Healthcare Workers' Acceptance and Willingness to Implement a Pragmatic Triple‐Component Enhanced Recovery After Surgery Strategy (T‐ERAS): A Cross‐Sectional Study in Ethiopian Public Hospitals

Abstract

BACKGROUND: Enhanced recovery after surgery (ERAS) protocols have demonstrated substantial benefits in improving postoperative outcomes. However, in low-resource settings such as Ethiopia, ERAS adoption remains limited, necessitating pragmatic context-sensitive implementation approaches. The perspectives of frontline perioperative providers who are central to implementation have rarely been systematically assessed. This study aimed to evaluate acceptance, perceived benefits, implementation challenges, and readiness for sustained adoption of a pragmatic triple enhanced recovery after surgery (T-ERAS) protocol, comprising early oral intake, early ambulation, and early urinary catheter removal, among healthcare workers participating in a multisite ERAS trial in Ethiopia. METHODS: A descriptive cross-sectional survey was conducted among 20 perioperative care providers, including surgeons, obstetricians, anesthetists, and nurses, from five public hospitals involved in the ERAS implementation trial. A structured questionnaire administered via Google Forms captured demographic characteristics, ERAS knowledge and exposure, perceived benefits and challenges, and willingness to adopt ERAS practices. Data were analyzed using descriptive statistics and thematic summaries. RESULTS: Twenty perioperative care providers participated, of whom 13 (65.0%) were male, and 15 (75.0%) were affiliated with tertiary-level public hospitals. Twelve respondents (60.0%) reported being very familiar with ERAS protocols, although only 11 (55.0%) had directly participated in implementation. Sixteen participants (80.0%) believed ERAS improves patient outcomes; however, adherence varied, with 8 (42.1%) reporting rarely applying the protocol. Key implementation challenges included limited resources (85.0%), insufficient staff training (70.0%), resistance to change (50.0%), and inadequate patient education (50.0%). Despite these barriers, 17 participants (85.0%) expressed willingness to adopt ERAS practices permanently, and all (100.0%) were open to further training. The T-ERAS components were viewed favorably, with 15 participants (75.0%) rating each as effective. CONCLUSION: This study demonstrates high awareness and willingness among perioperative professionals in Ethiopian public hospitals to adopt ERAS principles, while highlighting persistent system-level barriers to consistent implementation. Strengthening institutional support, expanding training, and promoting locally led context-sensitive ERAS pathways such as T-ERAS may facilitate sustainable scale-up in low-resource settings.