Factors Influencing Evidence-Based Practice Engagement Among Clinical Dietitians: A Mixed-Methods Study Using the...

Background/Objectives: Evidence-based practice (EBP) is essential to high-quality nutrition care. Despite its critical importance, its use among clinical dietitians in Saudi Arabia remains poorly understood. This study aims to examine the behavioral factors of EBP engagement among Saudi clinical dietitians using the Capability-Opportunity-Motivation-Behavior (COM-B) model. Methods: This cross-sectional mixed-methods study was conducted in fall 2023 among 82 licensed clinical dietitians (LCDs). Participants completed a self-administered questionnaire including 19 items adapted from the Health Sciences Evidence-Based Practice (HS-EBP) instrument and mapped to the COM-B domains. Qualitative data were obtained from open-ended survey questions completed by a separate sample of LCDs (n = 12) and analyzed using inductive thematic analysis. Results: Descriptive analysis showed higher mean scores for capability (7.49 ± 2.76) and motivation (7.50 ± 2.57) than for opportunity (6.61 ± 2.74) and behavioral engagement (6.09 ± 1.25). All COM-B domains demonstrated excellent internal consistency (Cronbach's α = 0.857-0.959) and were significantly intercorrelated (p < 0.001). Multiple regression analysis indicated that motivation (β = 0.563, p = 0.001) and opportunity (β = 0.290, p = 0.002) independently predicted behavioral engagement (adjusted R² = 0.681), while capability was not independently associated. Qualitative findings identified professional motivation and research literacy as facilitators, and time pressure and administrative workload as key barriers. Conclusions: EBP engagement among Saudi clinical dietitians is strongly influenced by motivational and organizational factors rather than by knowledge or skills.