Australian Occupational Therapy

Journal

Australian Occupational Therapy Journal (2011) 58, 178–186 doi: 10.1111/j.1440-1630.2010.00900.x

Research Article

Evidence-based practice and research utilisation: Perceived

research knowledge, attitudes, practices and barriers
among Australian paediatric occupational therapists
Carissa Lyons,1 Ted Brown,1 Mei Hui Tseng,2 Jacqueline Casey3 and
Rachael McDonald1
1Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences,
Monash University – Peninsula Campus, Frankston, Victoria, Australia, 2School of Occupational Therapy, College of
Medicine, National Taiwan University, Taipei, Taiwan, and 3School of Health Sciences, University of Ulster –
Jordanstown Campus, Newtownabbey, UK

Background/aim: Evidence-based practice (EBP) and
research utilisation (RU) are promoted as ways for clients
to receive the best level of care. However, limited research
has evaluated the use of these approaches by occupational
therapists. This study investigated the knowledge, atti-
tudes, practices of and barriers to EBP and RU of a group
of paediatric occupational therapists from Australia.
Methods: Questionnaires were received from 138 partici-
pants (response rate 46%) who completed the Research
Knowledge, Attitudes and Practices of Research Survey,
the Edmonton Research Orientation Survey and the Barri-
ers to Research Utilisation Scale.
Results: The participants held positive attitudes towards
research, and were willing to access new information to
guide practice approaches. However, participants were less
confident in their research knowledge and practices and
implemented research findings into clinical practice. Mul-
tiple barriers to RU were perceived, particularly associated
Carissa Lyons BOccThy (Hons), BPsych, AccOT; Research
Assistant/Postgraduate Student. Ted Brown PhD, MSc,
MPA, BScOT (Hons), OT (C), OTR, AccOT; Associate
Professor/Postgraduate Coordinator. Mei Hui Tseng ScD,
OTR; Associate Professor. Jacqueline Casey MSc, BSc (Hons)
OT, PgCHEP; Lecturer. Rachael McDonald PhD, PGDip
(Biomech), BAppSc (OT); Senior Lecturer.
Correspondence: Dr Ted Brown, Department of Occupa-
tional Therapy, School of Primary Health Care, Faculty of
Medicine, Nursing and Health Sciences, Monash University –
Peninsula Campus, Building G, 4th Floor, McMahons Road,
PO Box 527, Frankston, Vic. 3199, Australia. Email:
ted.brown@med.monash.edu.au
Accepted for publication 21 July 2010.
C 2011 The Authors
Cusick, 2002). An understanding of paediatric occupa-
C 2011 Australian
Australian Occupational Therapy Journal
tional therapists’ use of EBP and RU is valuable, as
Association of Occupational Therapists
with the presentation and accessibility of research. Partici-
pants reported limited engagement in conducting research
studies, although the majority of the participants reported
implementing the findings of research into their clinical
practice to some extent.
Conclusion: Additional research education and support
within organisations would be beneficial to ensure that
children and families are receiving occupational therapy
services that are based on sound, high-quality research evi-
dence. The findings of this study provide insight into the
perceived research knowledge, attitudes, practices of and
barriers to Australian paediatric occupational therapists,
enabling specific strategies to be implemented to increase
the use of EBP and RU within the profession.
KEY WORDS attitudes, barriers, evidence-based practice,
paediatrics, research knowledge, research utilisation.
Introduction
The practice approaches implemented by health-care pro-
fessionals are guided by the use of evidence-based prac-
tice (EBP) and research utilisation (RU), which involves
the use of current, high-quality empirical evidence and
research when making decisions and recommendations
regarding client care (Sackett, Rosenberg, Gray, Haynes
& Richardson, 1996). The use of EBP and RU enable clini-
cians to remain up-to-date with health-care trends,
improve client care outcomes and health-care efficiencies
and provide high-quality care for clients (Law & Baum,
1998; Taylor, 2007). However, EBP and RU skills are not
well developed among therapists who work with chil-
dren and families, and there continues to be significant
knowledge gaps within the occupational therapy profes-
sion (Dobbins, Ciliska & DiCenso, 1998; McCluskey &
such knowledge will enable appropriate strategies to be
EVIDENCE-BASED PRACTICE AND RESEARCH UTILISATION
implemented to ensure that children and families receive
the best and most up-to-date care available. This article
outlines the findings of a study investigating the research
knowledge, attitudes, practices of and barriers to EBP
and RU of a group of Australian paediatric occupational
therapists.
Literature review
Evidence-based practice and RU originated from the field
of evidence-based medicine, defined as ‘the conscientious
and judicious use of current best evidence in making
decisions about the care of individual patients’ (Sackett
et al., 1996, p. 71). RU is described as a component of
EBP, involving the process of critiquing research find-
ings, implementing research findings into clinical prac-
tice and evaluating the implementation of research
findings (Taylor, 2007). According to McCluskey (2003),
being evidence-based implies that clinicians have the nec-
essary research knowledge and skills to access, appraise
and use research evidence in clinical practice when mak-
ing decisions.
