Methods
Detailed descriptions of the methods underpinning this qualitative study
were published previously 18. These methods are
summarised below.
Reporting framework: The Standards for Reporting Qualitative
Research (SRQR) were followed to ensure a rigorous reporting process of
the study findings 19. The SRQR checklist is provided
in Additional file 1.
Ethics: Ethics approval was received from the Health Research
Ethics Committee of Stellenbosch University (S17/05/100). Written
informed consent was obtained from the participants via an online form.
All research team members were familiar with the South African context
in which this study took place and were experienced in the conducting
and reporting of qualitative research.
Sample: The participants were South African PTs from private,
public or educator sectors (considered for analysis purposes as three
independent clusters). Participants needed to be registered with the
Health Professions Council of South Africa (HPCSA), and be practicing PT
for at least 25 hours per week in any field of PT. The email list
obtained from the HPCSA, was randomized, and groups of 30 participants
were contacted at a time.
Data collection and saturation: Semi-structured individual
interviews were conducted, audiotaped, and independently transcribed18. The question relevant to this paper was: “When
considering your workload, is it easy or difficult to integrate CPG into
your clinical load?” This question explored whether the participants
perceived CPG utilisation in practice as adding to or decreasing their
clinical workload. In the previously published paper18, the main theme that emerged from this questions
was “lack of time”, with the subthemes being: few staff; high
workload; access to CPGs; EBP as priority in clinical practice; “time
is money” attitude; and knowledge on the use of CPGs. Interviews
continued with PTs in each cluster until no new information was obtained
in consecutive interviews.
Data analysis: For the purposes of this paper, an inductive
thematic content analysis approach was taken where the transcript
content was analysed by hand, and the themes emerged from the analysis
of the relevant question 20. Data analysis followed an
iterative process of data immersion and familiarization; theme
identification; creating a codebook, data coding and categorizing; data
mapping and interpretation, and then checking the findings against the
original transcripts 20.
Establishing credibility: Member checking of transcriptions were
performed by 28 of the 31 participants (three participants did not
respond to requests to do this) 21.
Researcher bias : The interviewer was a practicing PT clinician
and educator. She could relate to the participants and analyse the data
within her understanding of South African PT practice. She brought a
recognized bias to the process of analysis of the interviews in that she
is enthusiastic about providing best-evidence PT care, and teaching PTs
about CPGs.
Determining SoC classification: There is currently no way of
establishing participant’s SoC for evidence uptake, thus the need arose
to categorise in the following manner. The best-fit SoC for each
interviewee was determined using an amalgamation of interview findings
and socio-demographic data, which was layered onto the Transtheoretical
model of the SoC 17.
The following steps were followed (See Figure 2):
- JS assessed whether the participants could provide a definition of
CPGs that aligns with recognised and published definitions and whether
they believed that CPGs were of benefit to the PT profession. This was
achieved by comparing the definition of CPGs according to Treweek et
al. 7 with the definition that each participant
provided. The participants’ answers were divided into Clear or Unclear
understanding of CPGs;
- Participants’ views (positive or negative) were explored to determine
whether the use of CPGs added to, or reduced, their workload, and
whether PTs perceived CPGs in their clinical practice as beneficial
(or not), and overall to the PT profession.
- A preliminary allocation into a SoC category was made for each
participant, by comparing participants’ understanding of CPGs, and
their views on benefits, with the definition for each level of the SoC
model.
- Exemplar quotations from the full interview transcript on
understanding, uptake and benefits of CPGs were identified as an
independent source of evidence for the preliminary categorisation;
- Differences in socio-demographic data (sectors of employment, years
since graduation, and gender) were then determined for each SoC.
- The authors discussed and agreed on the final SoC categorisation for
each participant.
>>Figure 2: Process of Stages of Change
allocation about here>>