Comparison of an interactive with a didactic educational intervention for improving the evidence-based practice knowledge of occupational therapists in the public health sector in South Africa: a randomised controlled trial

Helen Buchanan, Nandi Siegfried, Jennifer Jelsma, Carl Lombard, Helen Buchanan, Nandi Siegfried, Jennifer Jelsma, Carl Lombard

Abstract

Background: Despite efforts to identify effective interventions to implement evidence-based practice (EBP), uncertainty remains. Few existing studies involve occupational therapists or resource-constrained contexts. This study aimed to determine whether an interactive educational intervention (IE) was more effective than a didactic educational intervention (DE) in improving EBP knowledge, attitudes and behaviour at 12 weeks.

Methods: A matched pairs design, randomised controlled trial was conducted in the Western Cape of South Africa. Occupational therapists employed by the Department of Health were randomised using matched-pair stratification by type (clinician or manager) and knowledge score. Allocation to an IE or a DE was by coin-tossing. A self-report questionnaire (measuring objective knowledge and subjective attitudes) and audit checklist (measuring objective behaviour) were completed at baseline and 12 weeks. The primary outcome was EBP knowledge at 12 weeks while secondary outcomes were attitudes and behaviour at 12 weeks. Data collection occurred at participants' places of employment. Audit raters were blinded, but participants and the provider could not be blinded.

Results: Twenty-one of 28 pairs reported outcomes, but due to incomplete data for two participants, 19 pairs were included in the analysis. There was a median increase of 1.0 points (95% CI = -4.0, 1.0) in the IE for the primary outcome (knowledge) compared with the DE, but this difference was not significant (P = 0.098). There were no significant differences on any of the attitude subscale scores. The median 12-week audit score was 8.6 points higher in the IE (95% CI = -7.7, 27.0) but this was not significant (P = 0.196). Within-group analyses showed significant increases in knowledge in both groups (IE: T = 4.0, P <0.001; DE: T = 12.0, P = 0.002) but no significant differences in attitudes or behaviour.

Conclusions: The results suggest that the interventions had similar outcomes at 12 weeks and that the interactive component had little additional effect.

Trial registration: Pan African Controlled Trials Register PACTR201201000346141, registered 31 January 2012. Clinical Trials NCT01512823, registered 1 February 2012. South African National Clinical Trial Register DOH2710093067, registered 27 October 2009. The first participants were randomly assigned on 16 July 2008.

Figures

Figure 1
Figure 1
CONSORT flow diagram for the Occupational Therapy Evidence-Based Practice (OTEBP) Trial.

