There is a paucity of literature on knowledge translation (KT) interventions for occupational therapists (OTs) in assessing and caring for the neonate and at-risk infant. Care at this stage of life is paramount, requiring a shift from the survival of the neonate, to the quality of survival. Consequently, clinicians working with neonates have a crucial role in ensuring optimal development and preventing long-term adverse developmental outcomes.
This study aimed to explore experts’ opinions on KT interventions for OTs working with neonates and at-risk infants in South Africa.
This study was located in South Africa. Due to the virtual nature of data collection, no geographical limitations within the country were imposed.
A two-round Delphi study with a multidisciplinary expert panel (
Consensus on 127 items out of 130 was achieved. These included consensus on the definition of KT in neonatal care, the knowledge that OTs should possess, professional competencies, skills required, professional values, and characteristics. Further agreement was reached on the KT process, the usefulness of KT modalities, recommended courses in neonatal care, barriers to KT, best-practice and requirements for undergraduate training.
Knowledge translation required for OTs working with neonates and at-risk infants were established in this study.
This study may be useful for consideration in contextually relevant KT interventions for clinicians working in neonatal care.
The first 28 days of an infant’s life, known as the neonatal period, are reported as the most vulnerable as they pose many health risks (World Health Organization
Evidence-based practice and specialised training are essential components that provide occupational therapists (OTs) the foundation to advocate and engage in developmental care in neonatal intensive care units (NICUs) (Legendre et al.
Johnson (
When insufficient information on a topic exists, consensus methodology is often used (Hasson, Keeney & McKenna
This study forms part of a more extensive study on KT interventions for neonatal therapists using an appreciative inquiry process and is embedded within the ‘design’ phase of the process (
Study design (Delphi process) illustrated within the larger study design using appreciative inquiry.
Studies undertaken in developed and developing countries were considered to understand best practices in high- and low-resourced areas. Neonatal care in SA was researched systematically, using keywords ‘occupational therapy’ and ‘knowledge translation’ to understand current practice and gaps in the literature.
Pilot studies for Delphi surveys help identify ambiguities and improve the feasibility of administration (Powell
Descriptive statistics were used to analyse the data using Statistical Package for the Social Sciences (SPSS) version 21 (IBM SPSS Statistics for Windows
The responses from Round one were analysed using content analysis and assisted in (1) additions and application to the Round two questionnaire and/or (2) comment for general consideration. Similar items were grouped and reported. The content analysis and the statistical summaries contributed to the development of the Round two survey.
Analysis and feedback from participants prior to Round two included a summary table with the percentages of agreement on each item. Items that had reached a consensus in Round one were excluded in Round two. The items that did not achieve consensus were included in Round two to allow participants to re-vote. Consensus was reached at this round.
The UKZN Biomedical Research Ethics Committee (approval number: BREC/00001886/2020) approved the study. Ethical principles adhered to in the study included informed consent and autonomy, confidentiality (responses were collated anonymously using an identifying number known only to the authors) and voluntary participation (participants could withdraw from the study with no consequences).
