Strategies to improve compliance with personal protective equipment use in the textile industry: a scoping review

Abstract

Background

Compliance with the use of personal protective equipment (PPE) is essential for protecting workers from occupational hazards and accidents, particularly in the textile industry. However, achieving consistent PPE compliance remains a significant challenge in many countries. This study aims to review strategies designed to enhance PPE compliance among textile industry workers.

Methods

We applied a scoping review methodology. Systematic searches were conducted across six databases: PubMed, Scopus, ProQuest, ScienceDirect, EBSCO Medline, and SAGE Journals. Five articles met the inclusion criteria for final analysis. We focused on strategy types and reported outcomes when extracting the data. We did not conduct a quality appraisal of individual studies in accordance with the scoping review methodology. The review is registered on the Open Science Framework (10.17605/OSF.IO/U3YAH).

Results

Among the five included studies, only one employed an interventional design, demonstrating that an educational program improved knowledge, attitudes, and PPE compliance. The remaining four studies were observational in nature, identifying influential factors and recommending strategies such as training and adequate PPE provision. However, the contextual variability and observational designs limit the generalizability of the findings.

Conclusions

This review highlights the limited availability of interventional studies on PPE compliance in the textile sector. Nevertheless, observational studies have identified commonly recommended approaches, such as training and workplace improvements, which warrant further evaluation. Future research should prioritize intervention studies to evaluate the effectiveness of these strategies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-24037-9.

Introduction

One of the most important components in driving economic growth in both developing and developed countries is the textile industry. More than 60 million people work in the textile industry, which is one of the largest economic sectors in the world [1]. However, the working environment in this industry often poses significant health risks for workers, such as exposure to textile dust, hazardous chemicals, and excessive noise [2]. Several studies indicate that exposure to these factors can lead to respiratory diseases, hearing disorders, and skin diseases, which diminish the quality of life for workers [3, 4].

In the textile production process, exposure to dust, especially in the spinning and weaving sections, increases the risk of workers experiencing respiratory disorders. Studies in Ethiopia show that workers exposed to textile dust have a higher risk of experiencing cough and bronchitis [5]. Byssinosis, a specific pneumoconiosis in the textile sector, primarily affects workers exposed to cotton dust. Among textile workers, byssinosis prevalence varies greatly. According to a Benin study, 44.01% of workers exposed to cotton dust had the condition [6]. An additional study on Pakistani textile workers found that exposure to cotton dust (22%) caused variable levels of byssinosis symptoms [4]. In addition to dust, workers in the textile industry must be vigilant about exposure to chemicals such as carbon disulfide and other hazardous substances used during various stages of textile production. Prolonged exposure to excessive chemicals can disrupt organ function, particularly the respiratory system. For example, a study in Taiwan found that workers in rayon factories exposed to carbon disulfide experienced higher rates of dangerous health symptoms [7]. The high noise levels in textile factories are also a significant health concern for the workers. Without the use of ear protection, workers exposed to high noise levels are at risk of experiencing hearing impairment, sleep disturbances, and psychological stress. Studies in Iran show that educational interventions emphasizing the dangers of noise can increase workers’ awareness and compliance in using hearing protection, thereby reducing the negative effects of noise [8]. The use of PPE is essential to protect workers from these hazards. Personal protective equipment includes masks, gloves, safety goggles, and ear protection. Personal protective equipment is designed to reduce the impact of hazards in the workplace. The use of PPE has been proven to reduce health risks in the textile industry workplace [9]. However, the level of compliance with the use of PPE still varies across different countries. Studies in China show that an increase in organizational trust and safety culture in factories significantly enhances workers’ compliance with the use of PPE. Other factors include the availability of PPE, worker awareness, and training for workers [10]. In addition, one of the causes of this phenomenon is the lack of legal oversight for small industries [11]. In the textile sector, particularly in developing countries like India and Ethiopia, the lack of strict regulations regarding workplace safety exacerbates this issue. The workplace exposes many workers to pollutants, yet no policies mandate the regular use of PPE [5].

To improve worker compliance with PPE, various strategies have been attempted, ranging from health training to workplace improvements. Several studies on compliance strategies for PPE usage among workers, including a specific study conducted in Vietnam, found that a 90-minute education program significantly increased healthcare workers’ compliance with PPE; the intervention raised compliance rates from 44 to 79%. This program included presentations and video demonstrations on safe handling practices, demonstrating that targeted education in resource-limited settings can be effective [12]. Another study on educational interventions based on social cognitive theory is effective in improving workers’ knowledge, attitudes, and compliance behavior regarding the use of PPE [13]. There are still many factors that influence workers’ compliance with PPE in the textile industry. Some of these factors include a lack of awareness regarding the importance of PPE, discomfort when using it, and a poor safety culture [11, 13, 14]. Despite the recognized importance of PPE compliance in the textile industry, there remains a lack of systematic research analyzing the strategies implemented to enhance workers’ adherence. Many studies focus on identifying factors influencing PPE use, yet few evaluate practical or evidence-based interventions. This scoping review aims to map existing strategies that have been applied to improve PPE compliance among textile workers, evaluate their reported outcomes, and identify research gaps that can inform future occupational safety practices and policies.

The consistent use of PPE in the textile sector is not only a matter of occupational safety but also a public health priority. The presence of hazards in the textile industry work environment and the high prevalence of respiratory and dermal diseases as well as hearing loss among textile workers constitute a substantial burden on the national health system, especially in low- and middle-income countries [15–17].

Materials and methods

Data sources and search strategies

We conducted this scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines [18] from June to August 2024. The search strategy comprised identification, screening, and eligibility assessment. During the identification phase, a broad and inclusive approach was initially adopted to ensure comprehensive coverage of relevant literature on PPE strategies and compliance with the textile industry. In line with this approach, the initial search terms included both industry-specific (e.g., “textile workers”) and cross-industry terms (e.g., “construction workers,” “manufacturing workers”) to capture potentially transferable interventions and best practices from related industrial settings where PPE usage is relevant. However, throughout the screening and eligibility process, we maintained strict alignment with the objectives of this review by selecting only studies that focused on the textile industry or explicitly provided insights applicable to textile sector workers. The final set of included studies, therefore, reflects this focused scope. The search terms were organized as follows: (1) Population: “construction workers,” “manufacturing workers,” “textile workers,” (2) Concept: “PPE intervention,” “PPE education,” “PPE training,” “PPE awareness campaign,” “PPE incentive,” “PPE enforcement,” “PPE technology,” “PPE compliance,” “PPE use,” “PPE-related occupational accident,” “behavioral intervention,” “personal protective equipment.” (3) Context: workplace, “textile industry,” “manufacturing industry,” “occupational safety culture.” We conducted electronic searches across six major databases: (1) PubMed, (2) Scopus, (3) ProQuest, (4) ScienceDirect, (5) EBSCO Medline, and (6) SAGE Journals. We did not apply any restrictions on the publication year, but we restricted the search to titles or abstracts and only to English-published articles.