The concept of EBP is not without controversy in the
allied health professions, where a positivist bias towards
randomised controlled trials in medicine is regarded as
too narrow to encompass knowledge derived from alter-
nate research methodologies valued in allied health fields
(Coyler & Kamath, 1999). Nonetheless, EBP is promoted
in the professional literature and practice of allied health
(Law & Baum, 1998). As such, an understanding of health
professionals’ perceived research knowledge, attitudes,
practices and barriers is valuable to increase the use of
EBP and RU and ultimately, enhance client care.
Health professionals’ research knowledge,
attitudes, practices and barriers
Although a number of studies have investigated the atti-
tudes, practices and barriers to EBP and RU among occu-
pational therapists (Curtin & Jaramazovic, 2001; Davis,
Zayat, Urton, Belgum & Hill, 2008; Karlsson & Törnquist,
2007; Philibert, Snyder, Judd & Windsor, 2003; Salls,
Dolhi, Silverman & Hansen, 2009), no empirical studies
utilising samples of Australian paediatric occupational
therapists have been completed to date. Some studies
have investigated the use of EBP and RU among nurses
and allied health professionals working with adult
clients, which does provide some insight into this topic.
Allied health professionals (including occupational
therapists) have been found to hold a moderate level of
research orientation, which is a broad construct provid-
ing insight into clinicians’ overall perception of conduct-
ing research, implementing findings into clinical practice,
as well as the importance and value placed on providing
clients with the most current health care (Pain, Hagler &
Warren, 1996; Pain, Magill-Evans, Darrah, Hagler &
Warren, 2004; Waine, Magill-Evans & Pain, 1997). Posi-
tive attitudes towards EBP and RU have also been found
among health professionals (Eller, Kleber & Wang, 2003;
C2011 The Authors
Australian Occupational Therapy Journal
C 2011 Australian Association of Occupational Therapists
179
Witzke et al., 2008), with occupational therapists also
indicating that they are willing to access new information
to guide their clinical practice (Waine et al., 1997). How-
ever, concerns have been reported in the literature
regarding health professionals’ perceived research
knowledge and ability to perform (practices) research
activities, with clinicians typically rating their knowledge
and practices pertaining to research activities to be lower
than their knowledge and practices of identifying clinical
problems (Eller et al., 2003; Witzke et al., 2008). In addi-
tion, occupational therapists report less engagement in
implementing research findings into clinical practice and
in conducting research studies, compared with their posi-
tive research attitudes (Waine et al., 1997). Within Austra-
lia, occupational therapists have demonstrated positive
attitudes towards EBP. However, they have indicated
that they are not confident in using their research knowl-
edge and skills (Bennett et al., 2003; McCluskey, 2003).
Specific barriers to EBP and RU perceived by clinicians
need to be identified so that they can be reduced or elimi-
nated (Funk, Champagne, Weise & Tornquist, 1991), as
ultimately, it is the clinicians who are responsible for
implementing research evidence into their clinical prac-
tice. Past research investigating the perceived barriers to
EBP and RU of health professionals have found charac-
teristics of the organisation to be the greatest barriers
(Closs & Lewin, 1998; Hutchinson & Johnston, 2004;
Retsas, 2000). The most frequently reported barriers to
EBP and RU have included lack of time to read research
and implement research findings, not being able to
understand the statistical analyses in research articles,
and that the literature is not compiled in the one place
(Closs & Lewin, 1998; Metcalfe, Wisher, Perry, Bannigan
& Klaber, 2001).
As can be seen, there is a limited body of knowledge
available investigating the EBP and RU of occupational
therapists, with no studies utilising samples of Australian
occupational therapists working with children and fami-
lies. Therefore, this study aimed to investigate the per-
ceived knowledge, attitudes, practices and barriers to
EBP and RU of a group of paediatric occupational thera-
pists from Australia.
Method
Design
A quantitative study design utilising a mailed survey
was undertaken to gather numerical data from partici-
pants who met the inclusion criteria for this study.
Participants
A convenient sampling method was utilised. The inclu-
sion criteria for this study were (i) consenting to partici-
pate in the study; (ii) being a qualified occupational
therapist in Australia; and (iii) working with children
and/or adolescents aged birth to 18 years. Ethics
180
Committee approval was obtained from the Standing
Committee on Ethics in Research Involving Humans
(SCERH), Monash University, Australia prior to the com-
mencement of the study.
Instrumentation
Participants completed a self-report questionnaire that
included demographic information and indicators of RU,
the Research Knowledge, Attitudes and Practices of
Research Survey (KAP Survey; Van Mullem et al., 1999),
the Edmonton Research Orientation Survey (EROS; Pain
et al., 1996) and the Barriers to Research Utilization Scale
(BARRIERS; Funk et al., 1991).
The KAP Survey was used to assess the participants’
knowledge of, willingness to engage (attitudes) in and abil-
ity to perform activities (practices) related to the conduct
