Evidence-based practice and research utilisation: perceived research knowledge, attitudes, practices and barriers among Australian paediatric occupational therapists

Background/aim: Evidence‐based practice (EBP) and research utilisation (RU) are promoted as ways for clients to receive the best level of care. However, limited research has evaluated the use of these approaches by occupational therapists. This study investigated the knowledge, attitudes, practices of and barriers to EBP and RU of a group of paediatric occupational therapists from Australia. Methods: Questionnaires were received from 138 participants (response rate 46%) who completed the Research Knowledge, Attitudes and Practices of Research Survey, the Edmonton Research Orientation Survey and the Barriers to Research Utilisation Scale. Results: The participants held positive attitudes towards research, and were willing to access new information to guide practice approaches. However, participants were less confident in their research knowledge and practices and implemented research findings into clinical practice. Multiple barriers to RU were perceived, particularly associated with the presentation and accessibility of research. Participants reported limited engagement in conducting research studies, although the majority of the participants reported implementing the findings of research into their clinical practice to some extent. Conclusion: Additional research education and support within organisations would be beneficial to ensure that children and families are receiving occupational therapy services that are based on sound, high‐quality research evidence. The findings of this study provide insight into the perceived research knowledge, attitudes, practices of and barriers to Australian paediatric occupational therapists, enabling specific strategies to be implemented to increase the use of EBP and RU within the profession.     

Perceptions of evidence-based practice: A survey of Australian occupational therapists

Evidence-based practice (EBP) requires clinicians to access, appraise and integrate research literature with clinical experience and clients' perspectives. Currently, little is known about occupational therapists' attitudes to EBP, their perception of implementation barriers or their educational needs. A questionnaire reflecting these issues was sent to a proportionate random sample of 1491 members of the national professional occupational therapy association, OT AUSTRALIA. The questionnaire was completed by 649 (44%) participants. Occupational therapists were positive about EBP with most (96%) agreeing that EBP is important to occupational therapy. Although 56% used research to make clinical decisions, more relied on clinical experience (96%), information from continuing education (82%) and colleagues (80%). Lack of time, evidence and skills were identified as the main barriers to the implementation of EBP. Over half (52%) expressed strong interest in EBP skills training, and most (80%) indicated an interest in the availability of brief summaries of evidence. Targeted educational initiatives, resources and systems are needed to support EBP in occupational therapy.     

Occupational therapists' skills and attitudes regarding use of computers and assistive technology

The purpose of this study was to examine the skills and attitudes of a sample of practicing occupational therapists regarding the use of computers, and to explore their agreement with the Foundation Level Technology Competencies proposed for adoption in the United States of America (American Occupational Therapy Association, 1991; reported in Hammel and Smith, 1993). Out of a sample of 250 subjects, 89 occupational therapists in the USA completed a questionnaire regarding their experiences with, and attitudes towards computers, and their agreement with the proposed Competencies. The results indicated that while the majority of therapists had had some exposure to computers, they wanted to learn more—particularly how a computer could aid management tasks. While 50% or more of the therapists ‘Agreed’ or ‘Strongly Agreed’ with 19 of the 21 Competencies, the level of therapist ‘Indecision’ or ‘Disagreement’ with several of the Competencies suggests that either these Competencies require revision, or that if the Competencies are nationally adopted, many therapists may require intensive continuing education programmes to bring their skills to a competent standard. Adoption of these Competencies has many implications for international standards of occupational therapy practice and levels of computer education. Copyright © 1997 Whurr Publishers Ltd.     

Psychosocial Considerations in Occupational Therapy Treatment for Adults with Acquired Brain Injury: A Survey

ABSTRACT

The psychosocial factors of coping, locus of control, and self-efficacy have been shown to be associated positively with real-world outcomes following acquired brain injury (ABI), although to our knowledge there are no studies investigating whether occupational therapists address these factors in practice. This study used on-line survey methodology to investigate whether Canadian occupational therapists working in ABI rehabilitation were addressing these factors in their practice. Of 151 respondents, the majority reported being able to explain the factors to clients and that they and/or their team members were incorporating them into clinical practice. Participants also provided examples that were analyzed for common themes. The majority of examples of how these factors were incorporated into practice were implicit in nature. Further education regarding these factors may be warranted as only 25% of the respondents reported learning about these factors in their occupational therapy education.     

The Use of Standardized Assessments in Occupational Therapy in the United States

ABSTRACT

The purpose of this study was to investigate the use of standardized assessments in occupational therapy practice. Five-thousand surveys were mailed to recipients of ADVANCE for OT who indicated their primary role to be a “clinician.” With a response rate of 16%, 794 responses were analyzed. Results include occupational therapists in a pediatric practice setting reporting using standardized assessments more frequently to determine eligibility of services than do adult setting practitioners. Respondents also perceived they have the highest knowledge or skill level in their ability to communicate the results of standardized assessments to their clients and other health professionals, but lacked knowledge or skill level in knowing the difference between criterion and norm-referenced measures. Implications for practice, research, as well as academic and continuing professional education are discussed.     

