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

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