Evidence-based practice among nurses in Ethiopia: a mixed-methods systematic review of utilization, predictors, and barriers

Introduction Evidence-Based Practice (EBP) is a cornerstone of quality healthcare delivery, enhancing patient outcomes and supporting effective clinical decision-making. In low- and middle-income countries like Ethiopia, EBP utilization among nurses remains limited due to systemic and contextual challenges. This review explored the prevalence, predictors, barriers, and facilitators of EBP among Ethiopian nurses through a mixed-methods systematic review and meta -analysis. Methods Following PRISMA 2020 and JBI mixed-methods guidelines, we systematically searched databases up to May 1, 2025. Data were extracted between May 10 and 30, analyzed from June 1 to 30, and the report was finalized by July 5, 2025. Quantitative data were synthesized through meta -analysis to estimate pooled prevalence and associated factors, while qualitative data underwent thematic analysis. A convergent segregated approach was used for integration, and evidence certainty was assessed using GRADE and GRADE-CERQual. Results Nineteen studies met inclusion criteria. The pooled prevalence of EBP utilization among Ethiopian nurses was 46.7% (95% CI: 38.9%–54.6%). Predictors of utilization included good knowledge, positive attitudes, self-efficacy, advanced education, training, internet access, and managerial support. Barriers comprised time constraints, limited digital access, inadequate training, and weak leadership. Facilitators included leadership support, professional development, positive attitudes, and institutional readiness. Convergent findings emphasized the need for multilevel interventions. Conclusion EBP utilization among Ethiopian nurses remains suboptimal due to structural, educational, and cultural barriers. However, existing facilitators provide opportunities for improvement. Strengthening digital infrastructure, enhancing leadership engagement, and expanding continuous professional training are essential to establish a sustainable, evidence-based nursing culture in Ethiopia