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

High-quality physiotherapy care requires Evidence-Based Practice (EBP), but different clinical settings have different adoption rates, especially in regions with low or middle incomes. It is unclear how systemic, Organizational, and individual factors interact to affect the use of EBP by physiotherapists, or how these factors vary between rural and urban environments.

Three hundred physiotherapists participated in a convergent mixed-methods design (117 rural, 183 urban). A content-validated 43-item questionnaire measuring EBP Knowledge, Attitudes, Skills, Organizational factors, and adoption behaviors was used to gather the quantitative data. T-tests were used to analyze group differences, and hierarchical multiple regression was used to examine predictors. The results were integrated during interpretation following a reflexive thematic analysis of semi-structured interviews with 18 purposively selected participants.

While rural physiotherapists reported more financial pressure and hierarchical limitations, urban physiotherapists showed significantly higher Knowledge, Attitudes, Skills, resource access, managerial support, and policy support (p < 0.001). In urban settings, EBP adoption was significantly higher (p < 0.001). Regression analysis revealed that while financial pressure (B = -0.145) and hierarchical culture (B = -0.108) were significant negative predictors of EBP adoption, Knowledge (B = 0.012), Attitude (B = 0.268), Skill (B = 0.008), Resource access (B = 0.120), Managerial support (B = 0.065), and Policy support (B = 0.179). The urban practice setting continued to be a positive independent predictor (B = 0.515). The final hierarchical regression model explained 63.1% of the variance in EBP adoption (R² = 0.631). These findings were supported by qualitative research, which identified systemic limitations, a lack of autonomy, resource barriers, and patient preferences for passive treatments as the main obstacles.

Individual ability as well as Organizational and systemic factors influence the adoption of EBP among physiotherapists. Clearly visible differences between rural and urban areas are a reflection of systematic disparities that restrict the use of EBP in rural regions.