Abstract
<title>Abstract</title> <p>Background Sexual harassment remains a pervasive occupational hazard affecting healthcare workers, disproportionately the nursing professionals, with profound professional and psychosocial consequences. Positive organizational safety culture impacts workplace safety, however, its relationship with sexual harassment remains poorly understood in rural healthcare settings in low and middle-income countries. This study examines how perceived hospital safety culture affects workplace sexual harassment of nursing professionals in the Upper East Region of Ghana. Methods A cross-sectional survey was conducted among 812 nursing professionals selected using the purposive sampling method. The survey comprised the 25-item adapted Airline Safety Culture Index to measure safety culture (i.e., pathological, bureaucratic, or generative). Workplace sexual harassment and its subtypes (gender harassment, unwanted sexual attention, and sexual coercion) were measured using the Sexual Experiences Questionnaire. Descriptive statistics summarized participants' characteristics, and multivariable logistic regression models estimated adjusted associations between perceived safety culture and workplace sexual harassment outcomes, controlling for sociodemographic and workplace characteristics. Results Most participants perceived their workplace safety culture as bureaucratic (63.1%), and generative (29.4%). Overall, 65.3% of the nursing professionals experienced at least one form of sexual harassment while at work, like gender harassment (54.2%), unwanted sexual attention (43.7%) and sexual coercion (24.5%). Compared with nursing professionals working in facilities with a generative safety culture, those in bureaucratic safety culture facilities had higher odds of experiencing sexual harassment (aOR = 1.57; 95% CI: 1.08–2.28, p < 0.05), after adjusting for sociodemographic and workplace characteristics of the workers. Working in facilities with a pathological safety culture was associated with higher odds of gender harassment (aOR = 2.03; 95% CI: 1.07–3.84, p = 0.029) and unwanted sexual attention (aOR = 2.54; 95% CI: 1.32–4.98, p = 0.006). Conclusion and implication: The high prevalence of sexual harassment and its relationship with hospital safety culture suggests that workplace sexual harassment is not only an individual or interpersonal issue, but organizational safety culture also prays a critical role. Prevention requires system-level interventions where healthcare leaders foster a positive, generative safety culture by visibly committing to staff safety, enforcing clear anti-harassment policies, and strengthening mechanisms for confidential reporting and accountability when sexual harassment occurs. Clinical trial registration Not applicable.</p>