In this scoping review, we conducted systematic searches in six major interdisciplinary databases: PubMed, Scopus, ProQuest, ScienceDirect, EBSCO Medline, and SAGE Journals. We selected these databases due to their comprehensive coverage of peer-reviewed literature on occupational health, industrial safety, and public health interventions.

We recognize that specific databases for Occupational Safety and Health (OSH), like NIOSH, CISDOC (ILO), OSH-ROM, and HSELINE, could have useful information on PPE strategies compliance. However, these databases were not included in this review due to the following considerations: (1) the institutional access to these databases was limited at the time of the search, and (2) the primary focus of this scoping review was to map peer-reviewed scientific evidence published in international journals indexed in major multidisciplinary academic platforms.

Despite this, the selected databases are known to index high-quality research in OSH, and several of the included studies originated from reputable OSH-focused journals (e.g., Safety Science, Environmental Health Insights, Applied Acoustics). For future studies, especially systematic reviews or meta-analyses, it is recommended to include OSH-specific databases to collect grey literature and research on regulations or policies that are not available in regular academic platforms.

Inclusion and exclusion criteria

The authors filtered the titles and abstracts according to the established review questions and particular inclusion and exclusion criteria. Mendeley was used to gather the results, and in the second round of modifications, duplicates were eliminated. We choose the included papers in two steps after obtaining the search results. Two separate researchers choose articles from the search results in the first stage by looking at the abstract and title in addition to particular inclusion and exclusion criteria. The full text of the study that addressed the research issue was reviewed. In the second stage, two reviewers subject every paper to a comprehensive text evaluation. Eighteen full-text articles were successfully retrieved for eligibility. Two authors have independently reviewed each full-text article. Excluded is any research that is determined to be irrelevant to the goals and anticipated results. A documented cause led to the removal of the article. Thirteen publications in all were disqualified for two reasons: (1) divergent backgrounds (unrelated to the topic of PPE) and (2) unrelated results (unrelated to adherence to PPE use in the textile sector). The remaining five articles (Fig. 1) satisfy the requirements for data extraction.

Fig. 1.

Stages of scoping review

During the initial phase of keyword construction, we included terms such as “construction workers” and “manufacturing workers” alongside “textile workers” in the population domain. This broader inclusion was intentional to ensure sensitivity in the initial screening and avoid missing potentially relevant articles due to underspecific indexing or cross-industry studies that include textile sectors. However, during the title and abstract screening phase, we applied strict inclusion criteria to focus exclusively on textile industry workers, and any studies that primarily involved non-textile populations (e.g., construction workers) were excluded.

Inclusion and exclusion criteria were applied as outlined in Table 1.

Table 1.

Eligibility criteria (inclusion and exclusion criteria)

Criteria Type	Description
Inclusion Criteria	- Empirical studies involving workers in the textile industry. - Studies addressing compliance with PPE. - Research that examines strategies, interventions, or behavioral factors related to PPE use. - Primary studies with either observational or interventional designs. - The research has been published in peer-reviewed journals in English. - Full-text access is available.
Exclusion Criteria	- Studies focused solely on health outcomes or exposure (e.g., respiratory or dermal disorders) without any discussion of PPE behavior or compliance. - Studies conducted in non-occupational settings (e.g., household PPE, hospital visitors). - Papers discussing PPE from a design/material science perspective without behavioral or compliance relevance. - Articles that focus on regulatory frameworks or policy reviews without worker-level data. - Conference abstracts, dissertations, or government reports not subject to peer review.

In accordance with scoping review methodology, no risk of bias assessment was conducted, as the purpose was to map the breadth of existing literature rather than appraise study quality. No effect measures were calculated, as no meta-analysis was performed. Data were synthesized narratively, categorizing studies according to strategy type and context. No statistical or quantitative synthesis was performed. We acknowledged potential heterogeneity among included studies but did not formally analyze it due to the descriptive nature of this scoping review. We did not conduct a sensitivity analysis due to the lack of quantitative synthesis.

Data extraction

Two authors and an independent reviewer conducted data extraction using a previously tested data extraction form and stored it in a Microsoft Excel 2019 spreadsheet. Differences of opinion are resolved through consensus. The characteristics of the following publications are taken from each paper, consisting of year of publication, country, demographic distribution related to gender, and type of intervention for compliance with the use of PPE. Each study’s narrative description summarizes the characteristic variables (Table 3).

Table 3.

Demographic characteristics

Article number	First author (year)	Country	Total Sample	Mayoritas Demografi Data
				Gender	Age (years)	Marital status	Length of Work (years)	Education level
1.	Chou, T. et al. (2004)	Taiwan	65	Male (56 people)	Mean: 41.9; SDI: 9.9	-	20.9, standard deviation 12.3	-
2.	Kifle, et al. (2020)	Ethiopia	383	Male (57.2%)	19–29 (60.1%)	Single (unmarried) (55.4%)	≥ 5 (59.8%)	52.5% vocational education or higher
3.	Tounsadi, H., et al. (2020)	Morocco	90	Female (54.5%)	≥ 41 (53%)	Single (Unmarried) 52%)	1–10 39%	35.5% primary education
4.	Shabani, et al. (2020)	Iran	162 (77 cases & 85 controls)	Control: Male (52.9%); Case: Female (58.4%)	Mean Control: 31.84 ± 8.03; Case 29.84 ± 7.17	Control Married 69,4% & Case Married 58.4%	Mean case 6,45 ± 4.31, control 7.53 ± 3.9	Control was 62.3% diploma equivalent, and Case was 72.9% diploma equivalent.
5.	IJ, N. et al. (2024)	India	95	Male (67%)	Mean 45,7; Median 45	-	24.5, median 25.	53 (75%) attended primary to secondary school.

