Factors influencing evidence-based nursing practice in county hospitals in Southwest China: a qualitative study using the COM-B model and Theoretical Domains Framework

Evidence-based nursing practice (EBNP) is essential for evidence-informed clinical decision-making and nursing care quality. Its implementation is influenced by staff capability, organisational resources, and contextual support. Existing studies have focused on tertiary hospitals or well-resourced settings, while county hospitals remain insufficiently explored. This study explored factors influencing EBNP implementation among nursing personnel in county hospitals, using the Capability, Opportunity, Motivation-Behaviour (COM-B) model and Theoretical Domains Framework (TDF).

A qualitative descriptive design was used. Eight county hospitals were recruited through convenience sampling, and purposive sampling was used to recruit 21 nursing personnel, including nursing directors, head nurses, and frontline clinical nurses. One-to-one semi-structured interviews were conducted using an interview guide informed by the COM-B model and TDF. Data were analysed using a hybrid inductive-deductive thematic approach. Data collection and preliminary analysis proceeded concurrently, and thematic saturation was confirmed when three consecutive interviews generated no new codes or candidate subthemes.

Nine data-derived subthemes were identified and subsequently organised under the three COM-B components of capability, opportunity, and motivation. The subthemes were mapped to relevant TDF domains. Capability-related factors included insufficient EBNP knowledge and skills and difficulties in evidence-based decision-making and translation into practice. Opportunity-related factors included limited evidence resources and training support, insufficient staffing, research-trained personnel and protected time, inconsistent managerial and peer support, and difficulties adapting evidence to county-hospital contexts. Motivation-related factors included recognition of the professional value of EBNP, a gap between willingness to learn and sustained engagement, and unstable formal incentives and positive practice feedback.

Although nursing personnel recognised the value of EBNP, this was not consistently translated into routine practice. County hospitals should provide tiered, practice-oriented training, accessible evidence resources, protected time, managerial and peer support, and ongoing feedback and incentives to support sustained EBNP implementation.