the PPE use dynamics among auto‐artisans and assesses how perceived occupational risk predicts utilization rate.

Methods

This cross‐sectional study involved a sample of 957 auto‐artisans in the Ashanti region of Ghana using a multi‐sampling technique. Descriptive analyses such as Pearson's chi‐square test, bivariable and multivariable logistic regression models were performed using STATA 18.

Results

Overall, 72.5% of auto‐artisans used PPE. Safety boots were the most used PPE (71.26%), followed by goggles (8.76%), and face/nose masks (7.9%). Among auto‐artisans who used PPE, the majority bought their own PPE (96.7%). The major reason for the non‐use of PPE was that PPE are uncomfortable to use (30.65%). Other reasons were unavailability (29.5%), having no money to buy them (17.24%), and perceptions that it is unnecessary to use PPE (14.18%). Participants who perceived their jobs as risky had higher odds of using PPE, both in the crude (COR = 2.67, 95% CI: 1.42–5.01) and adjusted model (AOR = 2.43, 95% CI: 1.26–4.68).

Conclusion

This study underscores a need for the Ministry of Employment and Labour Relations, the Ghana National Association of Garages, and the other labor associations to enforce compliance and ensure that employers prioritize worker safety by supplying adequate and appropriate PPE. Given that discomfort, unavailability, and financial challenges were major barriers to PPE use, it is imperative for policymakers and stakeholders to prioritize the design and distribution of ergonomic and affordable PPE tailored to the specific needs of auto‐artisans. Occupational health literacy campaigns should be intensified to educate auto‐artisans on the importance of PPE, dispel misconceptions, and address discomfort‐related concerns.

Abbreviations

AIC

akaike information criterion

AOR

adjusted odds ratio

CI

confidence interval

COR

crude odds ratio

PPE

personal protective equipment

1. Background

As social beings, individuals long for a sense of purpose. One of the ways that individuals try to fulfill this sense of purpose is by working or taking on an occupation. In some societies, particularly in sub‐Saharan Africa (SSA), being employed is perceived as a mark of responsibility and maturity [1]. However, the occupational space has been characterized by significant hazards that threaten the health and wellbeing of workers [2]. Global estimates show that “2.9 million deaths were attributed to work, with 2.58 million deaths due to work‐related diseases and 0.32 million related to occupational injuries” [3]. Takala et al. [3] further assert that disability adjusted life years (DALYs) lost to occupational health hazards increased by 47% between 2014 and 2019. Thus, highlighting the public health concern that occupational health hazards pose.

While the health, construction and agricultural sectors have been characterized by significant health hazards [4, 5, 6], the automotive industry also shares in this burden of health [7, 8, 9]. For instance, Kattof et al. [10] report that auto‐artisans are exposed to oxyacetylene fumes, battery acid, and spray/painting fumes which exacerbate their risk of respiratory diseases. In Ghana, 83.9% of auto‐artisans are exposed to sharp objects while 45.8% are exposed to the inhalation of dust particles; similarly, 35.6% and 21.8% were exposed to objects falling from height and burns, respectively [7]. As such, promoting the use of personal protective equipment has become quintessential as a preventive measure against occupational hazards in the automotive industry.

Personal protective equipment (PPE) refers to equipment designed to protect workers from specific hazards encountered in their work environment [11]. This includes items such as gloves, goggles, masks, respirators, ear protectors, and protective clothing [11, 12]. Despite the health benefits of PPE, its utilization remains suboptimal. For example, Adejumo et al. [13] found that 91.9% of auto‐artisans did not use PPE. Afolabi et al. [8] also observed that only 35% of auto‐artisans who possess PPE use it regularly. A study conducted in the Volta region of Ghana also showed that only 34.1% of auto‐artisans were comfortable using PPE [14]. Given these dynamics, it is imperative to understand the factors that predict auto‐artisans' utilization of PPE.

While some studies have explored the general occupational health issues faced by auto‐artisan workers in Ghana [7, 14], there is limited research specifically addressing the risk perception and PPE utilization patterns among auto‐artisans. As such, the question remains, “to what extent does perceived occupational risk predicts auto‐artisans use of PPE?” Establishing this association is important as the health belief model postulates that high perceived risk/susceptibility is critical in informing the adoption of preventive health measures including PPE use [15]. This study contributes to what is already known about PPE use in Ghana by examining the association between occupational risk perception and PPE use among auto‐artisans in Ghana. One major contribution is the provision of empirical evidence on the prevalence and determinants of PPE use among auto‐artisans, a population often overlooked in occupational health research despite their exposure to significant physical and chemical hazards. In addition, the study advances theoretical understanding by applying the Health Belief Model to examine how perceptions of occupational risk influence PPE use, thereby offering insights into how informal workers' beliefs about susceptibility and severity shape their engagement with protective practices. The study also exposes critical structural challenges, particularly the lack of employer support and regulatory oversight in PPE provision within the informal sector, which limits workers' ability to protect themselves even when they are aware of occupational risks.

