Health Belief Model and Experiential Avoidance in Relation to PTSD Symptoms Among Healthcare Workers in Ekiti State, Nigeria: A Structural Model Analysis

Abstract

Abstract Background: Healthcare workers are at increased risk of post-traumatic stress disorder (PTSD) due to prolonged exposure to high-stress clinical environments. Although the Health Belief Model (HBM) has been widely used to explain health behaviors, its application to psychological outcomes such as PTSD remains limited. The role of cognitive-emotional processes, particularly experiential avoidance, in linking health beliefs to trauma symptoms is not well understood. Methods: This study adopted a quantitative cross-sectional design to collect data from 475 healthcare workers in Ekiti State, Nigeria. Participants completed standardized measures assessing Health Belief Model constructs, experiential avoidance, and PTSD symptoms. Data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM), with bootstrapping used to test direct, indirect (mediation), and moderation effects. Cluster analysis was also conducted using SPSS to validate differences in PTSD symptom severity across psychological constructs and demographic variables. Results: Experiential avoidance significantly predicted PTSD symptoms (β = 0.395, 95% CI [0.231, 0.565]). HBM constructs were negatively associated with experiential avoidance (β = -0.198, 95% CI [-0.270, -0.108]) and PTSD symptoms (β = -0.119, 95% CI [-0.216, -0.006]). Mediation analysis indicated that experiential avoidance partially mediated the relationship between HBM constructs and PTSD (β = -0.078, 95% CI [-0.132, -0.037]), with a total effect of -0.197. Age moderated the relationship between HBM and experiential avoidance (β = -0.114, 95% CI [-0.207, -0.025]) as well as the indirect pathway to PTSD. Sex significantly predicted PTSD symptoms (β = 0.358, 95% CI [0.214, 0.501]). Cluster analysis showed that experiential avoidance and perceived barriers significantly differentiated high and low PTSD symptom groups. Conclusion: The findings support a conditional cognitive-emotional model in which Health Belief Model constructs influence PTSD symptoms both directly and indirectly through experiential avoidance. Demographic factors shape the strength of these relationships, while perceived barriers and experiential avoidance emerge as key determinants of trauma-related distress among healthcare workers. Keywords: Health Belief Model; Experiential Avoidance; PTSD; Healthcare Workers; PLS-SEM; Mediation; Moderation