Drivers of agricultural transformation vary from place to place. They need to be explored, especially under the new context of changing climate, environment and socio-economic development in coastal regions. This paper aims to discover the drivers of change through an analysis of the agricultural transformation process in the Vietnamese Mekong delta and then develop a framework for the next steps to meet sustainable development objectives. A mixed approach of qualitative and quantitative methods was applied to collect primary and secondary data. Major techniques used in data collection consist of Key Informant Interviews (KII), Focus Group Discussions (FGD) and household surveys with 203 farmers in three coastal provinces, including Ben Tre, Kien Giang and Soc Trang. The results showed that the agricultural sector has been transforming towards the diversification of crops and livelihoods. For example, there has been a shift from rice monoculture to integrated farming systems (i.e. rice-shrimp or grass-cattle) and a move from on-farm to more off-farm or non-farm incomes. This transformation was found to be driven by many factors that can be categorised into the ‘4Ps of change’, consisting of the Price, the Producer, the Place and the Policy. The 4Ps of change are not isolated but interrelated. Then, considering the 4Ps of change, a holistic framework for sustainable agricultural transformation (SAT) has been developed. What distinguishes this SAT framework from others is a combination of value chain theory and agribusiness concepts. Hence, it would create resource use efficiency, add more value to products, deliver healthy food and contribute to successful transformation in the future. Successful implementation would need the government’s readiness to provide a practical legal framework and efficient support to motivate all actors involved in the transformation process.