Buchanan Helen, Siegfried Nandi, Jelsma Jennifer, Lombard Carl
Department of Health & Rehabilitation Sciences, F45 Old Groote Schuur Hospital Building, University of Cape Town, Observatory, 7925 Cape Town, South Africa.
Trials. 2014 Jun 10;15:216. doi: 10.1186/1745-6215-15-216.
Despite efforts to identify effective interventions to implement evidence-based practice (EBP), uncertainty remains. Few existing studies involve occupational therapists or resource-constrained contexts. This study aimed to determine whether an interactive educational intervention (IE) was more effective than a didactic educational intervention (DE) in improving EBP knowledge, attitudes and behaviour at 12 weeks.
A matched pairs design, randomised controlled trial was conducted in the Western Cape of South Africa. Occupational therapists employed by the Department of Health were randomised using matched-pair stratification by type (clinician or manager) and knowledge score. Allocation to an IE or a DE was by coin-tossing. A self-report questionnaire (measuring objective knowledge and subjective attitudes) and audit checklist (measuring objective behaviour) were completed at baseline and 12 weeks. The primary outcome was EBP knowledge at 12 weeks while secondary outcomes were attitudes and behaviour at 12 weeks. Data collection occurred at participants' places of employment. Audit raters were blinded, but participants and the provider could not be blinded.
Twenty-one of 28 pairs reported outcomes, but due to incomplete data for two participants, 19 pairs were included in the analysis. There was a median increase of 1.0 points (95% CI = -4.0, 1.0) in the IE for the primary outcome (knowledge) compared with the DE, but this difference was not significant (P = 0.098). There were no significant differences on any of the attitude subscale scores. The median 12-week audit score was 8.6 points higher in the IE (95% CI = -7.7, 27.0) but this was not significant (P = 0.196). Within-group analyses showed significant increases in knowledge in both groups (IE: T = 4.0, P <0.001; DE: T = 12.0, P = 0.002) but no significant differences in attitudes or behaviour.
The results suggest that the interventions had similar outcomes at 12 weeks and that the interactive component had little additional effect.
Pan African Controlled Trials Register PACTR201201000346141, registered 31 January 2012. Clinical Trials NCT01512823, registered 1 February 2012. South African National Clinical Trial Register DOH2710093067, registered 27 October 2009. The first participants were randomly assigned on 16 July 2008.
尽管人们努力确定有效的干预措施以实施循证实践（EBP），但不确定性仍然存在。现有的研究很少涉及职业治疗师或资源受限的环境。本研究旨在确定在12周时，交互式教育干预（IE）在改善循证实践知识、态度和行为方面是否比讲授式教育干预（DE）更有效。
在南非西开普省进行了一项配对设计的随机对照试验。卫生部雇佣的职业治疗师通过按类型（临床医生或管理人员）和知识得分进行配对分层随机分组。通过抛硬币决定分配到IE组或DE组。在基线和12周时完成一份自我报告问卷（测量客观知识和主观态度）和审核清单（测量客观行为）。主要结局是12周时的循证实践知识，次要结局是12周时的态度和行为。数据收集在参与者的工作场所进行。审核评分者是盲法的，但参与者和提供者无法设盲。
28对中有21对报告了结局，但由于两名参与者的数据不完整，19对被纳入分析。与DE组相比，IE组主要结局（知识）的中位数增加了1.0分（95%CI = -4.0，1.0），但这种差异不显著（P = 0.098）。在任何态度子量表得分上均无显著差异。IE组12周审核得分的中位数高8.6分（95%CI = -7.7，27.0），但这也不显著（P = 0.196）。组内分析显示两组的知识均有显著增加（IE组：T = 4.0，P <0.001；DE组：T = 12.0，P = 0.002），但态度或行为无显著差异。
结果表明，干预措施在12周时具有相似的结局，且交互式部分几乎没有额外效果。
泛非对照试验注册PACTR201201000346141，于2012年1月31日注册。临床试验NCT01512823，于2012年2月1日注册。南非国家临床试验注册DOH2710093067，于2009年10月27日注册。首批参与者于2008年7月16日被随机分配。
