Date Presented 03/26/20
A survey of OTs found participants used EBP less than once in the previous eight weeks. The most supportive factors of EBP use were doctoral-level education and high self-reflection behavior. Organizational factors of time, access to articles, and organizational support were marginally supportive. Future research should focus on exploring how self-reflection behavior acts as a support to EBP and the construction of models that integrate reflective practice with EBP in practice.
Primary Author and Speaker: Robert Krueger
Additional Authors and Speakers: Melissa Sweetman
Contributing Authors: Malissa Martin, Thomas Cappaert
PURPOSE: Evidence-based practice (EBP) implementation has been associated with quality health care outcomes, yet the literature suggests only a small proportion of occupational therapists implement EBP (Boström, Sommerfeld, Stenhols, & Kiessling, 2018; Salls, Dolhi, Silverman, & Hansen, 2009)). The purpose of the study was to investigate factors associated with EBP implementation and to specifically evaluate self-reflection behavior as a support to EBP implementation due to its role in learning, application of knowledge to practice, and commitment to change.
METHOD: A cross-sectional survey was used to measure EBP implementation in occupational therapists practicing in the U.S as phase I of a mixed-methods study. Survey invitations were randomly distributed via email to licensed occupational therapists practicing 20+ hours/week in 12 states from four U.S. Census Bureau regions. Participants completed informed consent followed by an online survey using the Qualtrics platform. Validated survey instruments were used to measure EBP implementation (Melnyk, Finout-Overholdt, & Mays, 2008), self-reflection behavior (Grant, Franklin, & Langford, 2002), and EBP skill and knowledge. In addition, the participants completed a demographic practice questionnaire of leading supportive factors from the literature. Multiple imputation (MI) was used to fill in missing values from incomplete surveys.
RESULTS: Of those invited, 1,225 participants began the survey (6.3% response rate), and 578 surveys were included in the final analysis, exceeding the projected sample size. Scores on the EBP Implementation Scale (N = 578, Mean = 14.8) indicated participants implemented EBP less than 1 time over the previous 8 weeks. Implementation was definitively higher in those with a doctoral degree (p = .014) and with high self-reflection behavior (p = 001) – both of these groups implemented EBP at the higher frequency of 1 to 3 times over the previous 8 weeks. Participants with a high degree of organizational support (p = .008), ≥ 30 minutes per week of time allotted for EBP activities at work (p = .009), and access to full text articles (p = .006) demonstrated marginally higher EBP use. Results from scale items when compared to the five steps of the EBP cycle indicated only 7% of participants generated a clinical question frequently, 8% accessed professional databases frequently, 18.4% read and critically appraised a research study frequently, 27% shared evidence from a research study with a client frequently, and 13% evaluated outcomes of a practice change frequently. The factors of gender, work status, practice setting, practice experience, EBP skill and knowledge, productivity standards, access to online databases, and access to a librarian were not associated with EBP implementation.
CONCLUSION: The survey results confirm low EBP implementation in a U.S. sample of occupational therapists challenging the profession’s competency standards in relation to using EBP for knowledge acquisition and translation to practice, critical reasoning, performance skills, and the vision of occupational therapy as an evidence-based profession. Organizational supports of time and access to resources were only marginally supportive factors. Individual factors of doctoral level education and high self-reflection behavior were identified as the most important supports for EBP use. Further research should (1) explore how reflective practice experiences in occupational therapists act as supports to EBP, (2) examine how various levels of doctoral education (i.e., entry-level, post-professional, research) act as added supports to EBP, and (3) investigate how self-reflection behavior may integrate with EBP in the construction of new models of professional thinking.
References
Boström, A-M., Sommerfeld, D.K., Stenhols, A.W., & Kiessling, A. (2018). Capability beliefs on, and use of evidence-based practice among four health professional and student groups in geriatric care: A cross sectional study. PLoS ONE, 13(2), 30192017. https://doi.org/10.1371/journal.pone.0192017
Grant, A.M., Franklin, J., & Langford, P. (2002). The Self-Reflection and Insight Scale: A new measure of private self-consciousness. Social Behavior and Personality, 30(8), 821-836. doi:10.2224/sbp.2002.30.8.821
Melnyk, B.M., Finout-Overholdt, E., & Mays, M.Z. (2008). The evidence-based practice beliefs and implementation scales: Psychometric properties of two new instruments, Worldviews on Evidence-Based Nursing, 5(4), 208-216. doi:10.1111/j.1741-6787.2008.00126.x,
Salls, J., Dolhi, C., Silverman, L., & Hansen, M. (2009). The use of evidence-based practice by occupational therapists. Occupational Therapy in Health Care, 23(2), 134-145. doi:10.1080/07380570902773305