References

    1. Buchanan H. Evidence-based practice in occupational therapy in South Africa and the Western Cape. PhD dissertation. Cape Town: University of Cape Town; 2011.
    1. Bennett S, Townsend E, Mancini M, Taylor C. Evidence-based practice in occupational therapy: international initiatives. WFOT Bull. 2006;53:6–12.
    1. Curtin M, Jaramazovic E. Occupational therapists’ views and perceptions of evidence-based practice. Br J Occup Ther. 2001;64:214–222.
    1. Bennett S, Tooth L, McKenna K, Rodger S, Strong J, Ziviani J, Mickan S, Gibson L. Perceptions of evidence-based practice: a survey of Australian occupational therapists. Aust Occup Ther J. 2003;50:13–22. doi: 10.1046/j.1440-1630.2003.00341.x.
    1. Dysart A, Tomlin G. Factors related to evidence-based practice among US occupational therapy clinicians. Am J Occup Ther. 2002;56:275–284. doi: 10.5014/ajot.56.3.275.
    1. Humphris D, Littlejohns P, Victor C, O’Halloran P, Peacock J. Implementing evidence-based practice: Factors that influence the use of research evidence by occupational therapists. Br J Occup Ther. 2000;63:516–522.
    1. McCluskey A. Occupational therapists report on low level of knowledge, skill and involvement in evidence-based practice. Aust Occup Ther J. 2003;50:3–12. doi: 10.1046/j.1440-1630.2003.00303.x.
    1. Stevenson K, Lewis M, Hay E. Do physiotherapists’ attitudes towards evidence-based practice change as a result of an evidence-based educational programme? J Eval Clin Pract. 2004;10:207–217. doi: 10.1111/j.1365-2753.2003.00479.x.
    1. Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O’Brien M, Wolf F, Davis D, Odgaard-Jensen J, Oxman AD. Continuing education meetings and workshops: effects onprofessional practice and health care outcomes. Cochrane Database Syst Rev. 2009;2 CD003030.
    1. Baker R, Camosso-Stefinovic J, Gillies C, Shaw E, Cheater F, Flottorp S, Robertson N. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2010;3 CD005470.
    1. Parkes J, Hyde C, Deeks J, Milne R. Teaching critical appraisal skills in health care settings. Cochrane Database Syst Rev. 2001;3 CD001270.
    1. Farmer A, Legare F, Turcot L, Grimshaw J, Harvey E, McGowan J, Wolf F. Printed educational materials: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2008;3 CD004398.
    1. O’Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, Forsetlund L, Bainbridge D, Freemantle N, Davis D, Haynes RB, Harvey E. Educational outreach visits: effects on professional practice and health care outcomes (Review) Cochrane Database Syst Rev. 2007;4 CD000409.
    1. Jamtvedt G, Young J, Kristoffersen D, O’Brien M, Oxman A. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2006;2:CD000259.
    1. AP statistics tutorial: experimental design. [ ]
    1. Caldwell E, Whitehead M, Fleming J, Moes L. Evidence-based practice in everyday clinical practice: strategies for change in a tertiary occupational therapy department. Aust Occup Ther J. 2008;55:79–84. doi: 10.1111/j.1440-1630.2007.00669.x.
    1. Dopson S, Fitzgerald L. The role of the middle manager in the implementation of evidence-based health care. J Nurs Manag. 2006;14:43–51. doi: 10.1111/j.1365-2934.2005.00612.x.
    1. McCluskey A, Bishop B. The adapted Fresno test of competence in evidence-based practice. J Contin Educ Health Prof. 2009;29:119–126. doi: 10.1002/chp.20021.
    1. McGraw K, Wong S. Forming inferences about some intraclass correlation coefficients. Psychol Methods. 1996;1:30–46.
    1. Johnston J, Leung G, Fielding R, Tin K, Ho L. The development and validation of a knowledge, attitude and behaviour questionnaire to assess undergraduate evidence-based practice teaching and learning. Med Educ. 2003;37:992–1000. doi: 10.1046/j.1365-2923.2003.01678.x.
    1. MacDermid J, Solomon P, Law M, Russell D, Stratford P. Defining the effect and mediators of two knowledge translation strategies designed to alter knowledge, intent and clinical utilization of rehabilitation outcome measures: a study protocol. Implement Sci. 2006;1:14. doi: 10.1186/1748-5908-1-14.
    1. MacDermid J, Law M, Stratford P, Solomon P. 15th International Congress of the World Federation of Occupational Therapists. Santiago, Chile: World Federation of Occupational Therapists; 2010. Evaluation of two knowledge transfer strategies to improve knowledge and use of outcome measures.
    1. Foote H, Lamont S, Burger E, Leishman A. The introduction of a quality assurance programme in Gauteng Health hospital occupational therapy services. S Afr J Occup Ther. 2006;36:6–10.
    1. World Health Organization. ICF checklist, version 2.1a, clinician form for International Classification of Functioning, Disability and Health. Geneva; 2001.
    1. McCluskey A, Lovarini M. Providing education on evidence-based practice improved knowledge but did not change behaviour: a before and after study. BMC Med Educ. 2005;5:40. doi: 10.1186/1472-6920-5-40.
    1. StatSoft Inc. STATISTICA 8 (data analysis software system) Version 8 edn. Tulsa, OK. 2008.
    1. Smith H, Brown H, Hofmeyr G, Garner P. Evidence-based obstetric care in South Africa - influencing practice through the ’better births initiative’. S Afr Med J. 2004;94:117–120.
    1. Mlambo T, Amosun S, Concha M. Assessing the quality of occupational therapy records on stroke patients at one academic hospital in South Africa. S Afr J Occup Ther. 2004;34:10–13.
    1. Forsetlund L, Bradley P, Forsen L, Nordheim L, Jamtvedt G, Bjorndal A. Randomised controlled trial of a theoretically grounded tailored intervention to diffuse evidence-based public health practice. BMC Med Educ. 2003;3:2. doi: 10.1186/1472-6920-3-2.
    1. Straus S, Ball C, Balcombe N, Sheldon J, McAlister F. Teaching evidence-based medicine skills can change practice in a community hospital. J Gen Intern Med. 2005;20:340–343. doi: 10.1111/j.1525-1497.2005.04045.x.
    1. Clark MPA, Westerberg BD. Holiday review. How random is the toss of a coin? Can Med Assoc J. 2009;181:E306–E308. doi: 10.1503/cmaj.091733.
    1. Gulmezoglu A, Langer A, Piaggio G, Lumbiganon P, Villar J, Grimshaw J. Cluster randomised trial of an active, multifaceted educational intervention based on the WHO Reproductive Health Library to improve obstetric practices. Br J Obstet Gynaecol. 2006;114:16–23. doi: 10.1111/j.1471-0528.2006.01091.x.
    1. Moher D, Hopewell S, Schulz K, Montori V, Gotszche P, Devereux P, Elbourne D, Egger M, Altman D. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c869. doi: 10.1136/bmj.c869.
    1. Hollis S, Campbell F. What is meant by intention to treat analysis? Survey of published randomised controlled trials. BMJ. 1999;319:670–674. doi: 10.1136/bmj.319.7211.670.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel