Browsing by Subject "Occupational therapy"

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    Open Access
    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
    (2014-06-10) Buchanan, Helen; Siegfried, Nandi; Jelsma, Jennifer; Lombard, Carl
    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.
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    Open Access
    Measuring evidence-based practice knowledge and skills in occupational therapy - a brief instrument
    (Biomed Central, 2015-10-30) Buchanan, Helen
    Background: Valid and reliable instruments are required to measure the effect of educational interventions to improve evidence-based practice (EBP) knowledge and skills in occupational therapy. The aims of this paper are to: 1) describe amendments to the Adapted Fresno Test of Competence in EBP (AFT), and 2) report the psychometric properties of the modified instrument when used with South African occupational therapists. Methods: The clinical utility of the AFT was evaluated for use with South African occupational therapists and modifications made. The modified AFT was used in two studies to assess its reliability and validity. In Study 1 a convenience sample of 26 occupational therapists in private practice or government-funded health facilities in a South African province were recruited to complete the modified AFT on two occasions 1 week apart. Completed questionnaires were scored independently by two raters. Inter-rater, test-retest reliability and internal consistency were determined. Study 2 was a pragmatic randomised controlled trial involving occupational therapists in four Western Cape Department of Health district municipalities (n = 58). Therapists were randomised in matched pairs to one of two educational interventions (interactive or didactic), and completed the modified AFT at baseline and 12 weeks after the intervention. An intention-to-treat analysis was performed. Data were not normally distributed, thus non-parametric statistics were used. Results: In Study 1, 21 of 26 participants completed the questionnaire twice. Test-retest (ICC = 0.95, 95 % CI = 0.88–0.98) and inter-rater reliability (Time 1: ICC = 0.995, 95 % CI = 0.99–0.998; Time 2: ICC = 0.99, 95 % CI = 0.97–0.995) were excellent for total scores. Internal consistency based on time 1 scores was satisfactory (α = 0.70). In Study 2, 28 participants received an interactive educational intervention and completed the modified AFT at baseline and 12 weeks later. Median total SAFT scores increased significantly from baseline to 12-weeks (Z = −4.078, p < 0.001) with a moderate effect size (r = 0.55). Conclusion: The modified AFT has demonstrated validity for detecting differences in EBP knowledge between two groups. It also has excellent test-retest and inter-rater reliability. The instrument is recommended for contexts where EBP is an emerging approach and time is at a premium.
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    An occupatiobnal perspectice on the journey of recovery from substance abuse among young Zimbabwean men
    (2014) Nhunzvi, Clement; Galvaan, Roshan; Peters, Liesl
    Substance abuse is a rising global health and social problem that is associated with serious medical, psychiatric, family, occupational, legal, financial and spiritual problems. While recovery from substance abuse is possible, it is a subjective and contested process. To date, the recovery process has not been explored from an occupational perspective in Zimbabwe, where as many as 60% of all readmissions at Zimbabwe’s psychiatric referral centre during the period from January 2010 to December 2011 were secondary to substance-induced disorders, and less than three percent of these patients moved into long-term recovery or sustained sobriety with rehabilitation follow-up. This qualitative narrative inquiry explores the journey of recovery from substance abuse among young adult Zimbabwean men. The aim of the study was to investigate how occupations played a role in the recovery journeys of each of these men. Three young adult men identified as former substance abusers were purposively selected for the study. Data generation occurred through in-depth narrative interviews with each participant. Principles of trustworthiness and validation emphasising the persuasiveness, coherence and pragmatic use of the narratives were applied throughout the research process, and ethical issues in narrative research were upheld. Ethical clearance was applied for and granted by the University of Cape Town’s Human Ethics Research Committee and permission to do the research was sought and given by the Medical Research Council of Zimbabwe. The findings of the study — explanatory stories — were produced through narrative analysis. These stories revealed substance abuse to be an occupation associated with both positive and negative consequences. Recovery from such abuse emerged as an ongoing occupational transition negotiated through participation in other occupations, and influenced by both personal and environmental factors. The way in which occupations were abandoned, modified and newly adopted during the process of this occupational transition is discussed. The construction and reconstruction of a positive occupational identity was seen as central to the process of occupational transition. The study concluded that engagement and participation in ‘engaging occupations’ was an intricate contributor to the recovery journey for young adult Zimbabwean men, and that narrative interviews should be used in generating data to explore the occupational nature of life and its events.