2. Methods

2.1. Study Design

The study was based on a cross‐sectional design. This design was chosen to provide a snapshot of PPE usage patterns, barriers, and determinants within the population.

2.2. Population

The target population consisted of a diverse group of auto‐artisans engaged in various trades within the Suame Magazine automotive hub. These included mechanics (locally referred to as fitters), auto‐body straighteners, auto‐body sprayers, welders, and vulcanizers [7]. Additionally, the population encompassed auto‐electricians, radiator repairers, bumper and headlight repair specialists, door and key fixers, blacksmiths, and engine borers/re‐borers. This broad representation ensured a comprehensive understanding of occupational health and safety practices across the different specialties within the auto‐repair industry [7]. Informed consent was obtained from all the respondents verbally. Two respondents (apprentices) were less than 18 years, consent was obtained from themselves and their masters (the master craftsmen) who were responsible for the welfare and upkeep of these apprentices.

2.3. Sampling

A multi‐sampling technique was employed. The Suame Magazine enclave, as organized by the Ghana National Association of Garages, is divided into 16 zones grouped under four main clusters: A, B, C, and D. These clusters were defined by clear physical boundaries, which facilitated identification and minimized the risk of double counting during the survey. An equal allocation of the sample was made across the clusters, with 250 participants (derived from the total sample size of 1000) assigned to each [16].

Based on an estimated auto‐artisan population of 100,000 at the Suame Magazine enclave, (Waldman‐Brown, et al., 2014; Gatune, 2016), the Rose, Spinks and Canhoto (2015) sample size determinant expressed below was employed to arrive at 1000 respondents.

$$n=\frac{z^{2}xp(1-p)}{C^2},$$

where:

• Z = Z‐value (1.96 for a 95% confidence level)

• P = Proportion of population having the characteristics of interest (safety practices), where 27% was chosen because according to Money, et al. (2014) safety practices (PPE use) among auto‐artisans in Ghana stands at 27%.

• C = Confidence interval, expressed as decimal (e.g., 0.028).

Using the above formula, the sample size was determined as follows:

$$n=\frac{{1.96}^{2}x0.27(1-0.27)}{{\left(0.028\right)}^2}=\frac{0.75717936}{0.000784}=965.79\approx 966.$$

The sample size estimated was 966. However, 34 respondents were added to take care of nonresponse and related issues, making a total of 1000 respondents for the study.

In the next stage, workshops were selected from each cluster using simple random sampling. Within each selected workshop, one master artisan or work‐and‐pay artisan (a master artisan working under another) and one apprentice were chosen [7]. In cases where only one artisan was present, they were automatically included in the sample. If a workshop had multiple master artisans or apprentices, one was selected through simple random sampling [7]. This method ensured a representative and unbiased selection of participants across the various clusters and workshops.

2.4. Study Variables

2.4.1. Outcome Variable

PPE use was the outcome variable. This was derived from the question: “Do you use any protective equipment?” The question has a dichotomous response of 0 = no and 1 = yes. Responding yes to this question meant that the auto‐artisan used PPE.

2.4.2. Explanatory Variables

The main explanatory variable was perceived occupational risk. This was from the question: “Do you often find your work risky?” Again, the responses were either yes or no. Responding yes to this question implied that the individuals perceived their work as risky.

2.5. Covariates

Other variables controlled for in this study included age (categorized as < 20 years, 20–29 years, 30–39 years, 40–44 years, and ≥ 50 years), formal education level (no formal education, primary education, and secondary/higher education), type of trade (auto‐body works, mechanic/fitting, and ancillary services), occupational status (master artisan, work‐and‐pay artisan, and apprentice), years in artisanship (1–10 years, 11–20 years, and > 20 years), membership in professional associations (yes/no), participation in workplace safety discussions (yes/no), attendance at health and safety training sessions (yes/no), and mode of PPE acquisition (bought by self/supplied by employer).