and utilisation of research. The three interrelated con-
cepts of research knowledge, attitudes and practices form
three subscales in which participants are required to rate
33 research activities as low (1), moderate (2) or high (3)
depending on their perceived knowledge, attitudes and
practices pertaining to each item (Burke, Farrell, Bru-
kwitzki & Van Mullem, 1999). Factor analysis of the KAP
Survey identified five factors related to research conduct
and utilisation, which included (i) identifying clinical
problems; (ii) establishing current best practice; (iii)
implementing research into practice; (iv) administering
research implementation; and (v) conducting and com-
municating research (Burke et al., 1999). Thus, a total
score is obtained for each of the knowledge, attitudes and
practices subscales, as well as for each of the five factors
rated according to participants’ self-reported knowledge,
attitudes and practices. Van Mullem et al. (1999) estab-
lished a 0.84 index of content validity for the KAP Survey
during its initial development. Test–retest reliability for
the three knowledge, attitudes and practice scales ranged
from 0.77 to 0.83 and internal consistency from 0.93 to
0.97. In another study, internal consistency scores of the
three scales ranged from 0.95 to 0.97 (Eller et al., 2003).
The EROS is a self-report questionnaire that measures
clinicians’ participation in research, and research orienta-
tion in their clinical work, by asking respondents to rate
38 items on a scale from 1 (strongly disagree) to 5
(strongly agree). The EROS provides an overall score,
indicating research orientation, as well as four subscale
scores (Pain et al., 1996). The four subscales were con-
firmed by principle components analysis and include (i)
valuing research; (ii) research involvement; (iii) being at
the leading edge; and (iv) EBP. The EBP subscale is an
indicator of RU. Pain et al. (1996) report high internal con-
sistency of the scale (Cronbach’s alpha = 0.93) and evi-
dence of construct validity. The EROS has been used
previously with occupational therapists and speech–lan-
guage pathologists (Waine et al., 1997).
The BARRIERS scale was used to measure participants’
perceived barriers to RU (Funk et al., 1991). The BARRI-
ERS scale contains four subscales derived from confirma-
C 2011 The Authors
Australian Occupational Therapy Journal
C. LYONS ET AL.
tory factor analysis: (i) the adopter (values, skills and
awareness); (ii) the organisation (setting); (iii) the innovation
(qualities of the research); and (iv) communication (presen-
tation and accessibility of the research). It consists of 28
items that are rated on the degree to which the respon-
dent perceives the item to be a barrier to the use of
research in their clinical practice. Items are rated as 1 ‘to
no extent’; 2 ‘to a little extent’; 3 ‘to a moderate extent’;
and 4 ‘to a great extent’. The authors report good internal
consistencies of the first three factors (Cronbach’s alphas
of 0.72–0.80), lower internal consistency for the fourth fac-
tor (Cronbach’s alpha of 0.65) and preliminary evidence
of test–retest reliability (Funk et al., 1991).
Procedure
Survey packages were mailed to prospective participants
who met the inclusion criteria. Names of participants
were obtained from the OT AUSTRALIA membership
database. Those OT AUSTRALIA members who indi-
cated that they worked with children and adolescents
aged 18 years and under were selected for a total poten-
tial sample of 850 participants. A random sample of 300
participants was generated of the 850 potential partici-
pants. The sample size was limited to 300 participants
due to the cost of labour and postage involved in the
mailing the surveys. Randomised selection of partici-
pants was achieved using a computer randomisation pro-
gram that generated a set of numbers that corresponded
to the numerical order of respondents’ names in the OT
AUSTRALIA membership database (e.g. if the randomi-
sation program generated participant numbers of 2, 10,
13, 25 and 27, then participants that came up in the
numerical order in the membership database list who
indicated paediatrics as their area of practice were
selected). In addition, an effort was made to ensure that
there was geographical representation of all the Austra-
lian states and territories. Two sets of address labels for
these 300 participants were printed. The first set of
address labels were appended to envelopes containing
the survey. These were then mailed to participants. The
second set of address labels were appended to envelopes
that contained a reminder letter that was mailed one
week after the survey was sent to participants. For pur-
poses of confidentiality, a staff member of OT AUSTRA-
LIA printed and appended the address labels. An effort
was made to ensure that potential participants were
included from all of the Australian states and territories
to gain as wide a geographical representation as possible.
Participants completed the demographic questionnaire,
KAP Survey, EROS and BARRIERS scale. Code numbers
were used to maintain participant anonymity, and
inferred consent was obtained through completion and
return of the questionnaire.
Data analysis
The Statistical Package for the Social Sciences Version
15.0 (SPSS, Chicago, IL, USA) was used for data entry,
C 2011 Australian Association of Occupational Therapists
EVIDENCE-BASED PRACTICE AND RESEARCH UTILISATION
storage, retrieval, as well as the generation of descriptive