Maternal and Child Health Graduate and Continuing Education Needs: A National Assessment

Objectives: The purpose of this report is to describe the methodology and results of a recent national assessment of long-term graduate and short-term continuing education needs of public health and health care professionals who serve or are administratively responsible for the U.S. maternal and child health population and also to offer recommendations for future training initiatives. Methods: The target of this needs assessment was all directors of state MCH, CSHCN and Medicaid agencies, as well as a 20% random sample of local public health departments. A 7-page needs assessment form was used to assess the importance of and need for supporting graduate and continuing education training in specific skill and content areas. The needs assessment also addressed barriers to pursuing graduate and continuing education. Respondents (n = 274) were asked to indicate the capacity of their agency for providing continuing education as well as their preferred modalities for training. Results: Regardless of agency type, i.e., state MCH, CSHCN, Medicaid or local health department, having employees with a graduate education in MCH was perceived to be of benefit by more than 70% of the respondents. Leadership, systems development, management, administration, analytic, policy and advocacy skills, as well as genetics, dentistry, nutrition and nursing, were all identified as critical unmet needs areas for professionals with graduate training. Education costs, loss of income, and time constraints were the identified barriers to graduate education. More than 90% of respondents from each agency viewed continuing education as a benefit for their staff, although the respondents indicated that their agencies have limited capacity to either provide such training or to assess their staff's need for continuing education. Program managers and staff were perceived in greatest need of continuing education and core public health skills, leadership, and administration were among the most frequently listed topics to receive continuing education training support dollars. Time away from work, lack of staff to cover functions, and cost were the top barriers to receiving continuing education. While attending on-site, in-state, small conferences was the continuing education modality of first preference, there was also considerable interest expressed in web-based training. Conclusions: Six recommendations were developed on the basis of the findings and address the following areas: the ongoing need for continued support of both graduate and continuing education efforts; the development of a national MCH training policy analysis center; the incorporation of routine assessments of training needs by states as part of their annual needs assessments; the promotion of alternative modalities for training, i.e., web-based; and, the sponsorship of academic/practice partnerships for cross-training.     

Rehabilitation of Infant Oral Feeding Difficulties: A Survey of Occupational Therapists Practice Approaches

This study identifies the scope of occupational therapy practice for the rehabilitation of oral feeding difficulties in infants who are in the neonatal intensive care unit (NICU). A written survey was administered to 127 occupational therapists who work with infants in the NICU. All 68 (54%) respondents used a client-centered approach, taking into consideration the infant (intrinsic), caregiver, and environmental (extrinsic) factors. Family and health team education was the most commonly provided service with the majority of occupational therapists providing services only until feeding problems were resolved. Continuing education (n = 20, 30%) and own clinical experience (n = 22, 33%) were the two most common justifications to support their choice of practice. These results suggest a client-centered approach in the rehabilitation of oral feeding difficulties is commonly used, but services are not extended beyond hospitalization. Few occupational therapists used peer-reviewed journals as sources of evidence for their practice strategies.     

The self-reported use of research in clinical practice: A survey of occupational therapists in Sweden

Background: Today, healthcare providers and occupational therapists are increasingly required to rely on evidence-based practices. In both outpatient and inpatient settings, the use of research-based practices can be identified using the Research Utilization Measure questionnaire. Aim: This study explores how occupational therapists in Sweden perceive research utilization. Method: The Research Utilization Measure was sent to 807 randomly selected occupational therapists in Sweden, and the response rate was 59% (n = 472). Results: The majority of respondents (56%, n = 256) reported use of research-based knowledge in their practice “very or rather often”, although 49% (n = 225) of the therapists noted that they “very seldom or never” discussed research findings with their managers. Differences in answers for most items were related to degree of education and length of experience. Occupational therapists with higher education levels more often reported use of research in their clinical practice and therapists with greater experience less often reported use of research in their clinical practice. Conclusion: Education seems to influence the degree to which occupational therapists rely on research to inform their practices. A future challenge for managers and occupational therapists is to create strategic discussions on how to implement treatment that is based on current research.     

Do dietitians feel that they have had adequate training in behaviour change methods?