2.6. Data Collection Procedures

A total of eight research assistants were recruited and trained to assist with the data collection exercise [17]. These research assistants were graduate students within the Faculty of Social Sciences, University of Cape Coast. Research assistants were trained over a period of 1 week. The training covered role‐play of the translation of the study instrument, ethical considerations and the purpose of the study. Following the training of research assistants, the data collection tool was pretested in Siwdo, a fitting cluster within the Cape Coast Metropolis [7, 17]. After the pretest, ambiguous sentences were clarified. Also, the pretest provided insights into how long the survey interviews would last. Each day, research assistants commenced data collection at 8:30 am and lasted till 5:00 pm. After each day's survey, all research assistants met to discuss the challenges faced and the way forward.

2.7. Statistical Analyses

Statistical analyses were conducted using STATA 18 (StataCorp, College Station, TX, USA). Descriptive statistics were computed to summarize the distribution of sociodemographic characteristics, occupational profiles, and PPE usage among participants. Pearson's chi‐square tests were performed to assess statistical differences in the distribution of PPE usage among the participants. p values from the chi‐square test were reported. Bivariable logistic regression analyses were then used to estimate crude odds ratios (COR) and their corresponding 95% confidence intervals (CI) to examine the relationships between perceived occupational risk and PPE usage, as well as other predictors. Subsequently, a multivariable logistic regression model was fitted to adjust for potential confounders, including age, education, years of experience, type of trade, and membership in associations. Variables were selected into the multivariable logistic regression based on a backward stepwise approach to reduce the number of variables and maintain those that best explain the data. The level of statistical significance for all tests was set at p < 0.05.

3. Results

3.1. Characteristics of Participants

Table 1 shows the distribution of the participants' characteristics. Most participants were aged 20–29 years (35.7%) and had secondary or higher education (82.1%). In terms of occupational status, 50.9% were apprentices, and mechanics (53.3%). Almost half (48.9%) had 1–10 years of experience; however, only 45.8% belonged to an association. About 30.6% had participated in workplace safety planning or attended health and safety training while 68.3% met with colleagues to discuss safety issues.

Table 1.

Distribution of sample and prevalence of PPE use.

Characteristics	Sample n (%)	Proportion that used PPE n (%)
Overall	957 (100.0)	696 (72.7)
Perceives work as risky
No	41 (4.3)	21 (51.2)
Yes	916 (95.7)	675 (73.7)
Age
< 20 years	78 (8.1)	48 (61.5)
20–29 years	342 (35.7)	246 (71.9)
30–39 years	283 (29.6)	217 (76.7)
40–44 years	170 (17.8)	130 (76.5)
50 years or older	84 (8.8)	55 (65.5)
Education
No formal education	64 (6.7)	44 (68.7)
Primary	107 (11.2)	71 (66.4)
Secondary/higher	786 (82.1)	581 (73.9)
Occupational status
Master artisan	443 (46.3)	331 (74.7)
Work and pay artisan	28 (2.9)	22 (78.6)
Apprentice	486 (50.9)	343 (70.6)
Years in artisanship
1–10 years	468 (48.9)	330 (70.5)
11–20 years	284 (29.7)	220 (77.5)
> 20 years	205 (21.4)	146 (71.2)
Type of trade
Auto‐body works	236 (24.7)	194 (82.2)
Mechanic (fitting)	510 (53.3)	356 (69.8)
Ancillary services	211 (22.0)	146 (69.2)
Income
Low	354 (37.0)	256 (72.3)
Moderate	156 (16.3)	104 (66.7)
High	447 (46.7)	336 (75.2)
Belongs to an association
No	519 (54.2)	357 (68.8)
Yes	438 (45.8)	339 (77.4)
Ever attended training on health and safety
No	664 (69.4)	461 (69.4)
Yes	293 (30.6)	235 (80.2)
Meet with colleagues to discuss safety issues
No	303 (31.7)	180 (59.4)
Yes	654 (68.3)	516 (78.9)
Participated in planning for workplace safety
No	664 (69.4)	489 (73.6)
Yes	293 (30.6)	207 (70.6)

3.2. Prevalence of PPE Use Among Auto‐Artisans

Overall, the majority of auto‐artisans (95.7%) perceived their work as risky while 72.5% used PPE. The prevalence of PPE use was higher among those aged 40–44 years (76.5%), those into auto‐body (82.2%), those who were members of an association (77.4%), those who have had previous training on health and safety (80.2%), and individuals who discussed safety issues with colleagues (78.9%) (Table 1).

3.3. Type of PPE Used

Safety boots were the most used PPE (71.26%), followed by goggles (8.76%), and face/nose masks (7.9%) (Figure 1)

Figure 1.

