Thomas et al. (2017) used a mixed-methods study to examine the attitudes of Master’s students in an occupational therapy program of evidence-based practice (EBP) and well as their perceptions of teaching and assessment of the same. The authors combine quantitative and qualitative in an explanatory sequential design. The quantitative phase explored attitudes towards EBP, perceptions of teaching and assessment of EBP, and EBP self-efficacy using a questionnaire. The qualitative phase followed-up on the questionnaire and focused on a group of senior students to further explore the qualitative findings. The findings of the quantitative phase of the study showed that students help favorable attitudes towards EBP without differences across all cohorts. However, there were notable differences in knowledge and experience of EBP between junior and senior students, with the latter having more favorable perceptions. Self-efficacy for EBP was high across cohorts. Results from the qualitative phase had four major themes: inadequacy of the curriculum, diverse feelings about the value of EBP, conflicting issues in practice, and barriers in applying EBP. This paper critically appraises the study by Thomas et al. (2017) in as suggested by Gray, Grove & Sutherland (2017, p.323-326).
Significance
The authors began by defining EBP and highlighted its importance in clinical practice. They noted that several individual and organizational factors limited the application of EB in practice, such as lack of time, knowledge, and skills in EBP. They indicated that strategies that targeted greater involvement of students in EBP improved its use in practice. Although limited, research of EBP in occupational therapy suggested that addressing organizational factors can reduce the barriers to EBP (Thomas et al., 2017, p.2). The authors cited other studies that emphasized the role of educational programs enhancing EBP competencies but noted gaps in determining the trajectory of development of these competencies. The research sought to provide insights on these gaps. Although the authors explained that the qualitative phase was formulated to explore the survey data from the quantitative phase in greater depth, they ought to have into more details to justify the use of mixed methods (Thomas et al., 2017, p.3). Therefore, the authors described convincingly described the relevance of the research question and established the need to use mixed methods.
Expertise
The research team possessed the necessary skills and experience to rigorously implement the study (Gray, Grove & Sutherland, 2017, p.323). All five authors were affiliated with the School of Physical and Occupational Therapy, Canada, research scientists at the Center for Medical Education, Faculty of Medicine, McGill University, and Center for Interdisciplinary Research in Rehabilitation, Canada (Thomas et al., 2017, p.11).
Appropriateness
The study purposes were aligned with the mixed method strategy that was used (Gray, Grove & Sutherland, 2017, p.324). The quantitative phase explored attitudes towards EBP, perceptions of teaching and assessment of EBP, and EBP self-efficacy using a questionnaire. The choice of this method was appropriate captured existing diversity among the cohorts in all aspects that were evaluated. For example Year 1 students had basic knowledge on EBP concepts but no exposure while new graduates had extensive knowledge of and exposure to EBP in practice. The sample (n=115) was appropriate for a quantitative approach (Thomas et al., 2017, p.3). The qualitative phase followed-up on the questionnaire and focused on a group of senior students to further explore the qualitative findings. The themes that arose from this phase were a true reflection of the information collected in the quantitative phase albeit more detailed. The sample (n=13) was appropriate for a qualitative approach. The differences in the participants in knowledge and experience in EBP would indicate the trajectory of the development of EBP competencies among students. Therefore, the mixed-method strategy fulfilled the purpose of the study.
Sampling
The rationale for selecting the samples for each component of the study was provided (Gray, Grove & Sutherland, 2017, p.324). The reason for choosing a diverse sample in the quantitative phase was to ensure that the students were at different stages of the curriculum and thus had differences in knowledge and experience on EBP. As such the sample would be an accurate representation of students on typical Master’s education program (Thomas et al., 2017, p.3). The sample selected for the qualitative phase involved students with vast knowledge and experience of EBP across both the academic and clinical settings. They would provide a realistic assessment and reflection on the efficacy of the education program and the barriers of EBP in practice. Therefore, the study participants chosen in both quantitative and qualitative phases were able to provide data needed to address the research question.
Methods
The methods for each component of the study were described in detail (Gray, Grove & Sutherland, 2017, p.325). The methods section consisted of the following sections: design, participants, quantitative phase (with five subsections), qualitative phase, recruitment and data collection, and analysis. The data collection methods for each study components were appropriate to the philosophical foundation of that component. The quantitative phase used a questionnaire while the qualitative phase used a 90-minute focus group discussion whose audio was recorded and transcribed. The protection of human subjects was addressed as ethical approval was obtained from the McGill University Institutional Review Board (Thomas et al., 2017, p.3). The reliability and validity of quantitative methods were described. The EPIC scale used in section 4 of the quantitative phase had “excellent internal consistency (0.89; 95% confidence interval 0.86 to 0.91) and test-retest reliability (0.89; 95% confidence interval 0.85 to 0.91)” (Thomas et al., 2017, p.3). Also, questionnaires with more than three items missing were removed. The trustworthiness, dependability, and credibility of qualitative methods were described. “The research team, including the senior researcher (AT) discussed the categories and emerging themes and resolved disagreement through discussion” (Thomas et al., 2017, p.3). The timing of collection, analysis, interpretation, and integration of the data was specified. “The focus group was developed following a preliminary analysis of the quantitative findings” (Thomas et al., 2017, p.3).
Findings
The integration of the quantitative and qualitative was only presented as a narrative in the discussion section (Gray, Grove & Sutherland, 2017, p.326). From the discussion, it is evident that the findings were consistent with the analysis, interpretation, and integration of the qualitative and quantitative data. The integrated findings indicate that while students generally have favorable attitudes, perceptions and value of EBP, these views are negatively affected by the challenges experienced in implementing EBP in their fieldwork placement (Thomas et al., 2017, p.8). The authors noted two primary limitations of the study: the cross-sectional nature of the study not capturing a change in perceptions over time and no differentiation between year 1 and year 2 students due to the groups being small and had to be collapsed (Thomas et al., 2017, p.9).
Conclusions and Implications
The conclusion and implication were congruent with the findings (Gray, Grove & Sutherland, 2017, p.326). The study demonstrates the importance of professional education in the development of EBP competencies. The findings suggest the need for a well-developed curriculum that sufficiently addresses EBP by equipping students with knowledge, skills, and confidence to implement EBP in practice.
Contribution to Knowledge
The study by Thomas et al. (2017) provided additional information on student’s knowledge and skills on EBP, mainly in academic settings. The authors also offered suggestions for future research to understand better the changes and transitions in the attitudes and confidence of learners in EBP application. The study’s contribution to knowledge was worth the time and resources of a mixed-methods study (Gray, Grove & Sutherland, 2017, p.326).