In line with scoping review methodology, risk of bias assessment was not performed, as the objective was to map the available evidence rather than evaluate the quality of individual studies.

Results

Characteristics of included studies

We retrieved 171 articles from six databases: PubMed (10), Scopus (19), ProQuest (5), ScienceDirect (130), EBSCO Medline (5), and SAGE Journals (2). After removing 29 duplicates, 142 articles were screened. Of these, 124 were excluded for reasons such as irrelevance to the textile industry, lack of PPE compliance outcomes, or non-primary research designs. Eighteen articles underwent full-text review, and 13 were excluded due to incompatible study objectives or outcome focus. Ultimately, five studies met the inclusion criteria (Fig. 1).

Included studies had sample sizes ranging from 65 to 383 participants. Common occupational hazards included textile dust, chemical exposure, and noise. These hazards were associated with respiratory problems, dermatological conditions, and hearing loss. Table 2 summarizes the main types of exposures and health risks.

Table 2.

General information about the articles included in the scoping review

No	Reference	Country	Total Sample	Design Method	Risk Exposure
1.	Chou, T. et al. (2004)	Taiwan	65	Observational	Carbon disulfide
2.	Kifle, et al. (2020)	Ethiopia	383	Observational	Cotton dust
3.	Tounsadi, H., et al. (2020)	Morocco	90	Observational	Hazardous chemicals
4.	Shabani, et al. (2020)	Iran	162	Quasi eksperimental	noise
5.	IJ, N. et al. (2024)	India	95	Observational	There was textile dust and poor ventilation.

The figure illustrates the barriers to PPE compliance. Across the five included studies, multiple barriers to PPE compliance were identified. The most frequently reported factors included (1) workers not knowing enough about job dangers and how to use PPE correctly (mentioned in 3 studies), (2) feeling uncomfortable while wearing PPE (3 studies), (3) dangerous work settings with dust, harmful chemicals, or loud noise (3 studies), (4) not enough PPE available or not using it correctly (3 studies), and (5) other issues noted by at least two studies included poor air flow in the workplace, lack of safety training or education, long exposure to dangerous conditions with older workers, and negative attitudes or low motivation to follow safety rules. Fig. 2 visually summarizes these findings by showing the number of studies citing each barrier.

Fig. 2.

Barriers to PPE compliance in the textile industry (based on five studies)

Scale and scope

The study designs employed in the articles include (1) a study involving 383 textile workers in Ethiopia, focusing on the prevalence of respiratory symptoms such as cough and bronchitis and the relationship between factors such as the use of PPE and the onset of respiratory symptoms [5]; (2) a study involving 95 textile workers in India, focusing on respiratory health and lung function through spirometry, as well as compliance with the use of PPE [9]; (3) a study evaluating how chemical exposure in the Moroccan textile industry and the use of PPE affect workers’ health [14]; and (4) a study involving 65 workers in a rayon factory in Taiwan exposed to carbon disulfide. The focus is on the influence of personal factors such as the use of PPE on chemical levels in urine [7]. (5) A study in the textile industry in Iran involved 162 workers, 77 in the intervention group and 85 in the control group. Focus on the impact of educational interventions on the increased use of PPE and the reduction of disturbances caused by noise [19].

Study design and geographic coverage

Four studies used observational designs, and one employed a quasi-experimental design. The observational studies primarily described usage rates and associated health symptoms, while only the experimental study assessed the impact of an educational intervention on PPE compliance. This methodological imbalance limits conclusions on causality and the effectiveness of strategies.

Geographically, the studies were conducted in Taiwan, Ethiopia, Morocco, Iran, and India. Regional differences influenced the nature of workplace hazards and proposed interventions. For instance, cotton dust-related respiratory symptoms were prominent in Ethiopia and India, while chemical and noise-related issues dominated studies from Morocco and Iran.

Main Findings

Demographic characteristics

Most studies show that the majority of respondents are men. For example, in a study (2) in Ethiopia, male respondents accounted for 57.2%. This finding indicates that men are more often represented in research related to OSH. However, in specific cases, there are exceptions where female dominance is higher, such as in the study (3) in Morocco, where 54.5% of the total sample were women, and in the case-control study (4) in Iran, where the case group was dominated by women (58.4%) (Table 3).

All studies have significant age variation. In several studies, the average age is relatively young, as in study (2), where the age group of 19–29 years dominates (60.1%). Other studies show that the average age of participants is older. For example, research (1) found an average age of 41.9 years (Table 2).

Several studies show that the majority of participants are married. In the study (4), in both the control and case groups, the dominance of married respondents was also high (control: 69.4%, case: 58.4%). However, there are also studies with a majority of single participants. For instance, research (2) in Ethiopia accounted for 55.4% of the participants (Table 3).

According to most studies, the majority of participants have a secondary education or lower. Study (5) found that 75% of the participants only attended elementary to junior high school. However, some studies show that the majority of participants have higher education. For example, research (2) showed that 52.5% of participants have a bachelor’s degree or higher (Table 3).

Variations in work experience differ among studies. According to study (2), the majority of respondents (59.8%) have more than five years of work experience. Conversely, study (3) found that the majority of participants have 1–10 years of work experience (39%); Table 3.

The work environment in the textile industry affects the health of workers and their adherence to PPE

All studies show the impact of the working environment in the textile industry on workers’ health. Exposure to cotton dust and airborne particles causes respiratory symptoms such as cough, phlegm, bronchitis, and other lung problems (2, 3, 5). Exposure to chemicals such as dyes and carbon disulfide can cause dermatological, neurological, and reproductive disorders (3, 1), and industrial noise also contributes to hearing impairment, especially in older workers (5). Most of the reviewed studies show that textile workers have significant health effects, especially on respiratory health (Table 3). All studies (1, 2, 3, 4, 5) emphasize the importance of compliance with the use of PPE (Table 4).

Table 4.

