Climate change awareness, motivation, and behaviours among primary health care nurses in South Africa: findings from the adapted CHANT survey

Abstract

Background: Climate change increasingly affects global health, with low- and middle-income countries (LMICs) facing recurrent droughts, heatwaves, and extreme weather events that strain primary health care (PHC) systems. Nurses, as frontline providers, are critical for managing climate-sensitive conditions and promoting resilience. Evidence on nurses’ climate-health engagement in LMICs remains limited. Objective: To assess awareness, motivation, and behaviours related to climate change among primary health care (PHC) nurses in the Western Cape, South Africa, using a contextualised Climate, Health, and Nursing Tool (CHANT). Methods: A descriptive cross-sectional survey was conducted in 38 PHC facilities. An all-inclusive sampling approach yielded 128 professional nurses. Data were collected via a self-administered questionnaire adapted for local context. Descriptive statistics and non-parametric tests were applied. Results: Most respondents (76.2%) were aware of climate change, primarily through television (75%) and social media (60.9%). Two-thirds (66.7%) had experienced extreme weather events, and 74.6% had managed climate-sensitive conditions, notably respiratory illnesses. Concern and motivation were high (90%), and 70% believed mitigation is possible; however, 51.6% perceived the issue as complex, and 25% felt overwhelmed. Climate-friendly behaviours were more frequent at home (15–77%) than at work (12–45%), and only 9% engaged in climate communication with policymakers. Conclusion: Despite strong concern and motivation, workplace climate actions remain limited. Strengthening nurses’ sustainability knowledge and institutional support is essential for advancing climate-resilient PHC systems.