There is an implementation gap between government plans and land-use changes at the local level in the Vietnamese Mekong Delta. This stands in the way of the sustainable development of the delta, especially in the face of environmental degradation, climate change, and water-use conflicts. To narrow the gap between plans and practice, the government needs a better understanding of what drives land-use decisions at the farm level. Our research developed and applied a multi-scale framework to identify the principal drivers of land-use changes at the farm level in the Vietnamese Mekong Delta over the past 40 years. We conducted semi-structured interviews with 31 farmers in the highly flooded zone, then used transcript analysis to quantify the influence of the drivers mentioned by farmers. We found drastic shifts in land uses, predominantly towards rice intensification. Among the 43 change drivers the farmers mentioned, those operating at the regional scale were particularly influential, including the activities of local authorities, neighborhood effects, and the development of water management infrastructure. Market factors have become more prominent in the last two decades, motivating farmers to shift from double to triple rice or to gradually diversify into vegetables. However, agricultural diversification remains limited by the agro-hydrological context, which favors triple rice cropping, as well as household scale factors such as natural and physical assets of the farm, household capital, and labor capacity. The local community also played a key role in land-use change, though with a double-edged effect, both delaying implementation of central government policy and forcing farmers to follow the majority’s decision.