statistics (mean, standard deviation, frequencies and per-
centages) from the demographic questionnaire, the KAP
Survey, the EROS and the BARRIERS scale.
Results
Participants
Responses were received by 138 participants (response
rate: 45.6%). The majority of the sample comprised
women (97.1%), with most participants aged between
20 and 39 years (63.7%). The majority of the partici-
pants reported their highest level of occupational ther-
apy qualification as a bachelors degree (78.3%), were
working full-time (67.4%), and held the position of an
occupational therapy clinician for an employer
(61.6%). Most of respondents reported their caseload
to be primarily outpatient/community based (68.1%)
and working with preschool-aged clients (71.7%) (see
Table 1).
KAP Survey descriptive statistics results
The knowledge, attitudes and practices subscales were all
rated as ‘moderate’ by participants, with the attitudes sub-
scale rated the highest and the practices subscale rated the
lowest. In terms of factor scores, participants’ attitudes
towards ‘identifying clinical problems’ (factor 1), was
rated as ‘high’, whereas knowledge and practices of ‘admin-
istering research implementation’ (factor 4) were rated as
‘low’. The remaining factor scores were all rated as ‘mod-
erate’ (see Table 2).
EROS descriptive statistics
The EROS total score, indicating research orientation was
found to be of a moderate level. The EROS subscales
rated from highest to lowest were as follows: being at the
leading edge (the degree to which clinicians access new
information to guide practice), valuing research (attitudes
towards research), EBP (an indicator of RU) and research
involvement (engagement in conducting research) (see
Table 3).
BARRIERS scale descriptive statistics
Barriers to RU were perceived from most to least extent
in the following order: the presentation and accessibility
of research (communication; BARRIERS subscale 4), the
organisation (BARRIERS subscale 2), the quality of the
research (innovation; BARRIERS subscale 3) and the par-
ticipants’ research skills and values (adopter; BARRIERS
subscale 1) (see Table 4). The five greatest perceived indi-
vidual barriers are also reported in Table 4.
Discussion
As the first study investigating the research knowledge,
attitudes, practices and barriers to EBP and RU among
C2011 The Authors
Australian Occupational Therapy Journal
C 2011 Australian Association of Occupational Therapists
181
Australian paediatric occupational therapists, the find-
ings of this study add to the limited body of knowledge
available. Overall, Australian paediatric occupational
therapists held positive attitudes towards all aspects of
EBP and RU. However, participants indicated that they
were not confident in their knowledge and ability to per-
form research activities, as well as their engagement in
conducting research. This finding is comparable with
past research studies utilising samples of nurses and
allied health professionals from other countries (Eller
et al., 2003; Van Mullem et al.,1999; Waine et al., 1997;
Witzke et al., 2008). Likewise, within an Australian con-
text, studies by Bennett et al. (2003) and McCluskey
(2003) found that occupational therapists held positive
attitudes towards EBP, but reported concerns regarding
their research knowledge and skills. A notable number of
barriers to the use of EBP and RU were perceived overall.
Interestingly, Australian paediatric occupational thera-
pists perceived the main barriers to be associated with
the presentation and accessibility of research, which is in
contrast with past investigations that have primarily
found the greatest research barriers to be associated with
the organisation (Hutchinson & Johnston, 2004; Retsas,
2000).
Research attitudes and values
Participants’ attitudes and values towards EBP and RU
were measured using the KAP Survey attitudes scales and
the EROS valuing research subscale. In addition, the BAR-
RIERS adopter subscale provides insight into the per-
ceived barriers associated with the clinicians’ research
values, skills and awareness, whereas the EROS being at
the leading edge subscale indicates clinicians’ willingness
to access information. The findings indicated that Austra-
lian paediatric occupational therapists in this study held
positive research attitudes and value the use of EBP and
RU to guide client care while indicating that they were
not concerned with their own research values. The per-
ceptions rated most highly by participants were associ-
ated with ‘identifying clinical problems’ (KAP Survey)
and their willingness to access new information to guide
clinical practice (EROS; ‘being at the leading edge’ sub-
scale). The current sample appears to perceive more
value in accessing new information and implementing
research into practice than in conducting research stud-
ies. The KAP Survey attitudes ratings associated with par-
ticipants’ views towards the research activities required
to conduct research were rated as ‘moderate’, but were
rated the lowest by participants.
These findings are consistent with past research utilis-
ing the KAP Survey, EROS and BARRIERS scale, which
also found occupational therapists to hold positive atti-
tudes towards research (Eller et al., 2003; Waine et al.,
1997) and reported that the fewest barriers to research
were associated with their own research values (Closs &
Lewin, 1998). Positive attitudes towards EBP and RU
have also been found in studies evaluating occupational
182 C. LYONS ET AL.