Type of PPE used.Source of PPE.

Among auto‐artisans who used PPE, the majority bought their own PPE (96.7%) while 3.3% had their PPE supplied by their employers (Figure 2).

Figure 2.

Source of PPE for auto‐artisans.

3.4. Reasons for Nonuse of PPE

The major reason for the nonuse of PPE was that PPE are uncomfortable to use (30.65%). Other reasons for nonuse of PPE were unavailability (29.5%), having no money to buy them (17.24%), and perceptions that it is unnecessary to use PPE (14.18%) (see Figure 3).

Figure 3.

Reasons for nonuse of PPE among auto‐artisans.

3.5. Association Between Perceived Occupational Risk and Use of PPE

Participants who perceived their jobs as risky had higher odds of using PPE, both in the crude (COR = 2.67, 95% CI: 1.42–5.01) and adjusted model (AOR = 2.43, 95% CI: 1.26–4.68). Compared to younger auto‐artisans, those aged 50 years or older (AOR = 2.14, 95% CI: 1.17–3.90) were more likely to use PPE. Mechanics (AOR = 0.46, 95% CI: 0.31–0.69) and ancillary service workers (AOR = 0.50, 95% CI: 0.31–0.80) were less likely to use PPE compared to auto‐body workers. Membership in an association (AOR = 1.64, 95% CI: 1.19–2.25), previous health and safety training (AOR = 1.45, 95% CI: 1.00–2.10), and meeting with colleagues to discuss safety issues (AOR = 2.57, 95% CI: 1.87–3.52) significantly increased the odds of PPE use (Table 2).

Table 2.

Association between perceived occupational risk and use of PPE.

Characteristics	Model I crude odds ratio (95% CI)	Model II adjusted odds ratio (95% CI)
Perceives work as risky
No	Ref.	Ref.
Yes	2.67 [1.42–5.01]**	2.43 [1.26–4.68]**
Age
< 20 years		Ref.
20–29 years		1.73 [0.85–3.52]
30–39 years		2.13 [1.23–3.70]**
40–44 years		2.50 [1.43–4.35]**
50 years or older		2.14 [1.17–3.90]*
Type of trade
Auto‐body works		Ref.
Mechanic (fitting)		0.46 [0.31–0.69]***
Ancillary services		0.50 [0.31–0.80]**
Belongs to an association
No		Ref.
Yes		1.64 [1.19–2.25]**
Ever attended training on health and safety
No		Ref.
Yes		1.45 [1.00–2.10]*
Meet with colleagues to discuss safety issues
No		Ref.
Yes		2.57 [1.87–3.52]***
Model fit statistics
AIC	1116.549	1057.378
Prob > chi2	0.002	< 0.001

Note: Variables were included in the multivariable logistic regression through a backward stepwise approach.

^* p < 0.05.

^** p < 0.01.

^*** p < 0.001.

4. Discussion

According to Afolabi, Beer and Haafkens [8] auto‐artisans who perceive themselves to be at high risk of occupational health problems are more likely to use PPE. The study therefore examined the association between occupational risk perception and PPE use among auto‐artisans in Ghana. It was found that the majority (95.7) of the respondents perceived their jobs as risky. This high perception of risky job by the auto‐artisans has the potential to transform into safety practices such as wearing PPE among auto‐artisans [8]. This finding is also in line with a systematic review on the relationship between risk perception and safety behavior by Priolo, Vignoli and Nielsen [18] which concluded that there is a positive association between work‐related risk perception and safety behaviors at the workplace.

The study shows that almost two‐thirds (72.7%) of auto‐artisans used at least one PPE. This prevalence is higher than what has been reported among auto‐artisans in Nigeria (8.1%) [13]. It is also higher than a study conducted among welders in Accra where only 33.2% used PPE [19]. Similarly, the estimated prevalence is higher than when compared to the 22.7% reported in the Tema Metropolis of Ghana [20]. The findings also align with Khoshakhlagh et al's. [21] reported PPE use prevalence of 72.4%. Among auto‐artisans who used PPE, only 3.3% of of them had their PPE supplied by their employers. This highlights a critical gap in employer responsibility for worker safety, potentially placing a financial burden on workers and exacerbating disparities in PPE access. The inability to afford PPE or lack of perceived necessity may deter its use.

