Research knowledge, attitudes, practices and barriers among paediatric occupational therapists in the United Kingdom.
Abstract: Evidence-based practice and research utilisation are promoted to enable clients to receive the most current care; however, there is limited research evaluating the use of these approaches within the occupational therapy profession. This study aimed to investigate the knowledge, attitudes, practices and barriers to evidence-based practice and research utilisation of a group of paediatric occupational therapists in the United Kingdom. Questionnaires were received from 145 participants (response rate 30%), who completed the Research Knowledge, Attitudes and Practices of Research Survey (KAP Survey), the Edmonton Research Orientation Survey (EROS) and the Barriers to Research Utilisation Scale (BARRIERS).

The results indicated that the respondents held positive attitudes towards research and were willing to access new information and implement research findings to guide clinical practice. However, they were less confident in their research knowledge and practices, and perceived multiple barriers associated with the organisation, accessibility and quality of research. The respondents reported limited engagement in conducting research studies; however, the majority of the sample reported implementing the findings of research in their clinical practice to some extent.

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 research evidence.

Key words:

Evidence-based practice, research utilisation, attitudes, occupational therapy, barriers.
Article Type: Report
Subject: Pediatrics (Research)
Pediatrics (Practice)
Evidence-based medicine (Research)
Evidence-based medicine (Usage)
Occupational therapists (Management)
Medical care (Quality management)
Medical care (Research)
Authors: Lyons, Carissa
Casey, Jackie
Brown, Ted
Tseng, Mei
McDonald, Rachael
Pub Date: 05/01/2010
Publication: Name: British Journal of Occupational Therapy Publisher: College of Occupational Therapists Ltd. Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 College of Occupational Therapists Ltd. ISSN: 0308-0226
Issue: Date: May, 2010 Source Volume: 73 Source Issue: 5
Topic: Event Code: 310 Science & research; 200 Management dynamics Computer Subject: Company business management
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 227280908
Full Text: Introduction

The practice approaches implemented by health professionals are informed by evidence-based knowledge, whereby evidence-based practice and research utilisation enable clinicians to provide high quality care for clients: they remain current with health care trends and improve client care outcomes and health care efficiencies (Law and Baum 1998, Brown and Roger 1999a, Gray 2004, Taylor 2007). However, the use of evidence-based practice and research utilisation is not well developed among therapists who work with children and families, and there continue to be significant knowledge gaps within the occupational therapy profession (Waine et al 1997, Dobbins et al 1998, Brown and Rodger 1999b, Bannigan and Bryar 2002, McCluskey and Cusick 2002). In order to ensure that children and families receive the best and most current care available, an understanding of paediatric occupational therapists' use of evidence-based practice and research utilisation is valuable. This paper outlines the results of a study investigating the knowledge, attitudes, practices and barriers to evidence-based practice and research utilisation of a group of children's occupational therapists in the United Kingdom (UK).

Literature review

Evidence-based practice and research utilisation

The definitions and models of evidence-based practice and research utilisation originated from the field of evidence-based medicine and, although their development has occurred over several decades, the models have not been well evaluated (Brown and Rodger 1999b, Sudsawad 2006). The most widely cited definition of evidence-based (practice) medicine is that of Sackett et al (1996), who described the process as 'the conscientious and judicious use of current best evidence in making decisions about the care of individual patients' (p71). Research utilisation is regarded as a subset of the field of evidence-based practice (Estabrooks 1999a) which, according to Estabrooks (1999b), is 'at its simplest, the use of research to guide practice, and is particularly concerned with the use of research evidence--i.e., the findings of scientific studies' (p54). The process of research utilisation involves critiquing research findings, implementing research findings into clinical practice and evaluating the implementation of research findings (Taylor 2007).

Evidence-based practice and empirically validated therapies are being promoted in the professional literature and practice of the allied health professions (Sheldon 1998, Law and Baum 1998, Gambrill 1999). However, the concept of evidence-based practice is not without controversy in the allied health professions, where a positivist bias towards randomised controlled trials in medicine is regarded as too narrow to encompass the knowledge derived from the alternative sources and research methodologies valued in the allied health fields (Coyler and Kamath 1999, French 1999). Although health professionals demonstrate positive attitudes towards research, evidence indicates that they are less confident in their research knowledge and ability to perform research activities (Van Mullem et al 1999, Eller et al 2003, Witzke et al 2008). Furthermore, there is limited research utilisation amongst the allied health professionals, with the literature replete with examples of research evidence published in professional journals not being adopted, integrated or implemented in clinical practice (Armitage 1990, Rogers 1994, Clarke et al 1996, McCluskey and Cusick 2002, Philibert et al 2003).