TABLE 1: Participant demographic data (N = 138, response rate: 46%)

Frequency Percentage

Gender
Female 134 97.1
Male 4 2.9
Total 138 100
Age (years)
20–29 38 27.5
30–39 50 36.2
40–49 27 19.6
50–59 21 15.2
60+ 2 1.4
Total 138 100
Highest level of occupational therapy qualification obtained
Diploma/certificate in occupational therapy 7 5.1
Bachelors degree in occupational therapy 108 78.3
Entry level masters degree in occupational therapy 3 2.2
Course work/research masters in occupational therapy 16 11.6
Doctorate in occupational therapy 3 2.2
Total 138 100
Employment status
Full-time between 20 and 40 h per week 93 67.4
Part-time < 20 h per week 36 26.1
Student/postgraduate student 3 2.2
Non-practicing 2 1.4
Other 4 2.9
Total 138 100
Current position
Occupational therapy clinician working for an employer 85 61.6
Private practitioner 32 23.2
Occupational therapy manager/administrator 5 3.6
Academic faculty/educator 2 1.4
Researcher 3 2.2
Administrative coordinator/supervisor/case-manager 5 3.6
Other 6 4.4
Total 138 100
Client caseload
Inpatient 4 2.9
Outpatient/community-based 94 68.1
Mixed (both inpatient and outpatient) 17 12.3
Other 11 8.0
Not applicable 12 8.7
Total 138 100
Client age group—reported ‘frequently’ or ‘all the time’
Infants 22 15.9
Toddlers 51 37.0
Preschoolers 99 71.7
School-age 93 67.4
Preadolescent 51 37.0
Adolescent 21 15.2
Young adults 9 6.5
Adults 23 16.7
Older adults 16 11.6

C 2011 The Authors

Australian Occupational Therapy Journal

C 2011 Australian Association of Occupational Therapists
EVIDENCE-BASED PRACTICE AND RESEARCH UTILISATION 183

TABLE 2: Research Knowledge, Attitudes and Practices of Research Survey (KAP) descriptive statistics (N = 138)

KAP Survey Subscale Mean SD Rank

Knowledge Subscale Total Score 1.80 0.40 Moderate

Attitudes Subscale Total Score 2.08 0.46 Moderate
Practices Subscale Total Score 1.73 0.41 Moderate
Knowledge Subscale
Factor 1: Identifying clinical problems 2.22 0.55 Moderate
Factor 2: Establishing current best practice 1.89 0.46 Moderate
Factor 3: Implementing research into practice 1.96 0.48 Moderate
Factor 4: Administering research implementation 1.51 0.45 Low
Factor 5: Conducting and communicating research 1.75 0.46 Moderate
Attitudes Subscale
Factor 1: Identifying clinical problems 2.36 0.55 High
Factor 2: Establishing current best practice 2.15 0.49 Moderate
Factor 3: Implementing research into practice 2.23 0.50 Moderate
Factor 4: Administering research implementation 1.85 0.57 Moderate
Factor 5: Conducting and communicating research 2.06 0.53 Moderate
Practices Subscale
Factor 1: Identifying clinical problems 2.00 0.59 Moderate
Factor 2: Establishing current best practice 1.79 0.48 Moderate
Factor 3: Implementing research into practice 1.91 0.48 Moderate
Factor 4: Administering research implementation 1.48 0.46 Low
Factor 5: Conducting and communicating research 1.74 0.49 Moderate

The KAP Survey scales with the highest mean scores are in bold font.
Rating scale: ‘low’ mean = 1.0–1.66; ‘moderate’ mean = 1.67–2.33; ‘high’ mean = 2.34–3.0.

TABLE 3: Edmonton Research Orientation Survey (EROS) perceived barriers indicate that positive attitudes alone
descriptive statistics (N = 138) are not sufficient to ensure engagement in EBP and RU.
As such, strategies need to be implemented to facilitate
EROS Subscale Mean SD the use of these approaches.
Overall, these findings indicate that paediatric occupa-
Factor 1: Valuing research 3.86 0.61 tional therapists surveyed in this study held a positive
Factor 2: Research involvement 2.72 0.77 attitude towards EBP and RU, particularly with regard to
accessing new information and implementing research
Factor 3: Being at the leading edge 4.21 0.53
findings into clinical practice. However, participants held
Factor 4: Evidence-based practice 3.77 0.55
less positive perceptions towards conducting research
EROS total 3.64 0.50
studies to contribute to the available literature.
Possible scores can range from 1 (strongly disagree) to 5 Conducting research
(strongly agree).
Engagement in conducting research studies was limited
The EROS subscale with the highest mean score is in among the sample of Australian paediatric occupational
bold font. therapists included in this study. The KAP Survey results
indicated that participants rated their knowledge, attitudes
therapists perceptions of EBP (Bennett et al., 2003; and practices the lowest for the two subscales associated
Humphris, Littlejohns, Victor, O’Halloran & Peacock, with research conduct (‘administering research imple-
2000). Consistent with past research, although the current mentation’ and ‘conducting and communicating
sample was found to hold positive attitudes towards research’), with ‘low’ ratings being found regarding par-
EBP, they were less confident in their research abilities ticipants’ knowledge and practices of ‘administering
(Eller et al., 2003; Humphris et al., 2000; Van Mullem research implementation’. The EROS research involvement
et al., 1999; Witzke et al., 2008). Therefore, the lower rat- subscale reflects that the majority of participants
ings of paediatric occupational therapists’ research ‘disagreed’ with statements regarding their engagement
knowledge, conduct and utilisation and multiple in conducting research studies, rating this subscale the

C2011 The Authors
Australian Occupational Therapy Journal
C 2011 Australian Association of Occupational Therapists
184 C. LYONS ET AL.