The multidisciplinary sample comprised
Demographic profile of panellists (
Participant | Professional group | Age band | Gender | Neonatal care experience (in years) | Highest level of education | Geographic location (province in SA) | Post-graduate courses in neonatal care |
---|---|---|---|---|---|---|---|
P1 | SLT | 31–40 | F | 12 | Masters | Gauteng | Certification in Neonatal Therapy, NBAS, Advanced NDT Baby), Little Steps, Training through NANT |
P2 | OT | 31–40 | F | 10 | Masters | Gauteng | NANT Ignite programme, NBAS, Prechtl’s GMA Advanced Practice for the complex neonate, Advanced NDT (baby), Certified Neonatal Therapist (NTNCB), Infant SI |
P3 | Midwife | 41–50 | F | 28 | Doctorate | Free State | Clinical Masters’ degree |
P4 | Professional nurse | 41–50 | F | 26 | Diploma | KZN | Certificate in NICU Care |
P5 | OT | 31–40 | F | 7 | Masters | KZN | NDSC, Infant SI, Infant massage, Reflex integration training |
P6 | SLT & Audiologist | 31–40 | F | 5 | Doctorate | Gauteng | NDSC |
P7 | Professional nurse | 41–50 | F | 25 | Doctorate | Gauteng | Advanced Midwifery and Neonatology |
P8 | PT | 21–30 | F | 8 | Masters | Gauteng | NDSC, Neonatal Gold Online course, Paediatric and Neonatal assessment and management (DOH), HINE, Basic Life Support/CPR for Neonates, SI for Allied Healthcare (Meg Faure) |
P9 | Midwife | 51–60 | F | 21 | Bachelor | Free State | Diploma in Neonatal Nursing Science and NDSC |
P10 | OT | 41–50 | F | 2 | Masters | WC | Perinatal neuroscience, NDT (paediatric), Kangaroo mother care |
P11 | SLT | 21–30 | F | 3 | Bachelor | WC | None |
P12 | PT | 31–40 | F | 10 | Masters | Gauteng | Advanced NDT (Baby), MSc Physio (Paediatric neonatal neurology), TIMP, Prechtl’s GMA, HINE, numerous lectures and short courses. |
P13 | Midwifery lecturer | 41–50 | F | 20 | Doctorate | North West | Advanced midwifery (include neonatal nursing), Ignite, NBAS, Baby Massage |
P14 | SLT | 31–40 | F | 4 | Bachelor | Gauteng | None |
P15 | OT | 31–40 | F | 12–14 | Bachelor | KZN | NDT (paediatric) |
P16 | Doctor | 31–40 | F | 8 | Masters | KZN | None |
P17 | SLT | 21–30 | F | 7 | Bachelor | Gauteng | Multiple skills building, online courses/webinars; Little steps neurodevelopmental supportive care of the preterm infant; Advanced NDT (baby) |
P18 | Professional nurse | 51–60 | F | 25 | Doctorate | Gauteng | Diploma in NICU nursing |
P19 | OT | 41–50 | F | 17 | Masters | KZN | Advanced NDT (Baby) |
P20 | OT | 21–30 | F | 3 | Bachelor | EC | None |
GMA, General Movement Assessment; HINE, Hammersmith Infant Neurological Examination; NANT, National Association of Neonatal Therapists; NBAS, Neonatal Behavioural Scale; NDT, Neurodevelopmental Therapy; NDSC, Neurodevelopmental Supportive Care; SI, Sensory Integration; TIMP, Test of Infant Motor Performance; OT, occupational therapy; SLT, speech and language therapy ; PT, physical therapy; KZN, KwaZulu-Natal; WC, Western Cape; EC, Eastern Cape; NICU, neonatal intensive care units; CPR, cardiopulmonary resuscitation; SI, sensory integration; NTNCB, Neonatal Therapy National Certification Board; SA, South Africa.
Similar to other SA studies using the Delphi technique to achieve consensus on clinical practice issues, this study used a two-round Delphi (Naidoo & Joubert
The Delphi Round one survey comprised 123 items. Seven items were added to the questionnaire for Round two, based on comments made by experts in Round one. Of a total of 130 final items in Round two, consensus was reached for 127 items. The three items not reaching consensus did not warrant an additional Delphi round. The findings are presented against each section with a percentage of agreement achieved in each round.
The Round one survey included nine items related to the
Definition of knowledge translation for occupational therapy working in neonatal care.
Round 1 |
Round 2 |
Statements for inclusion in the definition of knowledge translation for OTs working in neonatal care | ||
---|---|---|---|---|
Agree | Disagree | Agree | Disagree | |
95 | 5 | KT is a complex and dynamic process | ||
85 | 15 | KT involves attaining (verb that means reaching or achieving a goal) evidence | ||
95 | 5 | KT involves obtaining (to take ownership of something and is unrelated to any level of difficulty) evidence; | ||
100 | 0 | KT involves synthesising (identifying, selecting and combining results from multiple studies) evidence | ||
100 | 0 | KT involves exchanging (collaborative problem solving between researchers and decision-makers that happen through linkage – resulting in mutual learning) evidence | ||
- | - | 94 | 6 | KT occurs within a system of interactions among the family |
100 | 0 | KT occurs within a system of interactions among a multidisciplinary team | ||
- | - | 94 | 6 | KT aims to optimise enablers |
100 | 0 | KT aims to overcome various barriers to evidence utilisation | ||
100 | 0 | KT strategies should include adaptations to the local context | ||
100 | 0 | KT aims to apply the best possible care |
KT, knowledge translation; OT, occupational therapy.
