Does a targeted, integrated knowledge translation intervention increase the uptake of evidence-based practice in community children’s occupational therapy settings?

Abstract

Background: Research shows it can take between 10-20 years for new evidence to be routinely implemented into occupational therapy practice. This ‘knowledge-to-practice gap’ has serious implications on quality of care, particularly in services for children and young people, where early interventions can significantly influence life outcomes. This thesis evaluated the impact of a targeted, integrated knowledge translation intervention on evidence-based practice behaviours of children's occupational therapists working in England’s community-based National Health Services (NHS). Methods: Multiple research designs were used, including a scoping review, qualitative enquiry, intervention development protocol, qualitative process evaluation, a before-andafter study and cross-sectional study. Forty-nine occupational therapists from five sites, including one comparison site, participated. Results: Early findings identified 77 beliefs grouped into seven key determinants influencing evidence-based practice, with self-efficacy, social influence, and attitudes most prominent. An integrated knowledge translation intervention was developed informed by Intervention Mapping and delivered online. The intervention included educational outreach, file auditing and feedback, and the creation of an ‘evidence library’. Data collection included focus groups, file audits, Canadian Occupational Performance Measure scores, and service user length of stay. Thematic analysis and generalised linear mixed-effects models were primarily used to assess impact. Results showed nuanced outcomes at a clinician behaviour level, service user level and an organisational level. Key mechanisms of impact included expert facilitation, reflection, peer learning, multimodal feedback, and strengthened accountability. Conclusion: This research contributes to a growing evidence-base in children’s occupational therapy knowledge translation. It highlights the importance of integrating theory with practical strategies and clinician collaboration. The findings support the use of multifaceted knowledge translation strategies to address therapist behaviour change, that in turn can influence organisational aspects and service user outcomes.