TABLE 4: Barriers to Research Utilization Scale (BARRIERS) paediatric occupational therapists to add to the knowl-
descriptive statistics edge base, continuing professional development to edu-
cate and support therapists in conducting research is
BARRIERS Subscale N Mean SD both valuable and necessary. Another option might be to
consider issues that contribute to the ‘scholarship-prac-
Factor 1: The Adopter 137 2.41 0.72 tice divide’ where Kielhofner (2005) recommends that
Factor 2: The Organisation 137 2.59 0.75 ‘occupational therapy scholarship can be more clearly
Factor 3: The Innovation 136 2.57 0.67 grounded in everyday practice are examined drawing
Factor 4: The Communication 137 2.76 0.66 from experience with participatory research’ (p. 231).
Total BARRIERS 137 2.57 0.59
Research utilisation and research barriers
Top five individual research barriers
The findings of this study indicated that paediatric occu-
The clinician does not have time 136 3.10 0.97
pational therapists in this study held positive perceptions
to read research (O)
towards implementing research findings into clinical
There is insufficient time on 136 3.07 0.98
practice, and were doing so to some extent. Moderate rat-
the job to implement new ideas (O)
ings were held by the sample overall regarding their
Statistical analyses are 136 2.93 0.90 research knowledge, attitudes and practices related to imple-
not understandable (C) menting research findings into clinical practice. The
Implications for practice 134 2.87 0.83 majority of the sample reported some implementation of
are not made clear (C) research findings into their clinical practice, as indicated
The clinician does not feel 135 2.86 0.97 by the moderate rating of the EROS EBP subscale, which
capable of evaluating the is a measure of RU (Pain et al., 1996). Although these
quality of the research (A) findings are positive, there is the potential to increase the
degree to which paediatric occupational therapists are
Possible scores can range from 1 (no extent) to 4 (great integrating research findings into clinical practice, given
extent). the moderate ratings reported in this study. Past research
The BARRIERS scale with the highest mean score is in is consistent with the current findings with occupational
bold font. The number (N) of responses varies for each therapists reporting more positive attitudes towards RU
subscale as some respondents left some items blank. than their actual engagement in implementing research
BARRIERS subscales: O, organisation; C, communication; findings into practice (Humphris et al., 2000; Waine et al.,
A, adopter. 1997; Witzke et al., 2008).
In Australia, McCluskey (2003) identified that
lowest EROS scale. These results indicate that paediatric although occupational therapists held positive attitudes
occupational therapists in this study might perceive that towards EBP, they were not confident in their ability
they have insufficient knowledge and ability to perform to conduct database searches and critically appraise
research activities associated with the initial stages of evidence, which are two integral components in identi-
conducting research (e.g. submitting proposals for fund- fying research to be implemented into practice. Barri-
ing and ethical approval) as well as activities involved in ers to RU associated with the organisation (particularly
completing the research project (e.g. designing the pro- time constraints) have been identified in past research
ject, through to presenting the findings). Subsequently, it as the most frequent barrier to health professionals’
is not surprising that the sample reported conducting RU (Closs & Lewin, 1998; Metcalfe et al., 2001).
limited research. Although the current sample did perceive time con-
These findings are consistent with past research with straints as significant barriers to RU, the presentation
Eller et al. (2003) also finding these two KAP Survey fac- and accessibility of research (BARRIERS communication
tors to be rated lowest among their sample of occupa- subscale) were found to be the greatest barriers to the
tional therapists, whereas Waine et al. (1997) found the RU of Australian paediatric occupational therapists.
EROS research involvement subscale to be rated lowest by Such barriers include research articles not being readily
their sample of Canadian occupational therapists. available or being compiled in one place, statistical
According to Bannigan et al. (2008), the majority of analyses not being understandable and implications for
research projects are undertaken within the occupational practice not being made clear in research papers.
therapy profession in order to achieve higher research Although communication barriers are evident in the
degrees. With 78% of the current sample holding Bache- professional literature (Closs & Lewin, 1998; Metcalfe
lor’s Degrees, again, it is not all that surprising that there et al., 2001), the current sample perceived such barriers
was limited engagement in research conduct across the to impact their RU to a greater extent than previously
sample. reported studies. Interestingly, participants also
Research studies are integral to any evidence-based reported the barrier ‘the clinician does not feel capable
profession. As such, to increase research conduct among of evaluating the quality of the research’ within the

