4 DISCUSSION
This paper reports, to the best of our knowledge, the first valid survey
on KAP in occupation-based hand therapy, for hand therapists. We believe
that the sound psychometric properties of this survey offer promise for
future research and interventions in this area.
The methodology used to develop and validate this survey was rigorous,
iterative and used well-defined stages and processes to create the
initial item list, identify appropriate experts and peers to review the
instrument, consider it in terms of validity, utility and respondent
burden, make subsequent modifications to ensure optimum impact, and then
translate and verify it in Afrikaans.
Ensuring that South African hand therapists are competent and embrace
evidence-based practice is an essential element of professional
quality5. Evidence-based practice shows that OBP has
proven benefits in the treatment of a hand-related
condition3,21,25,41,42,43,44. The survey can thus be
used as a tool to plot practice trends to identify areas where
occupational therapists treating hand-related conditions can incorporate
OBP. This questionnaire should be of interest to South African hand
therapy educators delivering undergraduate and postgraduate programmes
as a tool to identify knowledge and attitudes towards OBP to inform
educational endeavours to promote the use of OBP. This questionnaire may
also be relevant for hand therapy educators internationally as the
initial items were derived from international literature, and no local
contextual issues were raised during the validation process. Moreover,
the questionnaire items lend themselves to adaptation to other fields of
practice, as KAP is a universal concern.
There are potential limitations in the process undertaken for
questionnaire development and its validation:
- The questionnaire items were identified from a comprehensive
literature search, however, as with all searches, there is the
possibility that important information was overlooked and relevant
items were not included. Furthermore, as accurate records were not
kept of the search process, there is no evidence that all relevant
literature was captured. However, as none of the validation group
identified new items, we believe that the item list is comprehensive.
- Bias may have been introduced by the purposive sampling of experts and
peers in the validation group. All participants were of the same race,
and from relatively similar backgrounds. They therefore may not have
brought important knowledge about culture and race to the discussions,
in ways that may have provided a different lens to capture information
on KAP in occupation-based hand therapy in South Africa. This was
partially unavoidable due to the limited pool of occupational therapy
academics with expertise in the field of hand therapy in South Africa.
The peer group could however have been more diverse and larger; this
is a serious limitation that should be addressed in further validation
studies of this instrument.
A pilot study was not conducted, to test for utility, to determine
whether there were further redundant items, or to consider issues of
intra-rater reliability over time. KAP contains attributes that may
change between two test periods, depending on participant exposure to
learning opportunities in the interim period.18 The
decision not to conduct a pilot study was made because the sample of
hand therapists in South Africa is relatively small, and the intention
of the eventual application of this questionnaire was to capture KAP
nationally. Conducting a pilot study would thus have reduced the
available pool of respondents for a larger national survey. The
questionnaire development and validation process could thus be
criticised as no information on its wider application exists.