Healthcare providers’ perspectives on implementing evidence-based practice guidelines to reduce cesarean section rates: a qualitative study

Thailand’s cesarean section rates continue to rise despite national mandates for evidence-based practice tools, such as the Robson classification. As the clinical effectiveness of these mandates remains limited, this study explored healthcare providers’ perceptions of evidence-based practice implementation and the barriers and facilitators influencing the use of clinical practice guidelines to address unnecessary cesarean sections. A descriptive qualitative study was conducted across eight hospitals participating in the QUALI-DEC project in Thailand. In-depth interviews were conducted with 42 healthcare providers, including administrators, obstetricians, and nurses. Data were analyzed using thematic analysis based on Braun and Clarke’s approach. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guideline. The analysis identified three key themes: (1) From evidence to action, highlighting the necessity of localizing guidelines, engaging stakeholders, and evaluating effectiveness to ensure usability; (2) Barriers to evidence-based practice utilization, revealing how individual experience and hierarchy often override evidence, alongside a lack of structured feedback mechanisms and operational constraints; and (3) Facilitators for successful implementation, emphasizing the need to raise awareness regarding unnecessary cesarean section, promote positive attitudes towards evaluation, and leverage guideline adherence as a mechanism for legal protection. The findings suggest that collaborative leadership and systematic feedback mechanisms may support evidence-based practice adoption. They also highlight contextual factors, including the perceived clinical and legal protection roles of guidelines, that may inform strategies to address unnecessary cesarean sections in Thailand.