Currently, no studies have investigated the evidence-based practice and research utilisation of UK paediatric occupational therapists. As such, research that investigates the knowledge, attitudes, practices and barriers to evidence-based practice and research utilisation amongst paediatric occupational therapists in the UK would be valuable.

Research orientation

'Research orientation' is a term intended as a broad construct, which provides insight into clinicians' overall perception of conducting research and implementing findings into clinical practice, as well as the importance and value placed on providing clients with the most current health care (Pain et al 1996). The Edmonton Research Orientation Survey (EROS; Pain et al 1996) has been used in several studies investigating the research orientation of Canadian allied health professionals, including occupational therapists. However, there have been no studies investigating paediatric occupational therapists or occupational therapists in the UK.

Using the EROS, Waine et al (1997) investigated the research orientation of 293 occupational therapists in Alberta, Canada. The results indicated that participants' views towards accessing new information to guide clinical practice (EROS subscale being at the leading edge) was rated the highest, whereas their research involvement was rated the lowest. Participants' overall research orientation was of a moderate level (Waine et al 1997). Comparably, Pain et al (2004) utilised the EROS and found their sample of 165 Canadian allied health professionals (including occupational therapists) to rate their research orientation to be of a moderate level. Finally, McCleary and Brown (2002) used the valuing research and evidence-based practice subscales of the EROS with 283 paediatric health professionals employed at a Canadian children's hospital, in which the findings illustrated an equal moderate rating for both subscales. Evidently, there is a need for additional research in this area, including within the UK.

Barriers to research utilisation

Specific barriers to research utilisation perceived by clinicians need to be identified so that they can be reduced or eliminated (Funk et al 1991) since, ultimately, it is the clinicians who are responsible for implementing research evidence into their clinical practice. Despite many studies investigating the perceived barriers to the research utilisation of registered and paediatric nurses, few studies have investigated the perceptions of allied health professionals. To date, no empirical studies investigating the perceived barriers to research utilisation of paediatric occupational therapists have been completed. However, some studies have investigated the perceived research barriers of nurses and allied health professionals in the UK (Dunn et al 1997, Closs and Lewin 1998, Metcalfe et al 2001). Although nursing samples are not directly comparable with those of the occupational therapy profession, such studies provide an insight, given the limited research evidence available investigating the perceptions of allied health professionals.

The Barriers to Research Utilisation Scale (BARRIERS; Funk et al 1991) was developed as a measure of the extent to which participants perceive barriers to the use of research in their clinical practice. The BARRIERS can identify categories of barriers (subscale scores) as well as individual barriers represented by the BARRIERS items. Several studies have identified that characteristics of the organisation are consistently reported to be the greatest barriers to the research utilisation of nurses (Retsas 2000, Brenner 2005, Thompson et al 2006, Carlson and Plonczyncki 2008). In the UK, Dunn et al (1997) investigated the perceived research barriers of a group of 316 nurses and found the most often reported barrier to be 'insufficient time on the job to implement new ideas', followed by 'statistical analysis is not understandable'.

Although the majority of research has been conducted with samples of nurses, two studies have investigated the perceived research utilisation barriers of British allied health professionals (Closs and Lewin 1998, Metcalfe et al 2001). Closs and Lewin (1998) found that among their sample of 103 British health professionals (dietitians, occupational therapists, physiotherapists, and speech and language therapists), the highest ranked barriers were 'insufficient time on the job to implement new ideas', followed by 'the therapist does not have time to read research' and, thirdly, 'statistical analysis is not understandable'. Specifically, the occupational therapists in Closs's and Lewin's (1998) study ranked 'insufficient time on the job to implement new ideas' as the most frequent barrier to research utilisation.

In contrast, the study conducted by Metcalfe et al (2001) utilised the Barriers and Attitudes to Research in the Therapies (BART) scale, which was composed of the BARRIERS plus 22 additional items. A total of 572 British allied health professionals (including dietitians, occupational therapists, physiotherapists, and speech and language therapists) completed the BART scale. The combined results for the four professions demonstrated that 'statistical analysis is not understandable' was the greatest barrier, followed by 'literature is not compiled in the one place' (Metcalfe et al 2001). The sample of 139 occupational therapists in the Metcalfe et al (2001) study also ranked these as the top two barriers, with the third most frequent barrier being reported as 'implications for practice are not made clear', followed by 'insufficient time to read research' (Metcalfe et al 2001). Overall, there is a need for additional research to investigate the perceived barriers to research utilisation of UK-based paediatric occupational therapists to enable strategies to be implemented to reduce the identified barriers and, subsequently, increase research utilisation.