Consensus reached in Round 1.
The final definition reads as, the:
[
Consensus was reached on all 14 items on the
The necessity of a
Knowledge translation process and knowledge brokerage (
KT process and knowledge brokerage | ||
---|---|---|
Agree | Disagree | |
100 | 0 | |
95 | 5 | The organisation or managers within the organisation (within the public sector facility) play an important role in supporting the process of knowledge translation regarding the care of the at-risk infant |
100 | 0 | National therapy associations should contribute to knowledge translation through the support of peer-reviewed journals, position papers, guidelines, conferences and workshops and through resources and information on the website/page and in their newsletters |
100 | 0 | |
100 | 0 | A KB should include a ‘champion/broker’ in the facility that looks for KT opportunities |
100 | 0 | KB should include joint positions between universities and clinical settings to encourage exchange of information between clinicians and researchers for the development and translation of research |
95 | 5 | KB should include paediatric interest groups for OTs |
95 | 5 | KB should include paediatric interest groups for Ots |
Consensus reached in Round 1
KT, Knowledge translation; OT, occupational therapy; MDT, multidisciplinary team.
Concerning the effectiveness of KT modalities, an agreement of 100% was achieved on all 12 items in round one (
Knowledge translation modalities for the knowledge translation process (
KT modalities for the KT process | ||
---|---|---|
Agree | Disagree | |
100 | 0 | Making use of multiple sources of evidence |
100 | 0 | Clinical experience |
100 | 0 | Internet (journal articles, websites) |
100 | 0 | Workshops (profession specific) |
100 | 0 | Workshops (multidisciplinary team) |
100 | 0 | Mentorship |
100 | 0 | Communities of practice (different interest groups, small-large associations) |
100 | 0 | In service training with other members of multidisciplinary team |
100 | 0 | In service training and journal reviews |
100 | 0 | Following knowledge acquisitions, consider context and create protocol |
100 | 0 | Following knowledge acquisition, consider context and update protocol (if there is already protocol in place) |
100 | 0 | Engage in a reflective process |
KT, knowledge translation.
Consensus reached in Round 1.
In Round one, not all 20 participants rated every item, the responses varied from 16 to 18. Three of the listed courses, namely, ‘Little Steps Neurodevelopmental supportive care of the preterm infant 4-day course’ and ‘1-day course’ and ‘Movement Analysis Education Strategies (MAES) Therapy’ had an agreement of ≤67%. These were included in Round two and an additional five courses as recommended for inclusion by experts. These included ‘Special interest webinars or online courses’, ‘lactation support – Lactation consultant course SA’, ‘Neuroscience for Improved Neonatal Outcomes (NINO)’, Training in administration of ‘test of motor infant performance’ and ‘NDT/Bobath Advanced baby course (post foundation course)’. Of these eight items (three from round one and five additional items), consensus was reached on six items. After Round two, a consensus was not achieved for ‘MAES therapy’ and ‘lactation support consultant course SA’.
Following Round two, only one item, ‘lack of financial incentives or promotion opportunities’ did not reach a consensus (
Barriers to knowledge translation.
Round 1 |
Round 2 |
Barriers to KT | ||
---|---|---|---|---|
Agree | Disagree | Agree | Disagree | |
80 | 20 | Lack of time to train | ||
80 | 20 | Lack of time to integrate knowledge into practice | ||
60 | 40 | 72 | 28 | Lack of available evidence |
75 | 25 | Lack of confidence in ability to integrate evidence into practice | ||
75 | 25 | Lack of clinical relevance in training | ||
55 | 45 | 61 | 39 | Lack of financial incentives or promotion opportunities |
90 | 10 | The organisation of the healthcare system (public sector health facilities) | ||
75 | 25 | Lack of existing recommended standards of practice | ||
95 | 5 | Individual healthcare professionals and their lack of knowledge | ||
80 | 20 | Attitudes in critically appraising and using evidence-based practice | ||
85 | 15 | Skills in critically appraising and using evidence-based practice |
KT, knowledge translation.