C 2011 The Authors

Australian Occupational Therapy Journal

C 2011 Australian Association of Occupational Therapists
EVIDENCE-BASED PRACTICE AND RESEARCH UTILISATION
top five individual BARRIERS items, further highlight-
ing the participants’ lower perceptions of their research
skills.
In their sample of Australian occupational therapists,
Bennett et al. (2003) found that clinicians perceived
there to be ‘not enough evidence’ in the literature.
However, this sample also reported low skills in access-
ing and locating literature. Therefore, it is important for
research papers to be available and clearly written to
enable valuable findings to be implemented into occu-
pational therapy practice when working with children
and families. In addition, designated time made avail-
able for accessing, reviewing and critiquing research
might be beneficial. It has been suggested that forming
journal clubs, which bring together a group of people
to discuss journal articles, is a useful approach to over-
come certain barriers associated with reviewing and
understanding what is reported in the literature
(Bannigan & Hooper, 2002). The use of journal clubs, in
conjunction with other strategies, might be an effective
method to allow Australian paediatric occupational
therapists to discuss the implications of research find-
ings and identify means of integrating evidence into
their clinical practice (Deenadayalan, Grimmer-Somers,
Prior & Kumar, 2008; Ebbert, 2001; Macrae et al., 2004).
Continuing professional education tailored towards
accessing and evaluating literature, understanding
statistics, and as previously mentioned, conducting
research studies, could be beneficial to increase paediat-
ric occupational therapists knowledge and skills in
implementing research findings into clinical practice
and conducting research to contribute to the profession
(Cleary, Walter, Horsfall & Matheson, 2009).
Limitations and recommendations
The limitations of this study are associated with the con-
venience sampling method utilised, resulting in a rela-
tively low response rate. This limits the generalisability
of the study findings. However, for a mailed survey, the
response rate was in the accepted range for this type of
study (Kielhofner, 2006). Potential reasons for the low
response rate could include the fact that the topic was not
of interest to participants, the questionnaire appeared too
long for participants to fill out, or that participants had
competing time demands placed on them by work and
home life. In addition, the results of this study might
have been impacted by respondent bias, whereby partici-
pants who answered the questionnaire may have been
different in some aspects compared with non-respon-
dents (Kielhofner, 2006).
The following suggestions for future research studies
are made: (i) examine the knowledge, attitudes, practices
and barriers to EBP and RU of paediatric occupational
therapists from other countries; (ii) investigate the knowl-
edge, attitudes, practices and barriers to EBP and RU of
occupational therapists from other clinical areas of
practice (e.g. mental health, neurology, orthopaedics,
C2011 The Authors
Australian Occupational Therapy Journal
C 2011 Australian Association of Occupational Therapists
185
aged care/geriatrics); (iii) compare the EBP and RU of
occupational therapist with other health disciplines; and
(iv) identify strategies to increase the research knowledge
and skills of occupational therapists.
Conclusion
This study investigated the research knowledge, atti-
tudes, practices and barriers to EBP and RU of a group of
Australian paediatric occupational therapists. Positive
attitudes towards EBP and RU were found among the
sample overall, with the highest perceptions being held
towards their willingness to access new information to
guide clinical practice and in identifying clinical prob-
lems. However, respondents were less confident in their
knowledge and ability to perform research activities,
with limited engagement in conducting research evident
among the sample. Respondents were found to imple-
ment research findings into clinical practice only to some
extent. The greatest perceived barriers to RU were associ-
ated with the presentation and accessibility of research
studies. Overall, Australian paediatric occupational ther-
apists would benefit from additional research education
and support within their organisations to ensure children
and families are receiving care based on sound, high-
quality research evidence, and to encourage clinicians to
engage in conducting their own research to contribute to
the occupational therapy profession.
References
Bannigan, K. & Hooper, L. (2002). How journal clubs can
overcome barriers to research utilization. International
Journal of Therapy and Rehabilitation, 9 (8), 299–303.
Bannigan, K., Boniface, G., Doherty, P., Nicol, M., Porter-
Armstrong, A. & Scudds, R. (2008). Priorities of
occupational therapy research in the United Kingdom:
Executive summary of the POTTER project. British
Journal of Occupational Therapy, 71 (1), 13–16.
Bennett, S., Tooth, L., McKenna, K., Roger, S., Strong, J.,
Ziviani, J. et al. (2003). Perceptions of evidence-based
practice: A survey of Australian occupational therapists.
Australian Occupational Therapy Journal, 50, 13–22.
Burke, L. J., Farrell, M. P., Brukwitzki, G. & Van Mullem,
C. (1999). Nurses’ Knowledge, Attitudes, and Practices of
Research Survey manual. Milwaukee, MI: Nursing
Research Center, Aurora Health Care-Metro Region.
Cleary, M. L., Walter, G., Horsfall, J. & Matheson, S. (2009).