Impact of the textile industry work environment on worker health and compliance with the use of PPE

Article number	Author(s) Years	Hazard Exposure	Health Impact on Workers	Compliance with PPE Use
1.	Chou, T. et al. (2004)	The level of chemical exposure to carbon disulfide is high.	Exposure to carbon disulfide causes neurological and reproductive problems.	- Personal factors such as age and smoking exacerbate health risks, but the use of PPE reduces exposure.
2.	Kifle, et al. (2020)	- Exposure to cotton dust in the spinning section causes a higher prevalence of respiratory symptoms.	- Respiratory symptoms: cough (8.1%), phlegm (11.7%), bronchitis (6.8%), chronic bronchitis (0.5%), and chest pain (5.5%). - Overall, 36.81% of workers reported respiratory symptoms.	- The use of PPE significantly reduces respiratory symptoms (AOR = 4.88, 95% CI: 1.54–15.45).
3.	Tounsadi, H., et al. (2020)	Hazardous chemicals like dyes and solvents expose people.	- Significant health impacts due to chemical exposure, including respiratory and dermatological issues.	- Training and enforcement of PPE usage are very important to reduce the risk of chemical exposure.
4.	Shabani, et al. (2020)	The study focuses on the effects of chronic industrial noise exposure.	- Noise disturbance significantly increases among older workers. - Educational interventions improve knowledge, attitudes, and practices regarding noise hazard management.	- Intervention, compliance with the use of PPE for hearing protection, and awareness of noise hazards have increased.
5.	IJ, N. et al. (2024)	- Airborne particle exposure in home-based textile units. - Lack of ventilation worsens health effects.	- 88% of workers have abnormal spirometry results; 82% have a restrictive lung disease pattern.	- Improvement of working conditions and the use of PPE are highly recommended to reduce respiratory issues.

Recommendations & strategies for compliance with PPE use

Most studies (2, 3, 4, 5) recommend strategies for ensuring compliance with PPE use by providing PPE, offering training and education, fostering a safety culture and management support, improving ventilation and the work environment, and conducting risk assessments along with hazard communication. Among the five studies, four studies (2, 3, 4, and 5) recommend strategies for compliance with PPE use through training and education. Also, three studies (2, 3, 5) highlight the need to mix training and education with providing PPE (2), improving ventilation and work environments (5), and conducting risk assessments and hazard communication. There is only one study each that provides recommendations for compliance with PPE use strategies without combining them with other types of strategies, namely only through safety culture and management support (1) and only through training and education (4) (Table 5).

Table 5.

Recommendations & strategies for compliance with PPE use

Article number	Author(s) Years	Main Findings on the Use of PPE	Recommendations & Strategies for Compliance with PPE Usage
			Provision of PPE	Training & Education	Safety Culture & Management Support	Ventilation & Work Environment	Risk Assessment & Hazard Communication
1.	Chou, T. et al. (2004)	Workers with skin diseases tend to use PPE less frequently, increasing their exposure to chemicals.	0	0	1	0	0
2.	Kifle, et al. (2020)	PPE is associated with a reduction in respiratory symptoms, but only 37% of workers consistently use it.	1	1	0	0	0
3.	Tounsadi, H., et al. (2020)	Despite exposure to hazardous chemicals, only 38% of workers consistently use PPE	0	1	0	0	1
4.	Shabani, et al. (2020)	Intervention in the form of education about noise and the use of PPE improves workers’ knowledge, attitudes, and practices related to PPE.	0	1	0	0	0
5.	IJ, N. et al. (2024)	Workers with abnormal lung function have a low rate of PPE usage. Workplace safety measures can increase the use of PPE.	0	1	0	1	0

Figure 3 shows the key findings developed to illustrate the relationship between workplace hazards, health impacts, intervention strategies, and expected outcomes. It also illustrates how exposure to textile dust, hazardous chemicals, and industrial noise can cause a range of health problems such as respiratory disorders, hearing loss, and skin conditions. We recommend several strategies in response, which include training and education, providing PPE, fostering a positive safety culture, risk communication, and environmental controls. These strategies aim to increase compliance with PPE use and encourage safer behavior in the workplace. Further studies are necessary to support the expectation that increased compliance may reduce health risks and improve the well-being of textile workers.

Fig. 3.

Summary of strategies to improve PPE compliance and their impact on worker health in the textile industry

Discussion

Study design

Study design in various articles

This review did not assess the risk of bias in individual studies, which is consistent with the aim of scoping evaluations to provide an overview of available evidence rather than a critical appraisal. We employed several research methods, specifically observational and experimental studies. It is important to note that one study initially identified during the selection process (Liu et al., 2015) was excluded from the final analysis because it did not specifically focus on textile industry workers and thus did not meet the predefined inclusion criteria.

Strength of Evidence and Prevalence of Observational Designs: An important observation from this review is the predominance of observational study designs, which accounted for four of the five included articles. This trend shows the practical and ethical difficulties of using experimental designs in workplaces, like getting permission, managing environmental factors, or randomly assigning treatments to workers. While observational studies provide helpful information regarding real-world conditions and associations, they fall short in establishing causal links between interventions and outcomes. Consequently, there is a lack of strong evidence about what actually enhances PPE compliance. To move the field forward, future research should focus on including studies that test interventions over time, can assess lasting changes in behavior, and are effective in controlled settings.

Implications of the findings

Demographic characteristics

This review reveals demographic differences in OHS research, which may vary based on region and topic. Demographic factors such as gender, education level, and length of service are relevant in understanding risk exposure and PPE compliance. While some studies report no direct correlation between demographics and OHS knowledge, these factors may influence safety practices [20–22]. However, male gender dominance, lower secondary education, and a tendency to marry are common trends. In the analysis of risks related to OHS, these factors are important to consider. Several demographic variables, such as age, gender, education, and work duration, can affect work risks and the OHS policies that need to be implemented. Men and women have different exposures to occupational hazards [20]. In another study, it was found that there is no significant relationship between sociodemographic factors such as gender, age, education level, and work experience with the level of OHS knowledge, but there is a significant relationship between gender and age with OHS practices [21]. There is a significant relationship between job-related education and the likelihood of experiencing accidents, and lower income levels are associated with a higher risk of work-related accidents [22].

The impact of the textile industry’s work environment on worker health and strategies to ensure compliance with the use of PPE

All studies reported significant health impacts from the textile work environment, particularly respiratory issues due to cotton dust and chemical exposure. For instance, study (2) found that workers exposed to dust without PPE use had increased respiratory symptoms (AOR = 4.88). This finding is consistent with findings emphasizing the relationship between workplace exposures and pulmonary dysfunction [2].

