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      Students’ attitudes and perceptions of teaching and assessment of evidence-based practice in an occupational therapy professional Master’s curriculum: a mixed methods study

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          Abstract

          Background

          Most health professions, including occupational therapy, have made the application of evidence-based practice a desired competency and professional responsibility. Despite the increasing emphasis on evidence-based practice for improving patient outcomes, there are numerous research-practice gaps in the health professions. In addition to efforts aimed at promoting evidence-based practice with clinicians, there is a strong impetus for university programs to design curricula that will support the development of the knowledge, attitudes, skills and behaviours associated with evidence-based practice. Though occupational therapy curricula in North America are becoming increasingly focused on evidence-based practice, research on students’ attitudes towards evidence-based practice, their perceptions regarding the integration and impact of this content within the curricula, and the impact of the curriculum on their readiness for evidence-based practice is scarce. The present study examined occupational therapy students’ perceptions towards the teaching and assessment of evidence-based practice within a professional master’s curriculum and their self-efficacy for evidence-based practice.

          Methods

          The study used a mixed methods explanatory sequential design. The quantitative phase included a cross-sectional questionnaire exploring attitudes towards evidence-based practice, perceptions of the teaching and assessment of evidence-based practice and evidence-based practice self-efficacy for four cohorts of students enrolled in the program and a cohort of new graduates. The questionnaire was followed by a focus group of senior students aimed at further exploring the quantitative findings.

          Results

          All student cohorts held favourable attitudes towards evidence-based practice; there was no difference across cohorts. There were significant differences with regards to perceptions of the teaching and assessment of evidence-based practice within the curriculum; junior cohorts and students with previous education had less favourable perceptions. Students’ self-efficacy for evidence-based practice was significantly higher across cohorts. Four main themes emerged from the focus group data: (a) Having mixed feelings about the value of evidence-based practice (b) Barriers to the application of evidence-based practice; (c) Opposing worlds and (d) Vital and imperfect role of the curriculum.

          Conclusion

          This study provides important data to support the design and revision of evidence-based practice curricula within professional rehabilitation programs.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12909-017-0895-2) contains supplementary material, which is available to authorized users.

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          Designing and conducting mixed methods research

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              Development and assessment of the Alberta Context Tool

              Background The context of healthcare organizations such as hospitals is increasingly accepted as having the potential to influence the use of new knowledge. However, the mechanisms by which the organizational context influences evidence-based practices are not well understood. Current measures of organizational context lack a theory-informed approach, lack construct clarity and generally have modest psychometric properties. This paper presents the development and initial psychometric validation of the Alberta Context Tool (ACT), an eight dimension measure of organizational context for healthcare settings. Methods Three principles guided the development of the ACT: substantive theory, brevity, and modifiability. The Promoting Action on Research Implementation in Health Services (PARiHS) framework and related literature were used to guide selection of items in the ACT. The ACT was required to be brief enough to be tolerated in busy and resource stretched work settings and to assess concepts of organizational context that were potentially modifiable. The English version of the ACT was completed by 764 nurses (752 valid responses) working in seven Canadian pediatric care hospitals as part of its initial validation. Cronbach's alpha, exploratory factor analysis, analysis of variance, and tests of association were used to assess instrument reliability and validity. Results Factor analysis indicated a 13-factor solution (accounting for 59.26% of the variance in 'organizational context'). The composition of the factors was similar to those originally conceptualized. Cronbach's alpha for the 13 factors ranged from .54 to .91 with 4 factors performing below the commonly accepted alpha cut off of .70. Bivariate associations between instrumental research utilization levels (which the ACT was developed to predict) and the ACT's 13 factors were statistically significant at the 5% level for 12 of the 13 factors. Each factor also showed a trend of increasing mean score ranging from the lowest level to the highest level of instrumental research use, indicating construct validity. Conclusions To date, no completely satisfactory measures of organizational context are available for use in healthcare. The ACT assesses several core domains to provide a comprehensive account of organizational context in healthcare settings. The tool's strengths are its brevity (allowing it to be completed in busy healthcare settings) and its focus on dimensions of organizational context that are modifiable. Refinements of the instrument for acute, long term care, and home care settings are ongoing.
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                Author and article information

                Contributors
                (514) 398-4496 , aliki.thomas@mcgill.ca
                lu.han2@mail.mcgill.ca
                brittony.osler@gmail.com
                emily.turnbull@mail.mcgill.ca
                erinashleydouglas@gmail.com
                Journal
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                1472-6920
                27 March 2017
                27 March 2017
                2017
                : 17
                : 64
                Affiliations
                [1 ]ISNI 0000 0004 1936 8649, GRID grid.14709.3b, , School of Physical and Occupational Therapy, ; 3654 Sir William Osler, Montréal, Québec H3G 1Y5 Canada
                [2 ]ISNI 0000 0004 1936 8649, GRID grid.14709.3b, , Research Scientist, Center for Medical Education, Faculty of Medicine, McGill University, ; 1110 Pine Avenue West, Montréal, Québec H3G 1A3 Canada
                [3 ]ISNI 0000 0000 9810 9995, GRID grid.420709.8, , Centre for Interdisciplinary Research in Rehabilitation, ; Montréal, Québec Canada
                Author information
                http://orcid.org/0000-0001-9807-6609
                Article
                895
                10.1186/s12909-017-0895-2
                5368912
                28347300
                2d886722-e6e6-4ddf-84fe-863aa39b7af1
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 28 October 2016
                : 8 March 2017
                Funding
                Funded by: there is no funding for this research
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Education
                evidence-based practice,rehabilitation,curriculum,professional education,attitudes,self-efficacy

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