Objective: Evidence-based practice (EBP) has been associated with quality health care outcomes, yet only a small proportion of occupational therapists implement EBP. This study aimed to clarify factors from the literature associated with EBP, and to explore the thinking experiences of occupational therapists to determine how reflection behavior may act as a support to EBP implementation. Method: This study used a sequential explanatory mixed-method design. Phase I was a national online survey measuring EBP implementation, skill and knowledge, self-reflection behavior, and practice demographics. A total of 578 surveys were included in the final analysis. Phase II used a telephone interview of thirty participants selected based on aspects of the survey results. A grounded theory approach was used to analyze the collected data. Results: Scores on the EBP Implementation Scale indicated participants implemented EBP less than one time over the past 8 weeks. Implementation was higher for those with a doctoral degree, organizational support, time allotted for EBP, access to full articles, and high reflection behavior. Triggers to reflection included challenges to knowledge, challenges to communication, challenges to safety, and challenges to ethics. Actions taken by participants aligned with steps of the EBP cycle. Depth of reflection indicated high reflectors were more likely to engage in critical analysis and take action to correct practice. Conclusion: Participants infrequently implemented EBP in practice and in relation to steps of the EBP cycle. Organizational supports, doctorate level education, and engagement in the deepest levels of reflection acted as supports to EBP implementation. Future models of professional thinking and EBP should incorporate the full construct of reflective practice.