Workers in the textile industry are exposed to various occupational hazards, but exposure to cotton dust and dangerous chemicals has the most detrimental effects on health, especially on the respiratory system. According to studies, extended exposure causes lung conditions, chronic bronchitis, and possibly long-term occupational asthma. The risks are increased by the fact that chemical exposure, including carbon disulfide, has also been connected to neurological and reproductive issues.

The Important Role of PPE: The use of PPE is very important to reduce the negative effects of exposure to workplace hazards [13, 23]. Studies show that workers who do not use PPE have a higher risk of health problems, especially respiratory disorders and issues due to chemical exposure. A study in Bahir Dar also indicates that workers who use PPE are less likely to experience severe respiratory symptoms. Workers in dusty environments, such as factories in Ethiopia, show a high prevalence of respiratory symptoms. Not using PPE significantly increases the risk of respiratory disorders [24].

The use of PPE is often reported to be associated with reduced health risks in observational studies, though causal relationships cannot be confirmed without experimental evidence. These findings can be further explained using the Health Belief Model (HBM), which posits that compliance is influenced by workers’ perception of risk and benefit [13, 23, 24]. Key components such as perceived severity, cues to action, and self-efficacy play critical roles in PPE use decisions.

Training and Education Interventions: The most common strategies identified in the reviewed studies were those involving educational interventions. Study (3) demonstrated that PPE compliance increased following the training provided [19]. Similarly, another study found that intervention strategies based on Social Cognitive Theory (SCT) improved knowledge and attitudes [13]. The Theory of Planned Behavior (TPB) also applies here, highlighting subjective norms and perceived behavioral control as influences on PPE use intentions [13, 25–27].

Proper training in the use of PPE is essential, as incorrect use can lead to significant exposure risks [25]. Educational interventions in textile workplaces reduce the risk of health disturbances due to noise and exposure to other hazards. A study conducted in Iran showed that training on workplace hazards and the importance of using PPE successfully improved workplace safety. This training increases workers’ awareness of noise risks and changes their attitudes and behaviors regarding the use of PPE. The results of this training demonstrate that it supports changes in attitudes and behaviors. Training and health education on the use of PPE have been associated with increased awareness and reported compliance in some studies. However, further interventional research is needed to confirm whether such strategies effectively reduce health risks in practice. Research on the efficacy of behavioral interventions like training is still needed, though [26]. Interventions based on the planned behavior theory model indicate that how people view the benefits of PPE and their perception of risk can affect their willingness to use it [27]. Education interventions based on SCT can significantly improve knowledge and practices regarding the use of PPE [13]. Continuous education and structured training can improve compliance with the use of PPE among healthcare workers [13, 28].

The managerial commitment and safety communication improve compliance [29]. Therefore, fostering a strong safety culture and supervisory support is critical [10, 29, 30].

Recommendations for improving the work environment: To reduce respiratory health risks, studies in Tamil Nadu and Bahir Dar suggest increasing ventilation in the workplace and better health standards. In addition, the informal sector, or unregistered households, where textile workers often work under inadequate conditions, requires special attention from the government and the industry. Some studies show that improving the work environment is essential to reduce exposure to hazards [31]. Furthermore, it is very important to implement the Occupational Safety and Health Management System (OSHMS) in the textile industry, because management often neglects worker safety [32]. It is necessary to adopt conventions focused on labor rights in the textile industry to promote fair and sustainable practices that benefit workers, companies, and the economy [33]. Industry owners and the government can play an important role, while other stakeholders also have a beneficial opportunity to improve safety issues from their respective perspectives [34].

To reduce these health risks, we should prioritize a number of initiatives: (1) Mandatory PPE Implementation: Employers should enforce the use of PPE, including chemical-resistant gloves and premium respirators; (2) Improving Workplace Ventilation: Textile factories may drastically lower airborne pollutants by improving air circulation; (3) Regular Health Surveillance: To identify early indicators of occupational disorders, routine medical examinations must be offered; (4) Educational Programs on PPE Compliance: To increase employee understanding of the dangers of non-compliance, ongoing training should be provided; (5) Regulatory Enforcement: To guarantee industry-wide compliance with PPE use, governments must set up stringent regulatory laws and oversight.

Understanding Barriers to PPE Compliance: The findings indicate that improving PPE compliance requires addressing multiple barriers simultaneously. The most common challenge is discomfort or poor fit of the equipment, which discourages prolonged use, especially in hot or physically demanding textile environments. Studies have emphasized that workers are more likely to avoid PPE when it interferes with their tasks or causes physical strain. Moreover, the limited availability of properly sized or appropriate PPE, particularly in small-scale or informal industry settings, further exacerbates noncompliance. Lack of awareness also emerged as a persistent issue, where workers underestimate occupational risks or fail to recognize the protective value of PPE. Insufficient training or hazard communication often exacerbates the problem. Also, poor supervision and enforcement make it hard to hold people accountable, and cultural attitudes, like the belief that PPE is not needed, can stop workers from using it even when it’s available. These barriers underline the need for a comprehensive approach that integrates ergonomic PPE design, structured training, consistent supervision, and a supportive safety culture to sustainably improve compliance.

The reviewed studies consistently reported several barriers to PPE compliance. On an individual level, discomfort from PPE due to poor ergonomic design or thermal burden was a major deterrent, particularly in warmer climates [35, 36]. Behavioral factors such as low risk perception, limited knowledge, and habitual non-use also contributed to low compliance rates [10, 13, 37–40]. Organizational influences, including weak safety culture, lack of enforcement, and insufficient supervisory support, further undermined efforts to promote consistent PPE use [41]. Environmental conditions like poor ventilation and overcrowding compounded these issues by making PPE use more cumbersome and less effective. Strategies are therefore needed to improve compliance with PPE use through (1) regular training and feedback [40], (2) behavioral interventions [42], and (3) management support [37, 39].

Challenges and Opportunities in Interventions: Despite the importance of PPE interventions, most studies are limited to observational studies, which do not assess long-term effectiveness. Longitudinal studies are needed to evaluate sustained behavior change [43, 44]. Moreover, PPE comfort and design remain underexplored; ease is a key determinant of use [35, 36].

