Abstract
INTRODUCTION: This study aimed to assess the knowledge, attitudes, and practices (KAP) of obstetrics and gynecology medical staff concerning enhanced recovery after cesarean section (ERAC). METHODS: A multi-center cross-sectional survey was conducted between February 22 and March 31, 2025, in 10 hospitals located across various regions of China. A structured questionnaire was employed to collect data on participants' demographic characteristics and assess their scores in the domains of knowledge, attitude, and practice related to ERAC. The cutoff score for each domain was set at 80% of the total possible score to categorize levels as "good" or "poor." RESULTS: A total of 766 valid responses were obtained, yielding a valid questionnaire rate of 85.97%. Among the respondents, 685 (89.43%) were female, and 276 individuals (36.03%) had previously received ERAC-specific training. The average scores were 14.64 ± 5.93 (range: 0-25) for knowledge, 44.18 ± 5.45 (range: 10-50) for attitude, and 32.33 ± 10.30 (range: 10-50) for practice. Structural equation modeling suggested that knowledge was significantly associated with attitude (β = 0.441, p = 0.009) and practice (β = 0.501, p = 0.005), while attitude was also associated with practice (β = 0.203, p = 0.008). In addition, knowledge showed an indirect association with practice through attitude (β = 0.089, p = 0.006). DISCUSSION: Despite generally positive attitudes, obstetrics and gynecology medical staff demonstrated insufficient knowledge and suboptimal practices concerning ERAC. Targeted educational interventions and systematic ERAC training programs are urgently needed to bridge the knowledge-practice gap and promote consistent implementation of evidence-based recovery protocols across diverse clinical settings.