Multi-Level Determinants of Evidence-Based Practice Adoption Among Physiotherapists: A Mixed-Methods Study Across...

Area of Science:

• Physiotherapy
• Evidence-Based Practice
• Health Services Research

Background:

• High-quality physiotherapy relies on Evidence-Based Practice (EBP).
• EBP adoption varies across clinical settings, particularly in low- and middle-income regions.
• Factors influencing EBP use by physiotherapists in rural versus urban settings are not fully understood.

Purpose of the Study:

• To investigate systemic, organizational, and individual factors affecting EBP adoption among physiotherapists.
• To compare these factors and EBP adoption rates between rural and urban practice environments.

Main Methods:

• A convergent mixed-methods design involving 300 physiotherapists (117 rural, 183 urban).
• Quantitative data collected via a 43-item questionnaire on EBP knowledge, attitudes, skills, organizational factors, and behaviors.
• Qualitative data from semi-structured interviews with 18 participants, integrated with quantitative findings.

Main Results:

• Urban physiotherapists demonstrated significantly higher EBP Knowledge, Attitudes, Skills, resource access, managerial support, and policy support (p < 0.001).
• EBP adoption was significantly higher in urban settings (p < 0.001).
• Financial pressure and hierarchical culture negatively predicted EBP adoption, while knowledge, attitude, skill, resource access, managerial support, and policy support positively predicted it. Urban setting was a positive predictor (B=0.515).

Conclusions:

• Individual, organizational, and systemic factors all influence EBP adoption in physiotherapy.
• Systematic disparities between rural and urban areas contribute to lower EBP use in rural regions, highlighting the need for targeted interventions.