A more comprehensive process is needed to build a behavioral intervention model for compliance with the use of PPE in the textile industry. The intervention must consider various variables that affect worker compliance, such as workplace environment and education factors. To address issues in various textile industries, the behavioral compliance intervention model using PPE can include the following important components and steps:

1. Behavioral-Based Education Approach (Behavioral-Based Education). According to an article on workplace education interventions, it is known that workers’ Knowledge, Attitudes, and Practices (KAP) greatly influence their compliance with the use of PPE. Therefore, behavior-based intervention models should focus on increasing knowledge about hazards in the work environment and the importance of PPE, as well as encouraging changes in workers’ attitudes and behaviors. The following strategies can help achieve this: (1) Regular training: Safety behavior becomes part of the daily work culture because repeated training programs are not just one-time training; (2) Interactive education: Involving workers in exercises or simulations of using PPE in real work situations can help them understand the benefits of PPE directly. (3) Hazard awareness enhancement: Using visual content, such as posters or videos, to emphasize the real consequences of not using PPE, such as the risk of respiratory diseases, noise, or chemical exposure. Regular training. Regular ongoing training programs are crucial for instilling safety behavior into the workplace culture. Research shows that repeated training significantly increases knowledge and compliance with the use of PPE [45]. Interactive education. Involving workers through simulations and practical exercises allows them to directly experience the benefits of PPE, fostering a deeper understanding of its importance [46]. The DO IT method, which includes observing and intervening in unsafe behaviors, has proven effective in modifying worker behavior and increasing PPE compliance [47]. This approach enhances workers’ awareness of potential hazards. Visual aids significantly influence risk communication. Visual aids have been proven to enhance risk understanding, as demonstrated by a study where participants using visual tools reported better comprehension and less information overload compared to those who did not use them [48]. The use of images in health communication has been linked to increased adherence to safety behaviors, indicating that emotional engagement through visuals can motivate compliance [49].

2. Social Strengthening and Support from Supervision. If there is positive pressure at the workplace, workers are more likely to use PPE. Support from supervisors and colleagues is an important factor in increasing compliance with PPE use. A study found that social support is a dominant factor influencing nurses’ compliance with PPE, alongside attitude and knowledge [50]. Leadership and training play a crucial role. In the construction industry, the lack of leadership and safety training has been identified as a significant barrier to PPE compliance, highlighting the need for strong managerial support [51], and for healthcare workers, Institutional policies and the quality of PPE, influenced by leadership, are crucial for compliance [41]. Information accessibility is crucial. Although social support is crucial, the accessibility of information also emerges as a key factor influencing PPE compliance, indicating that a multifaceted approach is necessary [52].

3. The proposed intervention model should include: (1) Consistent supervision: Managers or supervisors regularly monitor to ensure that PPE is used correctly and consistently in the workplace; routine monitoring by managers is critical for guaranteeing proper PPE usage. Studies show that inadequate supervision leads to poor compliance; for example, 48% of healthcare workers reported insufficient monitoring of PPE usage [53]. Effective supervision can significantly improve compliance with safety protocols. 2) Rewards and incentives: Providing rewards or bonuses can motivate workers or teams who comply with safety regulations and regularly use PPE. Correctly structured incentives can lead to improved safety outcomes over time, irrespective of potential short-term costs [54]. 3) Creating a supportive social environment: Building a strong safety culture can be achieved by encouraging coworkers to remind each other about the importance of PPE. Peer Reminders: Fostering a safety culture by encouraging coworkers to remind each other about PPE use is crucial for compliance [55]. Collective Recognition: Employees often prefer collective recognition over individual awards, indicating that a supportive team environment can enhance safety practices [56].

4. Modification of the Work Environment (Environmental Modifications). Modifications to the work environment are necessary to encourage the use of PPE, in addition to behavioral factors. Studies show that workers often do not use PPE due to unsupportive working conditions, such as lack of ventilation or the unavailability of comfortable PPE [2, 57]. Therefore, the creation of maintenance should involve (1) Providing ergonomic PPE: Industries must ensure that PPE is available in sufficient quantities and meets the needs of workers because workers are more likely to comply with regulations if the PPE is comfortable and simple to use; (2) Regular monitoring of environmental conditions: For example, improving ventilation and ensuring the work environment is free from dust and hazardous chemicals will reduce extreme exposure and encourage workers to use PPE better. (3) Improving layout and signage: This involves enhancing the factory layout by creating dedicated areas for collecting and storing PPE, as well as installing information boards at all key locations to remind workers of the importance of workplace safety.

5. Psychological factors play an important role in adherence to the use of PPE [58]. To enhance worker motivation, the following interventions may be implemented: (1) Ongoing safety campaigns: These are psychological methods designed to prioritize the safety and well-being of both workers and their families; (2) Self-monitoring: To encourage workers to track and assess their PPE, workers can use tools such as daily self-check cards or digital applications that provide reminders or record compliance. (3) Strengthening internal motivation: This strategy involves demonstrating the direct benefits of PPE implementation for workers’ health and quality of life, rather than merely focusing on compliance with rules.

6. Community-Based Intervention Model. The home textile industry, or informal sector, often has workers who work without direct managerial supervision. We should design interventions for this sector to engage the worker community more deeply [59, 60]. (1) Community-based safety programs: involving community members in safety training with a priority on maintaining the health and protection of the entire family involved in the textile process; (2) Family involvement: Since workers often work from home, it is important for them to educate their family members as well, especially to ensure that the work environment is safe and meets health standards.

7. The Use of Technology for Monitoring and Education. The textile industry can develop: To improve compliance with the use of PPE, technology can be used [61]: (1) Wearable applications or devices: For example, using a device that workers can wear to identify whether they are using PPE and provide automatic warnings when they are not using it in hazardous areas; (2) Application-based education: applications used to provide online safety training, such as modules on workplace hazards and the importance of PPE. To protect workers from workplace hazards, the model of PPE compliance behavioral intervention in the textile industry should include various approaches, such as behavioral education, social support, environmental modification, psychological approaches, community-based programs, and technology. Although most studies mention safety-related interventions, not all studies explicitly investigate or test the direct use of PPE interventions. Some studies focus more on other aspects, such as safety culture, the influence of the work environment, or general safety education.

Recommendations and interventions for compliance with PPE use

The recommendations and interventions for compliance with PPE use include several important points.