As can be seen, there is a limited body of knowledge available investigating the evidence-based practice and research utilisation of occupational therapists, with no studies using samples of UK occupational therapists working with children and families. Therefore, this study aimed to investigate the perceived knowledge, attitudes, practices and barriers to evidence-based practice and research utilisation of a group of paediatric occupational therapists in the UK.

Method

Design

A postal survey was completed by participants who met the inclusion criteria for the study in order to gather quantitative data. The quantitative study design was selected for use in this study to enable the gathering of a large quantity of data from paediatric occupational therapists regarding their perceived research knowledge, attitudes, practices and barriers.

Participants

A convenient sampling method was used: the membership data base from the the College of Occupational Therapists' Specialist Section--Children, Young People and Families (formerly known as the National Association of Paediatric Occupational Therapists [NAPOT]) in the UK was employed to generate a list of prospective participants who were occupational therapists indicating paediatrics as their primary clinical specialty. The inclusion criteria for this study were (i) consenting to participate in the study; (ii) being an occupational therapist in the UK; and (iii) working with children and/or adolescents aged from birth to 18 years. Ethics committee approval was obtained from the College of Occupational Therapists (number 07/NIR01/103) prior to the commencement of the study.

Instrumentation

Participants completed a self-report questionnaire, which included demographic information and indicators of research utilisation, the Research Knowledge, Attitudes and Practices of Research Survey (KAP Survey; Van Mullem et al 1999), the Edmonton Research Orientation Survey (EROS; Pain et al 1996) and the Barriers to Research Utilisation Scale (BARRIERS; Funk et al 1991).

The KAP Survey was used to assess the participants' knowledge of, willingness to engage (attitudes) and ability to perform activities (practices) related to the conduct and utilisation of research. The three interrelated concepts of research knowledge, attitudes and practices form three subscales in which participants are required to rate 33 research activities as low (1), moderate (2) or high (3) (Burke et al 1999). Factor analysis of the KAP Survey identified the following five factors: (i) identifying clinical problems; (ii) establishing current best practice; (iii) implementing research into practice; (iv) administering research implementation; and (v) conducting and communicating research (Burke et al 1999). Expert nurses established a 0.84 index of content validity for the KAP Survey during its initial development (Van Mullem et al 1999). Test-retest reliability for the three knowledge, attitudes and practice scales ranged from 0.77 to 0.83 and internal consistency from 0.93 to 0.97. In another study, the internal consistency scores of the three scales ranged from 0.95 to 0.97 (Eller et al 2003).

The EROS was used to measure paediatric occupational therapists' participation in research and the research orientation in their clinical work. The EROS asks respondents to rate 38 items on a scale from 1 (strongly disagree) to 5 (strongly agree) and provides an overall score, indicating research orientation, as well as the following four subscale scores, which were confirmed by principal components analysis: (i) valuing research; (ii) research involvement; (iii) being at the leading edge; and (iv) evidence-based practice (Pain et al 1996). The evidence-based practice subscale is an indicator of research utilisation. The authors report high internal consistency of the scale (Cronbach's alpha = 0.93) and evidence of construct validity (Pain et al 1996). The EROS has been used previously with occupational therapists and speech and language therapists (Waine et al 1997).

The BARRIERS was used to measure participants' perceived barriers to research utilisation. This scale has been widely used with nurses (Thompson et al 2006, Atkinson et al 2008, Carlson and Plonczynski 2008) and, to a lesser extent, with allied health professionals (Closs and Lewin 1998). The BARRIERS contains four subscales derived from confirmatory factor analysis: (i) the adopter (values, skills and awareness); (ii) the organisation (setting); (iii) the innovation (qualities of the research); and (iv) the communication (presentation and accessibility of the research). The 28 items are rated according to the degree to which the respondent perceives the item to be a research barrier, rated from 1 ('to no extent') to 4 ('to a great extent'). The authors report good internal consistencies of the first three factors (Cronbach's alphas of 0.72 to 0.80), lower internal consistency for the fourth factor (Cronbach's alpha of 0.65) and preliminary evidence of test-retest reliability (Funk et al 1991).

Procedure

Survey packages were posted to prospective participants who met the inclusion criteria. The participants were asked to complete the demographic questionnaire, the KAP Survey, the EROS and the BARRIERS, which took approximately 20 minutes. Code numbers were used to maintain participant anonymity and inferred consent was obtained through completion of the questionnaire.

Data analysis

The Statistical Package for the Social Sciences, Version 15.0, was used for data entry, storage and retrieval, as well as the generation of descriptive statistics (mean, standard deviation, frequencies and percentages) from the demographic questionnaire, the KAP Survey, the EROS and the BARRIERS.

