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:
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.