1. Provision of PPE: Specifically applied in the article from Ethiopia. Other articles do not mention the provision of PPE as a primary intervention. This suggests that direct provision of PPE is more commonly emphasized in industrial settings with a higher risk of respiratory issues, such as in the Ethiopian textile industry.

2. Training and Education: The most consistently applied intervention in most articles, except for those related to personal factors. This indicates that education and training are the main methods of improving workers’ compliance with the use of PPE, as these interventions equip workers with knowledge about the importance of safety.

3. Safety Culture and Management Support: Emphasized in two articles on safety climate and the influence of personal factors. This underscores that building a strong safety culture in the workplace and gaining management support can enhance worker compliance, although the focus is not always directly on PPE but on safety behavior in general.

4. Ventilation and Work Environment: Only mentioned in one article (Study of Respiratory Health in India). This shows that, although ventilation and environmental conditions are important for preventing exposure to pollutants, these interventions are less directly focused in the context of compliance with the use of PPE.

5. Risk Assessment and Hazard Communication: Only applied in one article (Chemical Impact). Risk assessment of chemical hazards is crucial to raise workers’ awareness about workplace dangers and the importance of using PPE.

Lack of specific interventions

One of the main findings of this review is the lack of focus on the development and implementation of specific interventions to improve compliance with the use of PPE in the textile industry. Although many articles discuss the importance of using PPE, few provide clear guidelines or recommendations on effective interventions. For example, an article about the prevalence of respiratory symptoms in Ethiopia [5] and lung function in textile workers in India [9] mentions the importance of PPE in preventing respiratory diseases but does not offer concrete strategies to encourage workers to adhere to PPE protocols. Further research needs to be conducted to design interventions that focus on worker safety behavior, such as implementing relevant training or providing comfortable and ergonomic PPE to encourage use. So, more research should focus on workers’ needs, the textile industry’s conditions, and how well it improves PPE compliance.

The role of safety education in improving compliance

Several reviewed articles highlight the role of education and training in raising workers’ awareness of safety risks and the importance of PPE. Articles discussing educational interventions to reduce noise disturbances [19] show that education can enhance workers’ understanding of noise risks, which may also be relevant in the context of PPE. Other research has shown that comprehensive training can increase workers’ awareness of the hazards they face and encourage compliance behavior [62, 63]. However, education alone may not be enough to ensure long-term compliance. A study suggests that although training can enhance knowledge, behavior change often requires reinforcement through strict supervision, incentives, or sanctions [44, 64]. Future research can explore the combination of training and better monitoring systems to ensure the sustainability of compliance behavior.

Safety climate and organizational culture

The safety climate in the workplace is also important as a factor influencing workers’ compliance with PPE [10]. Management that is committed to safety and support from co-workers can improve safety behavior. This conclusion is in line with previous research indicating that a positive safety climate, where workers feel supported and motivated to adhere to safety protocols, is associated with lower workplace accident rates and increased use of PPE [29, 30]. Further research is needed to explore the relationship between safety climate and PPE compliance in the textile industry. For example, the research could investigate how safety policies implemented by management can encourage workers to comply with PPE or weaken it, as well as how stricter supervision impacts compliance levels.

Limitations geographical context

Most of the reviewed articles discuss specific areas, such as Ethiopia and India. This limits the generalization of the results because the textile industrial conditions in different countries vary. Work safety standards and access to PPE can differ between developed and developing countries. It is very important to conduct broader research in various geographical contexts because the findings will provide a wider and more flexible perspective for building interventions that are suitable for local conditions.

The Role of design and comfort in PPE

Studies show that the comfort and design factors of PPE affect its compliance. Workers tend not to use PPE regularly if it is considered uncomfortable, heavy, or disruptive to their work [35]. Future studies could examine how changes in PPE design, such as lighter materials and better ventilation, can make workers more comfortable and improve compliance.

Overall, training and education emerged as the most frequently applied strategies in improving compliance with PPE use, followed by management support and safety culture. Most studies placed less emphasis on the provision of PPE and risk assessment, despite their importance in certain environments. Improvements in the work environment, such as ventilation, appear to play a significant role, despite not receiving widespread emphasis in all studies. Through the more consistent and effective use of PPE, further research can help improve the safety and health of workers in the textile industry by developing:

1. Intervention Research to Improve PPE Compliance: Further research should focus on the development and evaluation of specific strategies aimed at improving PPE compliance in the textile industry. These strategies may include awareness campaigns, worker training programs, the provision of more comfortable PPE, and stricter supervision. In addition, the research can investigate factors such as management support, organizational culture, and employee motivation that influence compliance.

2. Evaluation of the Effectiveness of Long-Term Safety Education Programs: Most of the reviewed studies only evaluate the short-term impact of education. Subsequent research could develop long-term studies that assess the long-term impact of education programs related to PPE and workplace safety, as well as measure whether employee compliance behavior has evolved.

3. The Influence of Safety Climate on PPE Compliance: Several studies have shown that a positive safety environment in the workplace is associated with better safety behavior, including PPE compliance. Further research can uncover more about how elements of safety climate (such as managerial support, supervision, and safety communication) can affect how well workers use PPE.

4. Research in Various Geographical and Industrial Contexts: The reviewed research is usually limited to specific areas, such as Ethiopia and India. Further research should encompass various regions and countries with different textile industry conditions to produce more generalizable results. Additionally, the research should examine the various types of PPE required in different textile production processes and how these differences impact compliance.

5. Qualitative Study on Barriers and Motivations for PPE Compliance: Further research can produce qualitative studies to understand the barriers faced by workers when using PPE, such as comfort, risk perception, and supervisor support. Additionally, it is necessary to investigate what drives workers to comply, such as incentives, strict regulations, and personal experiences with safety.

6. Application of Technology to Improve Compliance: Future research can investigate various technologies that can be used to track and enhance compliance with PPE in the textile industry. Some examples include sensors that detect the use of PPE, mobile applications that provide reminders or automatic reporting on compliance, or IoT-based monitoring systems that can alert when employees do not use PPE according to procedures.

7. Experimental Study on Variations in PPE Design: Further research can investigate various PPE designs to determine which elements can make PPE more comfortable and useful for workers. For example, research on lighter materials, better ventilation, or ergonomic designs can offer clues about how developing more comfortable and functional PPE can enhance compliance.

