Randomised Trial of Two Educational Intervention for Improving Evidence-based Practice Knowledge, Atttitudes and Practice

Study Overview
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Brief Summary
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This pragmatic randomised controlled trial (RCT) used a two-group parallel design with matched-pair stratification by type (clinician/manager) and knowledge score. The trial aimed to: 1) determine whether an IE was more effective than a DE for improving EBP knowledge, skills and use at 12 weeks, and 2) to investigate the feasibility of conducting a RCT with occupational therapists in a public health setting. Occupational therapists employed by the Western Cape Department of Health (DOH) form,ed the study population(N=98). Fifty-eight consented to participate and were randomly allocated to either an interactive (IE) or a didactic (DE) educational intervention using coin tossing. Data was collected at baseline and 12 weeks The primary outcome was increased EBP knowledge at 12 weeks shown by an improved total knowledge score. Secondary outcomes were improved attitudes and behaviour. Data were collected at the health facilities where participants were employed. Raters for the audit were blinded but participants and the provider could not be blinded. Thirty participants were allocated to receive the IE and 28 the DE. Twenty-five participants in the IE and 21 in the DE completed the trial and were included in the 12 week analysis. Results revealed no significant difference between the groups in the primary knowledge outcome at 12 weeks. Examination of within-group changes revealed significant improvements in knowledge in both groups (IE: T=4.0, p<0.001; DE: T=12.0, p=0.002), but the IE also showed a significant increase in behaviour (T=64.5, p=0.044) and attitudes on one sub-scale (T=33.0, p=0.039). As the study was powered at 43%, it may have failed to detect significant differences at 12 weeks. Conducting a high-quality RCT was feasible and the risk of bias was assessed as low. The OTEBP trial adds strength to the existing evidence that both didactic and interactive educational interventions can improve knowledge, but it seems that interactive interventions may be more effective for changing behaviour. High-quality pragmatic trials can feasibly be conducted within the public health service

Official Title
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Randomised Trial of the Effectiveness of Two Educational Interventions to Improve Evidence-based Practice Knowledge, Attitudes and Behaviour in Occupational Therapists

Conditions
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Health Knowledge, Attitudes, Practice

Intervention / Treatment
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* Behavioral: Education


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Occupational therapists employed by the Western Cape Department of Health (DOH) Working at least 20 hours per week Exclusion Criteria: Working at a distance of more than 1½ hours from Cape Town Therapists who would be leaving the DOH before December 2008 or taking leave during the time of the intervention

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Interactive educational intervention<br>Two education sessions (four-hours and two-hours respectively), emailed notes and reminders | Behavioral: Education<br>* Interactive educational intervention: 4 hour education session (with notes and 'evidence packs'); presentations, small group discussion tasks and practice of particular skills - 2 hour session (1 week later) Emailed notes from second session Telephonic/email follow-up (reminders) Didactic educational intervention: - 4 hour education session (with notes and 'evidence packs'; questions answered but no discussion or application of skills<br>|
| Experimental: Didactic educational intervention<br>Education alone | Behavioral: Education<br>* Interactive educational intervention: 4 hour education session (with notes and 'evidence packs'); presentations, small group discussion tasks and practice of particular skills - 2 hour session (1 week later) Emailed notes from second session Telephonic/email follow-up (reminders) Didactic educational intervention: - 4 hour education session (with notes and 'evidence packs'; questions answered but no discussion or application of skills<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Shortened Fresno Test of Competence in Evidence-based Practice (SAFT) | Modified from the Adapted Fresno Test of Competence in EBP (AFT) (McCluskey and Bishop, 2009), the SAFT consists of three items testing knowledge of writing a PICO question based on a clinical scenario, ability to identify the most suitable study design to answer the question, and knowledge of possible sources of information. The total possible score is 30 points. The test is scored using a grading rubric. Two versions are availbale for measuring outcomes of educational interventions. | 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Audit checklist | 9-item checklist for auditing patient records to determine the extent to which occupational therapists monitor the effectiveness of their interventions. | 12 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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randomised controlled trial, educational intervention, occupational therapy