Aim To investigate dietitians’ perceived adequacy of pre‐ and postregistration training in a range of behaviour change techniques, current main approach to dietary treatment and perceived usefulness of future training in five core behaviour change modalities. Method A questionnaire was designed and distributed to all dietitians registered in the BDA membership base (n = 4202). Results Three hundred and ninety‐four questionnaires were returned. The majority of these respondents had obtained their degree since 1982 (77%), since when courses were more likely to have contained a psychological component. Despite the fact that facilitating dietary behaviour change is a key dietetic role, respondents felt that they had not received adequate training in behaviour change skills in their dietetic training. Training was perceived to be most satisfactory in active listening skills, but this was perceived as barely adequate. Training was perceived as particularly poor in: applying theories of cognitive and behavioural therapy (CBT); motivational techniques; group work skills; and in both theory and skills of relapse prevention. Although 40% of respondents reported receiving explicitly psychologically based training, skills‐based training (mainly counselling) was reported by only 25% and was limited by being mainly short 1‐ or 2‐day courses. Overall, where further training was obtained it was perceived to be more adequate than that reported within preregistration dietetic training. Conclusion Respondents felt that they had not received adequate training in behaviour change skills in their dietetic training. The application of CBT, motivational techniques and relapse prevention was perceived as particularly deficient in training and the majority of respondents felt that future training would be useful or very useful. In the current health service climate, where evidence‐based practice is crucial for all practitioners with the emphasis on improved quality of care with measurable outcomes, research must be funded and undertaken to support attempts to improve dietitians’ effectiveness as behaviour change agents.     

A Profile of the Continuing Education Activities of Occupational Therapists in New South Wales

The purpose of this study was to discover the extent of participation in continuing education amongst occupational therapists in New South Wales. A questionnaire seeking information about the respondents' level of qualification and information about their employment; their participation in formal continuing education; their participation in informal activities of continuing education; and their attitude to continuing education, was sent to 128 therapists throughout New South Wales. The results obtained were examined in four ways: to report on the activities of the total number of respondents; on the differences between graduates and diplomates; on the differences between city therapists and country therapists; and on the differences between those working in teaching hospitals and those working in non-teaching institutions. These results showed that on the whole, the respondents actively participated in continuing education. The attitude of respondents to continuing education supported their participation and indicated that they would participate more fully if the obstacles of work conflict, cost and distance could be overcome.     

Barriers and bridges to client-centred occupational therapy in Sweden

This study investigates barriers to client-centred practice and solutions to overcome these barriers as experienced by Swedish occupational therapists. A British questionnaire was translated into Swedish and completed by 97 occupational therapists. The questionnaire consists of three sections: background information; a list of barriers identified in a literature review; and a list of methods to resolve barriers. The results show that the highest ranked barrier was “the therapist does not know enough about client-centred practice”. The highest ranked method to resolve barriers was “management and peer support for use of client-centred practice”. Introducing client-centred practice takes time, commitment, education, training, interview skills, discussions with colleagues, and reflection on the therapists’ own attitudes.     

Effects of profession and facility type on research utilization by rehabilitation professionals

Information about the use of research by rehabilitation professionals to make clinical decisions in everyday practice is limited. This study compared perceived research use and knowledge sources across professions, practice situations, and work environments. Participants were 165 randomly selected Canadian occupational therapists, physical therapists, and speech-language pathologists. Self-report ratings during an interview, an interviewer rating, and questionnaire scores (Edmonton Research Orientation Survey, General Use of Research, Knowledge Acquisition Survey) were compared. Speech-language pathologists had the most education and the highest research use ratings. Research use was highest during program planning. Programs to encourage research use must consider the research available to guide practice and therapists' education level. Facility size and location (rural, urban) do not affect perceived research use.     

Factors Associated with Comfort Level of School-Based Occupational Therapists in Providing Low-Vision Services

This study identified factors associated with the comfort level of school-based occupational therapists in providing services to children with visual impairments. Sixty-one school-based occupational therapists completed an on-line survey. Fifty-four percent of respondents were comfortable or somewhat comfortable when choosing assessments and 84% were comfortable or somewhat comfortable in providing occupational therapy services for children with visual impairments. Multivariable linear regression analyses indicated years of professional experience, history of a caseload of children with visual impairments, and training received in treating children with visual impairments from continuing education were uniquely and significantly associated with the respondents’ comfort level. Though not included in the final model, collaboration with other low vision service providers (e.g., teachers, optometrists, ophthalmologists, and orientation/mobility specialists) was also significantly associated with respondents’ comfort level in the univariate analysis. Findings provide an initial direction and strategies to improve occupational therapists’ comfort level in providing services to children with visual impairments in school settings.     

Occupational therapy in palliative care: Is it under‐utilised in Western Australia?

Aim: To explore potential barriers to occupational therapy in palliative care in Western Australia, as perceived by occupational therapists and other health professionals. Method: A qualitative research methodology was used. Semi‐structured interviews were conducted with 10 occupational therapists and 10 health professionals (including a physiotherapist, a social worker, medical registrars and clinical nurses). Interviews were transcribed verbatim and analysed using content analysis. Results: The four main themes identified were: inconsistent understanding of the contribution that occupational therapists can make to palliative care, insufficient promotion of the potential contribution of occupational therapy, insufficient funding, and limited research on the role of occupational therapy in palliative care. Conclusion: This study provides an understanding of the barriers that have limited occupational therapists’ involvement in providing palliative care in Western Australia.