Results

Participants

Responses were received from 145 participants (response rate: 30%). The sample consisted of 139 female and 6 male participants, with the majority aged between 30 and 49 years (61%). Most of the participants reported their highest level of occupational therapy qualification as a bachelor's degree (50%), were working full time (85%) and held the position of an occupational therapy clinician for an employer (79%). The majority of the respondents reported their caseload to be primarily outpatient/community based (79%) and working with school-aged clients (84%) (see Table 1).

KAP Survey descriptive statistics results

The knowledge, attitudes and practices subscales were all rated as 'moderate' by the participants, with the attitudes subscale rated the highest and the practices subscale rated the lowest. In terms of factor scores, the participants' knowledge and attitudes of 'identifying clinical problems' (factor 1) and attitudes of 'implementing research into practice' (factor 3) were rated as 'high', while knowledge and practices of 'administering research implementation' (factor 4) were rated as 'low'. The remaining factor scores were all rated as 'moderate' (see Table 2).

EROS descriptive statistics

The EROS total score, indicating research orientation, was found to be of a moderate level. The EROS subscales rated from highest to lowest were as follows: being at the leading edge (the degree to which clinicians access new information to guide practice), valuing research (attitudes towards research), evidence-based practice (an indicator of research utilisation) and research involvement (engagement in conducting research) (see Table 3).

BARRIERS descriptive statistics

Overall, the participants perceived research barriers to a moderate extent. Barriers to research utilisation were perceived from most to least extent in the following order: the organisation (BARRIERS subscale 2), the availability and accessibility of research (communication; BARRIERS subscale 4), the quality of the research (innovation; BARRIERS subscale 3) and the participants' research skills and values (adopter; BARRIERS subscale 1) (see Table 4). The most frequently reported barrier was 'there is insufficient time on the job to implement new ideas', in which 77.2% of the participants reported this to be a barrier to a 'moderate or great extent' (see Table 5).

Discussion

The findings of this study make a valuable contribution to the limited body of knowledge available investigating evidence-based practice and research utilisation, because it is the first study to investigate the perceived knowledge, attitudes, practices and barriers to evidence-based practice and research utilisation among UK-based occupational therapists working with children and families. Paediatric occupational therapists were found to perceive their attitudes towards research to be higher than their research knowledge and practices. The moderate research orientation of participants indicates relatively positive attitudes and some engagement in research utilisation. The KAP Survey factors were rated in the same order according to participants' perceived knowledge, attitudes and practices, which indicates consistency among the perceptions held regarding the research activities measured by the KAP Survey. Barriers to the use of research in their clinical practice were perceived by paediatric occupational therapists to a moderate extent. These findings suggest the need for additional education regarding research activities, and the implementation of strategies to reduce perceived research barriers, to ensure the use of evidence-based practice and research utilisation within the occupational therapy profession in the UK, particularly for those specialising in paediatrics.

Attitudes towards evidence-based practice and research utilisation

The current sample of paediatric occupational therapists displayed positive attitudes towards evidence-based practice and research utilisation, as indicated by the positive ratings of the KAP Survey attitudes scale and associated factors, and the EROS subscale valuing research, as well as the limited perceived barriers associated with the adopter. The KAP Survey attitudes scale was rated as the highest subscale of the KAP Survey, with participants' attitudes towards 'identifying clinical problems' and 'implementing research into practice' rated as 'high'. Comparably, the EROS subscale valuing research indicated that the majority of participants agree that research is important and valuable in guiding the care of their clients.

The BARRIERS subscale the adopter, a measure of the extent to which barriers associated with the clinicians' research values, skills and awareness are perceived by respondents, was rated the lowest out of the four BARRIERS subscales, with research values indicating the fewest perceived barriers. This further indicates that the sample holds positive attitudes towards research. Paediatric occupational therapists also held positive perceptions towards research activities associated with accessing information and implementing research into clinical practice. The KAP Survey factors 'identifying clinical problems' and 'implementing research into practice' were rated highest by the sample in terms of their knowledge, attitudes and practices. In addition, the EROS subscale being at the leading edge, which is a measure of clinicians' willingness to access new information to guide clinical practice, was the highest rated EROS subscale. These findings are consistent with past research using the KAP Survey, EROS and BARRIERS, which also found occupational therapists to hold positive attitudes towards research (Waine et al 1997, McCleary and Brown 2002, Eller et al 2003) and perceive the fewest barriers to research to be associated with their own research values (Closs and Lewin 1998).