A consideration of contemporary factors influencing
professional development in health research. Journal of
Continuing Education in Nursing, 40 (6), 273–279.
Closs, S. J. & Lewin, B. J. P. (1998). Perceived barriers to
research utilization: A survey of four therapies. British
Journal of Therapy and Rehabilitation, 5 (3), 151–155.
Coyler, H. & Kamath, P. (1999). Evidence-based practice. A
philosophical and political analysis: Some matters for
consideration by professional practitioners. Journal of
Advanced Nursing, 29 (1), 188–193.
186
Curtin, M. & Jaramazovic, E. (2001). Occupational
therapists’ views and perceptions of evidence-based
practice. British Journal of Occupational Therapy, 64 (5),
214–222.
Davis, J., Zayat, E., Urton, M., Belgum, A. & Hill, M. (2008).
Communicating evidence in clinical documentation.
Australian Occupational Therapy Journal, 55 (4), 249–255.
Deenadayalan, Y., Grimmer-Somers, K., Prior, M. &
Kumar, S. (2008). How to run an effective journal club: A
systematic review. Journal of Evaluation in Clinical Practice,
14 (5), 898–911.
Dobbins, M., Ciliska, D. & DiCenso, A. (1998). Dissemination
and use of research evidence for policy and practice: A
framework for developing, implementing and evaluating
strategies. Ottawa, ON: Canadian Nurses Association.
Ebbert, J. O. (2001). The journal club in postgraduate
medical education: A systematic review. Medical Teacher,
23 (5), 455–461.
Eller, L. S., Kleber, E. & Wang, S. L. (2003). Research
knowledge, attitudes and practices of health professionals.
Nursing Outlook, 51, 165–170.
Funk, S. G., Champagne, M., Weise, R. & Tornquist, E.
(1991). BARRIERS: The barriers to research utilization
scale. Applied Nursing Research, 4 (1), 39–45.
Humphris, D., Littlejohns, P., Victor, C., O’Halloran, P. &
Peacock, J. (2000). Implementing evidence-based practice:
Factor that influence the use of research evidence by
occupational therapists. British Journal of Occupational
Therapy, 63 (11), 516–522.
Hutchinson, A. M. & Johnston, L. (2004). Bridging the
divide: A survey of nurses’ opinions regarding barriers
to and facilitators of, research utilization in the practice
setting. Journal of Clinical Nursing, 13, 304–315.
Karlsson, U. & Törnquist, K. (2007). What do Swedish
occupational therapists feel about research? A survey of
perceptions, attitudes, intentions, and engagement.
Scandinavian Journal of Occupational Therapy, 14 (4), 221–
229.
Kielhofner, G. (2005). Scholarship and practice: Bridging
the divide. American Journal of Occupational Therapy, 59
(2), 231–239.
Kielhofner, G. (Ed.). (2006). Research in occupational therapy:
Methods of inquiry for enhancing practice. Philadelphia, PA:
F.A. Davis.
Law, M. & Baum, C. (1998). Evidence-based occupational
therapy. Canadian Journal of Occupational Therapy, 65 (3),
131–135.
Macrae, H. M., Regehr, G., McKenzie, M., Henteleff, H.,
Taylor, M., Barkun, J. et al. (2004). Teaching practicing
C 2011 The Authors
Australian Occupational Therapy Journal
C. LYONS ET AL.
surgeons critical appraisal skills with an internet-based
journal club: A randomised controlled trial. Surgery, 136,
641–646.
McCluskey, A. (2003). Occupational therapists report a low
level of knowledge, skill and involvement in evidence-based
practice. Australian Occupational Therapy Journal, 50, 3–12.
McCluskey, A. & Cusick, A. (2002). Strategies for
introducing evidence-based practice and changing clinician
behaviour: A manager’s toolbox. Australian Occupational
Therapy Journal, 49 (2), 63–70.
Metcalfe, C. L. R., Wisher, S., Perry, S., Bannigan, K. &
Klaber, J. (2001). Barriers to implementing the evidence
base in four NHS therapies. Physiotherapy, 87, 433–441.
Pain, K., Hagler, P. & Warren, S. (1996). Development of an
instrument to evaluate research orientation of clinical
professionals. Canadian Journal of Rehabilitation, 9 (2), 93–
100.
Pain, K., Magill-Evans, J., Darrah, J., Hagler, P. & Warren,
S. (2004). Effects of profession and facility type on
research utilization by rehabilitation professionals. Journal
of Allied Health, 33 (1), 3–9.
Philibert, D. B., Snyder, P., Judd, D. & Windsor, M. (2003).
Practitioners’ reading patterns, attitudes, and use of
research reported in occupational therapy journals.
American Journal of Occupational Therapy, 57 (4), 450–458.
Retsas, A. (2000). Barriers to using research evidence in
nursing practice. Journal of Advanced Nursing, 31, 599–606.
Sackett, D. L., Rosenberg, W. M. C., Gray, J. A. M., Haynes,
R. B. & Richardson, W. S. (1996). Evidence-based
medicine: What it is and what it isn’t. British Medical
Journal, 312, 71–72.
Salls, J., Dolhi, C., Silverman, L. & Hansen, M. (2009). The
use of evidence-based practice by occupational therapists.
Occupational Therapy in Health Care, 23 (2), 134–145.
Taylor, M. C. (2007). Evidence-based practice for occupational
therapists (2nd ed.). Oxford, UK: Blackwell Publishing.
Van Mullem, C., Burke, L. J., Dohmeyer, K., Farrell, M.,
Harvey, S., John, L. et al. (1999). Strategic planning for
research use in nursing practice. Journal of Nursing
Administration, 12, 38–45.
Waine, M., Magill-Evans, J. & Pain, K. (1997). Alberta
occupational therapists’ perspectives on and participation
in research. Canadian Journal of Occupational Therapy, 64
(2), 82–88.
Witzke, A., Bucher, L., Collins, M., Essex, M., Prata, J.,
Thomas, T. et al. (2008). Research needs assessment:
Nurses’ knowledge, attitudes, and practices related to
research. Journal for Nurses in Staff Development, 24 (1),
12–18.
C 2011 Australian Association of Occupational Therapists