Facilitators and Barriers to Implementing Pediatric Preoperative Fasting Guidelines Among Chinese Healthcare Practitioners

Background Preoperative fasting is critical for reducing intraoperative aspiration risk; however, pediatric fasting durations frequently exceed guideline recommendations such as the 6-4-2 fasting regimen (minimum fasting times of 6 h for solid food and infant formula, 4 h for breast milk, and 2 h for clear fluids). A significant evidence gap exists regarding barriers to and facilitators of adherence to these guidelines among pediatric healthcare practitioners in China. This study aimed to identify key barriers and facilitators influencing the implementation of pediatric preoperative fasting guidelines from the perspectives of anesthesiologists, nurses, and surgeons. Methods A qualitative descriptive design was employed. Using purposive sampling, 22 practitioners (8 surgeons, 8 anesthesiologists, and 6 nurses) were recruited from six tertiary grade A hospitals in mainland China. Semi-structured interviews were conducted between January and March 2025. Data were analyzed thematically, guided by the integrated the Capability, Opportunity, Motivation and Behaviour model(COM-B)and the Theoretical Domains Framework (TDF). Results Three components from the COM-B model and seven domains from the TDF were identified as barriers to pediatric preoperative fasting guideline adoption. The most prominent barriers mapped to the Opportunity component: lack of policy support, unpredictable surgical scheduling, insufficient training resources, communication challenges and a conservative culture. Interprofessional role conflicts between anesthesiologists and surgeons were also prominent. Additional Capability barriers included practitioners lack of knowledge and insufficient collaborative practices. Motivation barriers encompassed child anxiety and non-cooperation during fasting periods, lack of leadership engagement, and practitioner indifference. Conversely, facilitators aligned with four TDF domains under Capability and Motivation included healthcare professionals' strong communication and assessment skills, and the development of action plans. Additionally, all three professional groups demonstrated a profound sense of moral responsibility, strong professional beliefs, and clear role identity. Conclusions Effectively addressing the implementation challenges of pediatric preoperative fasting guidelines in China’s healthcare context requires systematically integrating existing facilitators while tackling barriers. Multifaceted intervention strategies are recommended, including establishing an anesthesiologist-led multidisciplinary collaboration framework, optimizing clinician-caregiver communication tools and processes, allocating necessary technological and human resources, strengthening hospital-wide policy support, and clarifying professional authority and responsibilities to resolve interprofessional conflicts. Clinical trial number: Not applicable