Positive attitudes towards evidence-based practice and research utilisation have also been found in studies evaluating occupational therapists' perceptions of evidence-based practice (Humphris et al 2000, Bennett et al 2003, Philibert et al 2003). As noted by Karlsson and Tornquist (2007), the positive attitude held by their sample of Swedish occupational therapists is a good starting point towards evidence-based practice. Consistent with past research, although the current sample was found to hold positive attitudes towards evidence-based practice, they were less confident in their research abilities (Van Mullem et al 1999, Humphris et al 2000, Eller et al 2003, Witzke et al 2008). Therefore, the lower ratings of paediatric occupational therapists' research knowledge, conduct and utilisation, and multiple perceived barriers indicate that positive attitudes alone are not sufficient to ensure engagement in evidence-based practice and research utilisation. As such, strategies need to be implemented to facilitate the use of these approaches.

Finally, paediatric occupational therapists appear to perceive more value in accessing new information and implementing research in practice than in conducting their own research studies. The KAP Survey attitudes ratings associated with participants' views towards the research activities required to conduct research were rated as 'moderate'. This is not surprising, given the promotion in the professional literature regarding the importance of implementing research, rather than conducting research studies, to ensure effective clinical practice. However, research studies are required to enable findings to be implemented into clinical practice and, therefore, paediatric occupational therapists should be encouraged to engage in conducting research, which, as will be discussed, is the responsibility of all occupational therapists (Bannigan et al 2007).

Overall, these findings indicate that paediatric occupational therapists in the UK hold a positive attitude towards evidence-based practice and research utilisation, particularly with regard to accessing new information and implementing research findings in clinical practice; however, the participants held less positive perceptions towards conducting research studies to contribute to the available literature.

Research conduct

Engagement in conducting research was limited among the sample of paediatric occupational therapists in this study. The KAP Survey contains two factors associated with research conduct. The first, 'administering research implementation', includes the research activities necessary for the initial stages of conducting research, such as submitting proposals for funding and ethical approval. The second, 'conducting and communicating research', is associated with completing the research, from designing the project to presenting the findings (Van Mullem et al 1999). These two factors were rated lowest and second lowest, respectively, according to participants' knowledge, attitudes and practices, with participants rating their knowledge and practices of 'administering research implementation' to be 'low'. The study by Eller et al (2003) also found these two factors to be rated lowest among their sample of occupational therapists. The findings of the present study indicate that UK-based paediatric occupational therapists may not see the value or perceive that they have sufficient knowledge and practices to engage in conducting research studies.

While the KAP Survey measures perceived knowledge, attitudes and ability to perform (practices) research activities, the EROS research involvement subscale indicates the extent to which clinicians are engaging in conducting their own research studies. Not surprisingly, given the KAP Survey findings outlined above, paediatric occupational therapists in the UK reported limited research involvement, rating this EROS subscale the lowest. Comparably, Waine et al (1997) also found the research involvement subscale to be rated lowest by their sample of Canadian occupational therapists. Similarly, Humphris et al (2000) reported that only a small percentage of their sample of British occupational therapists engaged in research conduct.

According to Bannigan et al (2008), the majority of research projects are undertaken within the occupational therapy profession in order to achieve higher research degrees. However, in 2006, only 0.7% of occupational therapists in the UK had completed or were registered to complete a research degree (Reid 2007), which could translate to limited research conduct within the profession. This is reflective of the current sample, with 92% of the participants holding diplomas and bachelor's degrees, which are not typically associated with vast education in conducting research.

As noted by Bannigan et al (2007), given the revised code of ethics developed by the College of Occupational Therapists, 'research is every occupational therapist's business' (p95). Therefore, in order to enable occupational therapists that do not hold research degrees to engage in conducting research, continuing professional development to educate and support therapists in conducting research is valuable and necessary. The current sample expressed lower ratings of their knowledge and ability to perform (practices) the research activities required to conduct research and, subsequently, perceived limited engagement in conducting research. This is suggestive of the need for additional research education and support within organisations to enable UK paediatric occupational therapists to conduct research studies.

Research utilisation

The findings of this study indicated that paediatric occupational therapists in the UK held positive perceptions towards implementing research findings in clinical practice and were doing so to some extent. The participants' attitudes towards 'implementing research into practice' were found to be 'high', whereas their knowledge and practices related to such tasks were rated as 'moderate'. The majority of the sample reported some implementation of research findings in their clinical practice, as indicated by the moderate rating of the EROS evidence-based practice subscale, which is a measure of research utilisation (Pain et al 1996). Although these findings are positive, there is the potential to increase the degree to which paediatric occupational therapists are integrating research findings into clinical practice, given the moderate ratings.

