Knowledge, attitudes, and practices of midwives towards evidence-based practice in Dhamar City, Yemen: a cross-sectional study

Evidence-Based Practice (EBP) is fundamental to improving the quality of maternal and newborn care. In low-resource settings like Yemen, understanding midwives’ engagement with EBP is critical for developing effective capacity-building strategies. This study aimed to assess the knowledge, attitudes, and practices (KAP) towards EBP among midwives in Dhamar City, Yemen, and identify associated demographic and professional factors. A descriptive cross-sectional study was conducted from November 2025 to January 2026 among 374 midwives working in healthcare facilities in Dhamar City, Yemen. Data were collected using a structured, self-administered questionnaire comprising sections on demographics, EBP knowledge 6 items (17 points), attitudes (9 items, 3-point Likert scale), and practices 6 items (10 points). Knowledge and practice were categorized as good (> 60%), moderate (40–60%), or poor (< 40%), while attitudes were classified as positive (mean > 2.33) or negative. Bivariate analyses employed chi-square tests and odds ratios with Bonferroni correction (α: knowledge/practice = 0.0083; attitudes = 0.0100). Multivariate logistic regression identified independent predictors. Data were analyzed using SPSS version 26. A p-value < 0.05 was considered statistically significant. Mean age was 28.98 ± 6.04 years; 87.7% were < 35 years; 77.5% held diplomas; 57.8% had < 5 years’ experience; only 24.3% had reliable internet access. Knowledge scores were low (6.13 ± 3.35/17; 55.1% poor, 16.3% good). Attitudes were positive (83.7%; mean 2.58 ± 0.22/3), but practices were poor (3.56 ± 2.10/10; 53.2% poor, 19.3% good), revealing attitude–knowledge difference (67.4%) and attitude–practice difference (64.4%). Bivariate analyses showed all six demographic factors significantly associated with knowledge and practice ( p < 0.001). Previous EBP training was the only factor associated with positive attitudes after correction (OR = 2.27, p = 0.004). Multivariate regression revealed: formal EBP education paradoxically predicted lower knowledge (OR = 0.481, p = 0.006); training, formal education, and internet access predicted lower attitudes (OR = 0.436, 0.356, 0.319; p < 0.01); and training predicted good practice (OR = 1.915, p = 0.009). Reliable internet access was not significantly associated with good knowledge in the multivariate model (adjusted OR = 1.554, p = 0.175). Knowledge–practice correlated moderately (ρ = 0.351, p < 0.001). Working hours associated with attitudes (χ²=14.229, p = 0.003). Midwives held positive attitudes but had critically low knowledge and practice, with a substantial KAP gap. Previous EBP training was the strongest predictor of good practice, while formal education paradoxically predicted lower knowledge and attitudes. Urgent competency-based training and improved infrastructure are needed to bridge the evidence–practice gap in Yemen’s resource-limited settings.