KNOWLEDGE, ATTITUDE, AND PRACTICE OF ENHANCED RECOVERY AFTER SURGERY PROTOCOL AND ASSOCIATED FACTORS AMONG HEALTHCARE PROFESSIONALS IN PUBLIC HOSPITALS OF HARAR CITY, EASTERN ETHIOPIA

Abstract

Background: The Enhanced Recovery after Surgery protocol is a systematic, evidence-based method to optimizing perioperative care, improving patient outcomes, and promoting recovery. Despite its established benefits, many healthcare settings, particularly those with limited resources, struggle to fully adhere to the protocol. In addition there is lack of evidence based information on the Knowledge, attitude, practice and factors associated with the practice of the enhanced recovery after surgery protocol among health care professionals in public hospitals in Harar, Eastern Ethiopia. OBJECTIVE: To assess knowledge, attitude, practice and factors associated with the practice of enhanced recovery after surgery protocol among health care professionals in public hospitals in Harar, Eastern Ethiopia, from September 1 to October 30, 2025. Methods: An institution-based cross-sectional study was conducted among 270 healthcare professionals who are working in public hospitals of Harar. Data were collected using Kobo Toolbox and analyzed with Stata version 17. Bivariable and multivariable logistic regression analyses were performed, and variables with p < 0.05 in the multivariable model were considered independent predictors of consistent practice. Results: Among the participants, 21% had adequate knowledge and 19% exhibited a positive attitude toward the Enhanced Recovery after Surgery (ERAS) protocol, while only 36% demonstrated consistent practice across all ERAS components. Working in referral or teaching hospitals (AOR = 1.89, 95% CI: 1.12–3.19) and having a positive attitude (AOR = 2.11, 95% CI: 1.11–4.00) were associated with higher odds of consistent practice, whereas participants with more than five years of experience had lower odds (AOR = 0.43, 95% CI: 0.24–0.79). Conclusion: Knowledge, attitude, and consistent practice of the ERAS protocol were low. Working in referral or teaching hospitals and having a positive attitude were associated with better practice, whereas longer professional experience was linked to lower adherence, underscoring the need for targeted interventions to improve ERAS implementation.