Past research investigating evidence-based practice and research utilisation amongst occupational therapists has identified findings similar to those of the present study. Although occupational therapists hold positive attitudes towards evidence-based practice and are willing to access information and implement research findings, they are less likely actually to implement research findings in clinical practice (Waine et al 1997, Humphris et al 2000, McCleary and Brown 2002, Witzke et al 2008). Multiple barriers to research utilisation are also perceived (Closs and Lewin 1998, Metcalfe et al 2001). In investigating the paediatric occupational therapy university programme curricula in the UK, Brown et al (2005) concluded that the structure of the curricula could lead graduates to use assorted approaches or adopt their own personal frameworks based on postgraduate education or clinical experience. As such, ensuring that paediatric occupational therapists are being guided by sound research in their clinical practice is particularly important to ensure that children and families are receiving high quality care.

The greatest barriers to the research utilisation of UK paediatric occupational therapists were associated with the organisation and the communication (availability and accessibility of research). Time constraints to read research and implement findings was the most commonly reported organisational barrier. The greatest perceived communication barriers related to understanding statistical analyses and feeling that the implications for practice are not clearly presented in research studies. Such barriers limit the ability to integrate research findings into clinical practice. Research barriers were also perceived within the innovation (quality of the research); however, such barriers were not perceived to have an impact on research utilisation to as great an extent as the barriers associated with the organisation or the communication of research.

Past research investigating the perceived barriers to research utilisation of health professionals in the UK demonstrate similarities with the findings of the present study. The sample of allied health professionals in Closs's and Lewin's (1998) study perceived the top five most frequently reported barriers to research utilisation to be associated with the organisation, the communication and the innovation of research. Specifically, the sample of occupational therapists perceived time constraints to be the most frequent barrier to research utilisation (Closs and Lewin 1998). Time constraints and the barriers associated with understanding statistical analysis have also frequently been reported as barriers to the research utilisation of nurses in the UK (Dunn et al 1997). Although not directly comparable with those from occupational therapists, these findings highlight the similarities in perceived research barriers between nurses and occupational therapists in the UK.

The paediatric occupational therapists perceived the barrier of time constraints in completing two aspects of the process of research utilisation defined by Taylor (2007), that is, reading research (given that clinicians need to read research in order to critique research findings) and implementing the research findings in clinical practice. This finding implies that if paediatric occupational therapists are successfully to use the current evidence base to guide practice approaches, they would benefit from additional time within their organisations dedicated to research utilisation. Kajermo et al (2008) identified that work tempo was an important predictor of perceived barriers to research utilisation. Therefore, by reducing the workload of paediatric occupational therapists and allowing more protected time for research utilisation activities, the number of perceived barriers would be likely to reduce. Similarly, Humphris et al (2000) identified that the most important facilitator to research utilisation among British occupational therapists was dedicated time within the working week to engage in research activities. This was followed by frequent research education and additional staff to assist in the implementation of research in practice (Humphris et al 2000).

It has been suggested that journal clubs, which bring together a group of people to discuss journal articles, is a useful approach to overcome certain barriers associated with reviewing and understanding what is reported in the literature (Bannigan and Hooper 2002). The use of journal clubs, in conjunction with other strategies, might be an effective method to allow paediatric occupational therapists in the UK to discuss the implications of research findings and identify means of integrating evidence into their clinical practice (Bannigan and Hooper 2002). Kajermo et al (2008) concluded that nurses should be supported by senior staff in professional development to enhance their use of evidence-based practice, with clear and realistic goals for their workplace. This approach is also recommended within the occupational therapy profession. Given that paediatric occupational therapists in the UK appear willing and see value in implementing research findings in their clinical practice, they would benefit from additional support and time within their organisations, as well as continuing professional development regarding accessing research and implementing research findings. Such strategies would contribute to increasing the use of evidence-based practice and research utilisation within the profession.

Limitations of the study

The limitations of this study are associated with the convenience sampling method used, resulting in a relatively low response rate. This limits the generalisability of the study findings. However, for a postal survey, the response rate was in the accepted range for this type of study (Forsyth and Kviz 2006). In addition, the results of this study might have been influenced by social desirability bias, whereby participants may have answered questionnaire items with the response that they believed the researchers were seeking (Kielhofner 2006).

Future research

The following suggestions for future research studies are made: (i)

To examine the knowledge, attitudes, practices and barriers to evidence-based practice and research utilisation of paediatric occupational therapists from other countries that are members of the World Federation of Occupational Therapists (for example, Australia, Taiwan, South Africa, Israel, Canada, Sweden, Brazil, Chile, Iceland and Malaysia)

(ii) To investigate the knowledge, attitudes, practices and barriers to evidence-based practice and research utilisation of occupational therapists from other clinical areas of practice (for example, mental health, neurology, orthopaedics and care of older people)

(iii) To compare the evidence-based practice and research utilisation of occupational therapists with other health care professional groups

(iv) To identify strategies to increase the research knowledge and skills of occupational therapists.