Discomfort emerged as the leading factor among auto‐artisans who did not use PPE. This is consistent with a study by Zhang et al. [22] that found discomfort of wearing occupational health PPE as a barrier. Also, the result aligns with Apreko et al. [14] who revealed that 64.9% of auto‐artisans in Ghana do not feel comfortable about using PPE. Thus, underscoring a need to prioritize occupational health literacy for auto‐artisans to allay concerns that trigger a sense of discomfort. In addition to discomfort, the study found the unavailability of PPE and financial challenges to be major challenges that impeded the utilization of PPE among auto‐artisans. This may be due to the point that more than 90% of the participants had to purchase their own PPE, leading to low PPE use. This finding is supported by that of Ojo, Naicker, Afolabi and Onayade [23] in Osun State, Nigeria where participants in the study stated that it is the responsibility of the government, and other stakeholders, to provide PPE for workers at subsidized costs. Similar findings have been reported in Nigeria [24] and Ghana [25].

Regarding the main hypothesis, the study shows that auto‐artisans who perceived their occupation as being risky are 2.43 times more likely to use PPE than their counterparts who do not perceive their work as risky. This observation confirms the HBM that argues that perceived susceptibility/risk significantly influences individuals to take up preventive health measures [15]. This observation resonates with the findings of Afolabi et al. [8] who reported a 2.05 times higher likelihood of PPE use among workers with high perceived occupational risk. The consistency between these studies underscores the robust influence of risk perception on protective behaviors across different occupational settings. Furthermore, the observed association may be explained by the psychological mechanisms underpinning risk perception where individuals are more likely to value and invest in preventive measures when they recognize the dangers associated with their work environment.

The findings also suggest that auto‐artisans who belong to a professional association were more likely to use PPE. A plausible explanation for this could be that joining an association offers auto‐artisans the opportunity to have access to occupational health information that guides them to make an informed decision on PPE use. Similarly, in a study by Ölmezoğlu and Özçelik [26] in Turkey, the findings highlighted the importance of Unions in occupational health and safety especially in PPE utilization. The study emphasized that worker unions contribute significantly to occupational health and safety by raising awareness of safety related events. It is, therefore, not surprising that auto‐artisans who participated in safety training sessions had a 45% higher likelihood of using PPE than those who had not participated in any safe training. The result is consistent with Wong et al. [5] whose study found a positive association between participation in safety training and PPE utilization.

Contrary to prior literature that found no significant association between age and PPE use among auto‐artisans [8], this study found a significant positive association. This means that older auto‐artisans were more likely to use PPE compared to younger artisans. A possible explanation could be that older auto‐artisans would have had more years of experience in the trade, and thus, may have encountered or witnessed occupational hazards, accidents and injuries. This experience is likely to result in a heightened awareness of the risks associated with their work. Hence, motivating them to adopt safer practices including the consistent use of PPE. This finding is not consistent with that of a study by Nolte and Hanoch [27] which suggested that older adults self‐report low favorable attitudes towards risks and risk‐taking.

5. Limitations

As an observational study based on a cross‐sectional design, causal inferences cannot be established. The findings are associations of a snapshot and do not infer causality. Future studies could consider a longitudinal design to fully understand changes over time and the causal pathways influencing PPE use. Also, auto‐artisans had to recall their experiences with PPE use. As such, there is the possibility there would be recall bias as well as social desirability bias.

6. Conclusion

In conclusion, the majority of the auto‐artisans in Ghana have a very high risk perception of their work and that there is a moderately high use of PPE. However, there is a high reliance on self‐procured PPE, which underscores a need for the government of Ghana to enforce compliance and ensure that employers prioritize worker safety by supplying adequate and appropriate PPE. Given that discomfort, unavailability, and financial challenges were major barriers to PPE use, it is imperative for policymakers and stakeholders to prioritize the design and distribution of ergonomic and affordable PPE tailored to the specific needs of auto‐artisans. Occupational health literacy campaigns should be intensified to educate auto‐artisans on the importance of PPE, dispel misconceptions, and address discomfort‐related concerns. Government and trade unions could collaborate to increase artisans' access to professional associations and incentivize participation in safety training sessions. Specifically, the government can partner with the trade unions to provide subsidies for PPE.

Author Contributions

Addae Boateng Adu‐Gyamfi: conceptualization, investigation, funding acquisition, writing – original draft, methodology, validation, writing – review and editing, formal analysis, resources, software, data curation.

Ethics Statement

As a student work, the Population and Health Departmental Board of the Faculty of Social Sciences of the University of Cape Coast, Ghana, gave the clearance for the study.

Consent

Verbal consent was obtained from all participants.

Conflicts of Interest

The author declares no conflicts of interest.

Transparency Statement

The lead author Addae Boateng Adu‐Gyamfi affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.