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Factors Affecting the Propensity to Adopt Evidence-Based Practice

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Factors Affecting the Propensity to Adopt Evidence-Based Practice FACTORS AFFECTING THE PROPENSITY TO ADOPT EVIDENCE-BASED PRACTICE IN PHYSICAL THERAPY by PATRICIA HULSEY BRIDGES (Under the Direction of Laura L. Bierema) ABSTRACT Many authors, as well as the American Physical Therapy Association, are advocating that physical therapy move to a practice based on research evidence known as “evidence-based practice.” This study sought to explain factors that affect the propensity of physical therapists to adopt evidence-based practice. 1,320 physical therapists licensed by the state of Georgia were surveyed on their perception of their propensity to adopt evidence-based practice, personal characteristics, characteristics of the social system in the workplace, and selected demographic variables. A self-completion forced choice survey instrument was used. Three instruments were embedded in the survey instrument: a Psychometric Instrument developed by Green, Gorenflo, and Wyszewianski (2001), the short form of the Dimensions of the Learning Organization Questionnaire (Watkins & Marsick, 1998; Yang, Watkins, & Marsick, 2002), and the Self- directed Learning Readiness Scale for Nurse Education (Fisher, King, & Tague, 2001). In addition seven demographic variables were included in the survey. The findings demonstrated that the best three variable model for predicting the propensity to adopt evidence-based practice in physical therapy included: desire for learning, the highest degree held, and practicality. These findings have implications for managers of physical therapy departments, adult educators, and educators of physical therapy students. INDEX WORDS: Evidence-based Practice, Learning Organization, Physical Therapy, Organizational Learning, Self-directed Learning FACTORS AFFECTING THE PROPENSITY TO ADOPT EVIDENCE-BASED PRACTICE IN PHYSICAL THERAPY by PATRICIA HULSEY BRIDGES B.S., The University of Florida, 1970 M. M. Sc., Emory University, 1985 A Dissertation Submitted to the Graduate Faculty of The University of Georgia in Partial Fulfillment of the Requirements for the Degree DOCTOR OF EDUCATION ATHENS, GEORGIA 2003 © 2003 Patricia Hulsey Bridges All Rights Reserved FACTORS AFFECTING THE PROPENSITY TO ADOPT EVIDENCE-BASED PRACTICE IN PHYSICAL THERAPY by PATRICIA HULSEY BRIDGES Major Professor: Laura L. Bierema Committee: Ronald Cervero Mark Ebell Wendy Ruona Tom Valentine Karen Watkins Electronic Version Approved: Maureen Grasso Dean of the Graduate School The University of Georgia December 2003 iv DEDICATION This dissertation is dedicated to my husband, Al Bridges, my son, Tripp Bridges, my mother, Roberta Hulsey, and my daddy, Jake Hulsey. v ACKNOWLEDGEMENTS The completion of this dissertation has been an enriching experience providing me with an opportunity for tremendous personal and professional growth. I am grateful to the many people who contributed to this endeavor through their interest and support. I extend my deepest gratitude to my dissertation committee. First, I want to thank my major professor, Dr. Laura Bierema, who graciously guided me through the course of my dissertation. Her style, support, and wisdom kept me going through this long process. I am grateful for the time and knowledge Dr. Tom Valentine shared to facilitate my understanding of survey research. I am very appreciative of the wisdom and guidance of Dr. Ronald Cervero. I thank Dr. Mark Ebell for sharing his vision, knowledge, and wisdom of evidence-based practice and research. I wish to thank Dr. Wendy Ruona for her insightful comments and suggestions and warm support throughout the process. I thank Dr. Karen Watkins for spurring my interest in the learning organization through her extensive scholarship in this area. I could not have had a finer committee working with me. I acknowledge and appreciate the use of the instruments that were embedded in the survey, Factors Affecting the Propensity to Adopt Evidence-Based Practice in Physical Therapy: Dimensions of the Learning Organization (Watkins & Marsick, 1998; Yang, Watkins, & Marsick, 2002), Psychometric Instrument (Green, Gorenflo, & Wyszewianski, 2001) and Self- directed Learning Readiness Scale for Nurse Education (Fisher, King, & Tague, 2001). I am grateful for the technical support that Stephanie Bales provided to ensure the completion of the dissertation. Her words of encouragement kept me going in the final stages. vi The encouragement of many people made the endeavor smooth sailing. In a special way I want to deeply thank my husband, Al Bridges, who has been with me as I climbed each mountain. I couldn’t have reached the pinnacle without him. The love and support he and the rest of my family gave me lifted me like eagle’s wings. Many days my son, Tripp Bridges, called just when I needed encouragement. I also want thank my mother, Roberta Hulsey, and my daddy, Jake Hulsey, for their love and support and instilling a love of learning in me at an early age. A special thanks is extended to my cheerleaders, Dr. Martha Coursey, Dr. Doris Hannaford, and Mary Grace Schaap. A big thank you to the Disciples Class at Saint Luke’s Presbyterian Church, who helped address mountains of envelopes. I am grateful to the members of the physical therapy community, who so graciously took their time to serve as expert panelists, pretest the survey, and complete the surveys. Above all, I am grateful to my Lord and Savior, Jesus Christ, who sustained me day by day as I worked on the project. vii TABLE OF CONTENTS Page ACKNOWLEDGEMENTS.............................................................................................................v LIST OF TABLES...........................................................................................................................x LIST OF FIGURES ..................................................................................................................... xiii CHAPTER 1 THE PROBLEM............................................................................................................1 Practice of Physical Therapy.....................................................................................3 History of Physical Therapy......................................................................................4 Movement Toward EBP in Physical Therapy...........................................................5 Evidence-based Practice............................................................................................6 The Effects of Adoption of EBP ...............................................................................6 Factors Affecting the Propensity to Adopt EBP .......................................................8 Problem Statement ..................................................................................................19 Purpose of the Study................................................................................................20 Significance.............................................................................................................21 Definitions...............................................................................................................22 2 LITERATURE REVIEW............................................................................................24 Introduction .............................................................................................................24 Evidence-Based Practice .........................................................................................24 Characteristics of Physical Therapists.....................................................................44 viii Self-directed Learning.............................................................................................49 Characteristics of the Social System .......................................................................88 3 METHODOLOGY ....................................................................................................118 Conceptual Framework .........................................................................................118 The Research Paradigm.........................................................................................122 Instrumentation......................................................................................................123 Sample...................................................................................................................144 Data Collection......................................................................................................145 Data Preparation....................................................................................................147 Data Analysis ........................................................................................................156 Chapter Summary..................................................................................................159 4 RESEARCH FINDINGS...........................................................................................160 Findings Related to Research Question # 1...........................................................160 Findings Related to Research Question # 2...........................................................162 Findings Related to Research Question # 3...........................................................163 5 DISCUSSION OF FINDINGS ..................................................................................167 Study Summary .....................................................................................................167 Discussion of Findings
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