Abstract:

Objective To explore the determinants influencing the utilization of hearing protection device（HPD） among petrochemical workers，and provide theoretical basis for mitigating noise-induced hearing loss（NIHL） and improving auditory health level of workers. Methods In November 2024，a cross-sectional study was conducted using convenience sampling to recruit 887 noise-exposed workers from a petrochemical enterprise in Lanzhou，Gansu Province. A health belief model（HBM）-based questionnaire was administered to collect demographic data（age，gender，work tenure，education level） and HBM constructs（perceived susceptibility，perceived severity，perceived benefits，perceived barriers，cues to action，self-efficacy） regarding HPD usage. Univariate analysis and binary Logistic regression were employed to identify determinants of HPD compliance，with HPD usage as the dependent variable and the aforementioned factors as independent variables. Additionally，a random forest model was constructed to explore the influencing factors of HPD usage and rank variable importance. Results Among the 887 petrochemical workers，437（49.27%） reported consistent use of HPD，while 450（50.73%） were non-compliant. Univariate analysis revealed that there were statistically significant differences in the impact of HPD usage with knowledge of hearing protection，perceived susceptibility，perceived barriers，perceived benefits，self-efficacy，and cues to action（all P<0.05）. The Logistic regression analysis results showed that self-efficacy（OR=2.203，95%CI：1.592-3.050），perceived barriers（OR=1.412，95%CI：1.073-1.859），and perceived susceptibility（OR=1.352，95%CI：1.022-1.789） were independent influencing factors of HPD compliance（all P<0.05），and higher scores in these variables correlated with increased likelihood of HPD utilization. The random forest model further prioritized determinants by variable importance：self-efficacy emerged as the primary predictor，followed by cues to action，perceived susceptibility，and perceived barriers. Conclusion The usage rate of HPD among petrochemical workers is still relatively low，and self-efficacy，perceived susceptibility，and perceived barriers are the main factors affecting the usage rate of HPD. Enterprises should implement targeted health education programs to cultivate and reinforce workers' self-efficacy，perceived susceptibility，and perceived barriers，thereby enhancing health behavior compliance and advancing auditory health outcomes.

Key words: Hearing protection, Health belief model, Random forest, Influencing factors