Using all the available evidence: perceptions of paediatric occupational therapists about how to increase evidence-based practice

Abstract

This study aimed to (i) explore occupational therapy practitioners' perceptions of the scope and sources of evidence that they use in clinical decision-making; and (ii) identify strategies and resources that would increase the use of evidence in a paediatric clinical service. An action research methodology was applied to systematically explore participants' experiences of using evidence in practice and to democratically develop ways of increasing evidence-based practice. A series of six focus groups were conducted with nine occupational therapists, whose clinical experience ranged from 5 to 24 years. All participants had completed or were undertaking research qualifications. A systematic process of data coding was used whereby data were coded, categorised, analysed thematically and summaries developed. Rigour was maintained through triangulation (i.e. multiple data sources and occasions of data collection), and consultation and interpretation by two researchers. Participants identified two distinct sources of evidence they use in clinical practice: research-based and practice-based. They identified features of each source that they valued but also described barriers to the utilisation of each. Participants proposed strategies to increase the value of each source of evidence in their clinical practice. Strategies included appraising the clinical relevance and utility of research-based evidence, and developing standards and systematic processes to increase the credibility of practice-based evidence. Participants in this study perceived that although it is necessary to use all the available evidence in practice settings, there are currently barriers to using both research-based and practice-based evidence. In particular, the study indicates that there is need for the development of a structured model with processes and standards to guide practitioners in the collection, trial, evaluation and dissemination of practice-generated evidence. Further research is needed to explore the extent to which valid evidence can be generated from individual client programs by examining therapists' strategies for goal attainment in practice settings.