Consensus reached in Round 1.
All items on best practice reached an agreement of ≥ 95% in Round one and were hence precluded from Round two (
Best practice for neonatal care.
Best practice for neonatal care | ||
---|---|---|
Agree | Disagree | |
100 | 0 | Controlling environmental variables (noise, light etc.) to promote neurodevelopment |
95 | 5 | Daily multidisciplinary team interaction to discuss patient care |
95 | 5 | Flexible time to care for infants throughout the day |
100 | 0 | Time dedicated for family intervention |
100 | 0 | Integration of infant into the family unit |
100 | 0 | Ensuring a follow up multidisciplinary action plan |
100 | 0 | Monitoring early childhood development for first 3 years of life (high-risk baby clinic) |
100 | 0 | Ensuring infant safety, adaption and development |
100 | 0 | Making use of standardised assessments to monitor the progress of the infant (e.g. General movements assessments, Hammersmith Neonatal Neurological Examination [HNNE]) |
Consensus reached in Round 1.
All items on KT for undergraduates reached a ≥ 95% agreement in Round one and were precluded from Round two.
Conducting research in a team strengthens the research carried out within a Delphi study (Du Plessis & Human
A two-round Delphi process, with a multidisciplinary panel of South African clinicians experienced in the field of neonatal care, were useful in establishing consensus for the definition of KT, professional competencies, the KT process, the effectiveness of KT modalities, barriers that may impede KT, best practice and KT for undergraduate training.
Knowledge translation is recognised in OT as a driving force to improve healthcare (Metzler & Metz
One of the issues highlighted within KT is the growing accumulation of evidence and practitioners’ ability to keep up to date (Graham et al.
Procedures, protocols, precautions, and support systems are crucial for the occupational therapist to understand when working in the NICU. Adapting or structuring the environment to enhance function is a well-accepted OT approach. The occupational therapist also needs to have a holistic understanding of the infant and the different interventions to collaborate and provide an environment of developmentally supportive care (Vergara et al.
The importance of KT has been receiving increased attention in the literature, especially in healthcare (Graham et al.
All items were agreed as applicable by experts. Both tacit knowledge and explicit knowledge were embedded in this section (David, Poissant & Rochette
Not all clinicians are exposed to the same courses and are primarily based on their specific profession. For example, the MAES therapy course is open to various clinicians (doctors, speech and language therapists [SLTs], OTs, physical therapists [PTs]). However, most participants are either OTs or PTs (MAES Therapy
Knowledge translation is intended to consider the range of influences affecting incorporating knowledge into practice (Metzler & Metz
After round two, a
The at-risk neonate is not well-adapted to the stressful environment of the NICU (Vergara et al.
In their study, Hardy et al. (
The two-round Delphi process described in this article was useful in establishing consensus on a definition of KT for OTs within the area of neonates and at-risk infants in the public health sector, professional competencies required of OTs, KT process for OTs, the effectiveness of KT modalities, the barriers that may impede KT, best practice for OTs working with neonates and at-risk infants in public health hospitals and practices included in undergraduate training. Considering that consensus on these factors has been ascertained for OTs, future studies could develop interventions based on these principles and aid in the practical implementation of these KT strategies in the NICUs. Moreover, monitoring and evaluation of KT may be implemented over time. The gap between ‘best practice’ and current practice and how to improve undergraduate training practically, should also be explored.
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
P.G. conceptualised the study as principal investigator of the larger project from which this study emanated. S.J.Y. was responsible for executing the study, analysis, interpretation and preparation of the draft manuscript. G.R., M.O.O., A.D. and P.G. made conceptual contributions to the study including data analysis and interpretation. All authors read and approved the final version.
The principal investigator (P.G.) of the larger study, from which this study emanates, has received support from the National Research Foundation (NRF) of South Africa via the Research Development Grants for Y-Rated Researchers Funding instrument, Grant Number 120400 (Reference: CSRP190423432325).
All data generated from this study have been synthesised and reported in this article.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.