Integrated measures aimed at improving PPE compliance hold potential to reduce occupational disease burden, although current evidence remains limited, and further studies are needed to establish these effects, which would serve more general public health objectives, including lowering the burden of non-communicable diseases and boosting worker health resilience.

Implications for practice

The results of this review offer valuable information that can guide the development of applicable intervention strategies and legislative measures to enhance compliance with PPE in the textile sector:

1. Policy Enforcement: Regular PPE use in textile industries should be required by governments and labor departments, especially in high-risk settings like spinning or dyeing facilities. Regulations should enforce the minimum requirements for PPE provision and use in small-scale and unorganized textile enterprises.

2. Workplace-Based Interventions: Companies should put in place regular, structured training courses that emphasize identifying hazards and using PPE correctly. To increase participation, these programs must employ interactive techniques like simulations.

3. Design-Oriented Improvements: To increase user comfort and compliance, industry stakeholders should work with PPE manufacturers to create ergonomically designed equipment appropriate for the hot, humid conditions seen in textile facilities.

4. Programs for Integrated Occupational Health: PPE measures must be incorporated into larger occupational health programs, such as supervisor training, regular health examinations, and ventilation upgrades.

5. Data-Based Monitoring: Use digital tools or checklists to create a system that tracks the use of PPE. Real-time compliance monitoring can support targeted intervention strategie

Limitations

1. Regional Focus: Many studies focus on specific regions (such as Ethiopia and India), making it impossible to generalize to a broader context.

2. Study observation: Some studies use an observational study, making it difficult to assess the long-term effectiveness of PPE interventions.

3. Lack of focus on intervention strategies: Although some articles acknowledge the importance of PPE, most do not thoroughly discuss it.

4. Scope of Data: Health outcomes (such as respiratory health and chemical exposure) are discussed more frequently than compliance behaviors related to the use of PPE.

5. One limitation of the current research is the absence of specialized OHS databases, such as NIOSH and CISDOC. These databases may contain additional literature or studies of strategies to improve compliance with PPE use in the textile industry that are not covered in general scientific databases. Such databases could provide a broader range of OHS-related strategies for future studies.

6. There are several limitations with the evidence in this review. Most research was observational, lacked long-term follow-up, and was done in various contexts, making direct comparison and generalization harder.

7. This review did not assess reporting bias because it had an exploratory scope and lacked a protocol-based exclusion process.

8. Certainty of the evidence was not evaluated, consistent with the objectives of a scoping review.

9. Because no synthesis involving statistical pooling was conducted, the risk of bias due to missing results was not assessed.

10. Certainty assessment was not applicable given the scope and nature of the evidence included.

In addition, this review did not perform a critical appraisal of the quality or risk of bias in the included studies. This omission restricts the ability to assess the quality and dependability of the evidence base, even though it is in line with the scoping review methodology. Future systematic reviews should include such assessments to provide more robust conclusions.

Moreover, the included studies did not report long-term follow-up or sustained behavior change in PPE compliance, making it difficult to assess whether observed improvements were maintained over time. This temporal limitation reduces the ability to draw conclusions about the durability of intervention outcomes.

Lastly, the review was limited to English-language peer-reviewed articles and excluded grey literature. This may have led to the omission of valuable local or unpublished studies, particularly from regions where OHS research is not widely indexed in major databases.

Conclusion and future research directions

A review of five articles reached several key conclusions regarding strategies for compliance with the use of PPE in the textile industry:

1. Lack of Focus on Specific Strategies for PPE: Most of the reviewed articles highlight the importance of PPE and the health risks faced by textile industry workers, such as respiratory disorders, hearing impairment, and exposure to hazardous chemicals. However, almost all the articles do not focus on specific interventions to improve compliance with PPE usage. Most articles primarily discuss the health impacts of hazardous and unsafe working environments.

2. Limited Study Design: Many articles use observational study designs, which limit the ability to assess the long-term effectiveness of PPE interventions. These studies can offer details about the prevalence and factors associated with non-compliance, but they cannot demonstrate behavioral changes resulting from the strategies.

3. Specific Regional Focus: This study primarily focuses on specific regional contexts, such as Ethiopia and India. The results may not be fully applicable to the global context or to different textile industry conditions in other countries. While this provides valuable insights into the issues faced in various regions, it also highlights the need for broader research in other areas.

4. The Impact of Strong Environmental Exposure: Studies show that exposure to chemicals, poor air quality, and noise are significant health risk factors for workers in the textile industry. This paper emphasizes the importance of using PPE as a mitigation step, but not much is discussed about how to ensure workers consistently adhere to PPE regulations.

5. The Role of Education and Safety Climate: Several studies show that education and increased awareness of workplace hazards can improve compliance with PPE. Research on educational interventions and safety climate indicates that awareness and safety-related behaviors in the workplace improve. However, more research is required to ascertain the precise impact of this intervention on the consistent use of PPE.

6. More research focusing on the development and evaluation of specific interventions is needed to improve PPE compliance in the textile industry. Enhancing health education, ensuring safety, and enforcing strict company policies are commonly recommended approaches that may improve compliance, although further interventional studies are needed to confirm their effectiveness. Long-term design research is also necessary to determine the long-term effectiveness of these interventions. Additionally, we should generalize the research results to encompass a wider range of geographical contexts and types within the textile industry.

Future studies should prioritize the development and evaluation of comprehensive intervention programs that address both behavioral and organizational barriers to PPE compliance. This includes designing multistrategies combining training, ergonomic improvements, and safety culture reinforcement. Researchers are encouraged to conduct longitudinal studies to assess the sustainability and long-term impact of PPE interventions over time, particularly in diverse textile work environments.

Also, looking into how technology can help with PPE compliance, like using wearable sensors, mobile safety training apps, or systems that monitor in real-time, is a great way to improve both following the rules and taking responsibility. Finally, comparative studies between formal and informal textile sectors can yield deeper insights into context-specific strategies.

Author Contributions

Yeremia Rante Ada, Agus Surono, Supriyati Supriyati wrote the main manuscript text, Ari Prayogo Pribadi prepared figures. All authors reviewed the manuscript.

Funding

None.

Data availability

Supporting data for this research has been uploaded in supplementary file folder along with prisma data.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.