Conclusion

This study investigated the knowledge, attitudes, practices and barriers to evidence-based practice and research utilisation of paediatric occupational therapists in the UK. Positive attitudes towards evidence-based practice and research utilisation were found among the sample, because they appeared to recognise the value in using research evidence to guide clinical practice. However, the respondents were less confident in their knowledge and ability to perform research activities and were found to implement research findings in clinical practice only to some extent. The paediatric occupational therapists perceived their research knowledge, attitudes and practices pertaining to conducting research to be lower than their perceptions of accessing information or implementing research findings in practice. Not surprisingly, the respondents also reported limited engagement in conducting research studies. Furthermore, barriers to research utilisation, such as time constraints to complete research activities, and the quality, availability and accessibility of research, were perceived by the sample to a moderate extent.

Overall, UK paediatric occupational therapists would benefit from additional research education and support within their organisations to ensure that children and families are receiving care based on sound, high quality research evidence, and to encourage clinicians to engage in conducting their own research to contribute to the occupational therapy profession.

Acknowledgements

The paediatric occupational therapists are thanked for their participation in this study. The World Federation of Occupational Therapists Thelma Cardwell Foundation Award for Research and Education and the Victorian Occupational Therapy Trust are acknowledged for their financial support in the form of research grants that allowed this study to be completed. Conflict of interest: None.

Submitted: 1 July 2009.

Accepted: 17 February 2010.

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Key findings

* Participants held positive attitudes; however, they were less confident in their research knowledge and practices.

* The greatest research barriers were associated with the organisation, quality and accessibility of research.

What the study has added

This study provided the first insight into the use of evidence-based practice and research utilisation among paediatric occupational therapists in the United Kingdom, thus highlighting areas for improvement.

Reference: Lyons C, Casey J, Brown T, Tseng M, McDonald R (2010) Research knowledge, attitudes, practices and barriers among paediatric occupational therapists in the United Kingdom. British Journal of Occupational Therapy, 73(5), 200-209.

DOI: 10.4276/030802210X12734991664147

Carissa Lyons, (1) Jackie Casey, (2) Ted Brown, (1) Mei Tseng (3) and Rachael McDonald (1)

(1) Monash University--Peninsula Campus, Frankston, Victoria, Australia.

(2) University of Ulster, Newtownabbey, Co. Antrim, Northern Ireland.

(3) National Taiwan University, Taipei, Taiwan, Province of China.

Corresponding author: Dr Ted Brown, Associate Professor and Postgraduate Coordinator, Department of Occupational Therapy, Monash University--Peninsula Campus, Building G, 4th Floor, McMahons Road, PO Box 527, Frankston, Victoria, Australia 3199. Email: ted.brown@med.monash.edu.au
Table 1. Participant demographic data (n = 145, response rate 30%)

                                              Frequency *   Percentage

Gender

Female                                            139           95.9
Male                                                6            4.1
Total                                             145          100
Age (years)
20-29 years                                        27           18.6
30-39 years                                        43           29.7
40-49 years                                        46           31.7
50-59 years                                        26           17.9
60+ years                                           3            2.1
Total                                             145          100

Highest level of occupational therapy qualification obtained

Diploma/certificate in occupational therapy        62           42.8
Bachelor's degree in occupational therapy          72           49.7
Entry-level master's degree in
occupational therapy                                4            2.8
Course work/research master's in                    6            4.1
  occupational therapy
Doctorate in occupational therapy                   1            0.7
Total                                             145          100

Employment status

Full time, between 20 and 40 hours per week       123           84.8
Part time, less than 20 hours per week             17           11.7
Non-practising                                      1            0.7
Other                                               4            2.8
Total                                             145          100

Current position

Occupational therapy clinician working
for an employer                                   115           79.3
Private practitioner                                9            6.2
Occupational therapy manager/administrator         12            8.3
Other                                               8            5.5
Total                                             144           99.3

Client caseload

Inpatient                                           4            2.8
Outpatient/community based                        114           78.6
Mixed (both inpatient and outpatient)               9            6.2
Other                                              13            9.0
Not applicable                                      2            1.4
Total                                             142           97.9

Client age group--reported 'frequently' or 'all the time'

Infants                                            12            8.3
Toddlers                                           52           35.9
Preschoolers                                       93           64.1
School age                                        122           84.1
Preadolescent                                      92           63.4
Adolescent                                         55           37.9
Young adults                                        7            4.8
Adults                                              3            2.1
Older adults                                        2            1.4

* Note: The total number of respondents in the study was 145. However,
the 'total' categories do vary since some respondents left some of the
demographic questions blank.

Table 2. KAP Survey descriptive statistics (n = 145)

                                                         Standard
KAP Survey subscale                               Mean   deviation

Knowledge subscale total score                    1.79     0.38
Attitudes subscale total score                    2.14     0.44
Practices subscale total score                    1.77     0.40

Knowledge subscale

Factor 1: Identifying clinical problems           2.34     0.52
Factor 2: Establishing current best practice      1.93     0.46
Factor 3: Implementing research into practice     2.03     0.49
Factor 4: Administering research implementation   1.37     0.39
Factor 5: Conducting and communicating research   1.71     0.46

Attitudes subscale

Factor 1: Identifying clinical problems           2.49     0.50
Factor 2: Establishing current best practice      2.28     0.47
Factor 3: Implementing research into practice     2.34     0.46
Factor 4: Administering research implementation   1.8      0.56
Factor 5: Conducting and communicating research   2.08     0.52

Practices subscale

Factor 1: Identifying clinical problems           2.16     0.55
Factor 2: Establishing current best practice      1.87     0.48
Factor 3: Implementing research into practice     2.01     0.50
Factor 4: Administering research implementation   1.42     0.44
Factor 5: Conducting and communicating research   1.74     0.46

KAP Survey subscale                               Rank

Knowledge subscale total score                    Moderate
Attitudes subscale total score                    Moderate
Practices subscale total score                    Moderate

Knowledge subscale

Factor 1: Identifying clinical problems           High
Factor 2: Establishing current best practice      Moderate
Factor 3: Implementing research into practice     Moderate
Factor 4: Administering research implementation   Low
Factor 5: Conducting and communicating research   Moderate

Attitudes subscale

Factor 1: Identifying clinical problems           High
Factor 2: Establishing current best practice      Moderate
Factor 3: Implementing research into practice     High
Factor 4: Administering research implementation   Moderate
Factor 5: Conducting and communicating research   Moderate

Practices subscale

Factor 1: Identifying clinical problems           Moderate
Factor 2: Establishing current best practice      Moderate
Factor 3: Implementing research into practice     Moderate
Factor 4: Administering research implementation   Low
Factor 5: Conducting and communicating research   Moderate

KAP: Research Knowledge, Attitudes and Practices of Research Survey.

Rating scale: 'low' mean = 1.0-1.66; 'moderate' mean = 1.67-2.33;
'high' mean = 2.34-3.0.

Table 3. EROS descriptive statistics (n = 145)

EROS subscale                            Mean   Standard deviation

Factor 1: Valuing research               3.85          0.63
Factor 2: Research involvement           2.74          0.79
Factor 3: Being at the leading edge. *   4.11          0.61
Factor 4: Evidence-based practice        3.70          0.55
EROS total                               3.65          0.53

EROS: Edmonton Research Orientation Survey.

Possible scores can range from 1 (strongly disagree) to 5 (strongly
agree).

Note: The EROS subscale with the highest mean score is indicated
with *.

Table 4. BARRIERS descriptive statistics (n = 145)

BARRIERS subscale              Number   Mean   Standard deviation

Factor 1: The Adopter           141     2.53          0.74
Factor 2: The Organisation *    139     2.89          0.68
Factor 3: The Innovation        136     2.71          0.70
Factor 4: The Communication     137     2.88          0.66
Total BARRIERS                  141     2.74          0.57

BARRIERS: Barriers to Research Utilisation Scale. Possible scores can
range from 1 (no extent) to 4 (great extent). Participants can also
select 'no opinion'.

Note: The BARRIERS subscale with the highest mean score is indicated
with *.

Table 5. Top five most frequently reported barriers to research
utilisation (n = 145)

                                                           Missing
BARRIERS item                  Frequency *   Percentage   ([dagger])

1. There is insufficient           112          77.2           7
time on the job to implement
new ideas (O).

2. The clinician does not          110          75.9           7
have time to read research
(O)

3. Statistical analyses are        103          71.0          12
not understandable (C).

4. The facilities are               97          66.9          11
inadequate for
implementation (O).

5. Implications for practice        95          65.5          32
are not made clear (C)

BARRIERS: Barriers to Research Utilisation Scale. BARRIERS subscales:
O: 'Organisation' and C: 'Communication'.

* Item reported as a moderate or great barrier to research utilisation.

([dagger]) Includes missing data and items rated as 'no opinion'.
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