Rationale and objective: Occupation-based practice (OBP) is a treatment approach unique to occupational therapy. It harnesses the power of occupation to achieve health and well-being. Most hand therapists are occupational therapists, however, current hand therapy treatment methods are component-based, focussing on physical impairments. This is despite an emerging body of evidence that supports the effectiveness of OBP with hand conditions. To explore the use of OBP in hand therapy, the knowledge, attitudes and practices (KAP) of South African occupational therapists towards OBP needed to be first established. There was no contextually-relevant instrument for this, thus this paper reports on the development processes of a new instrument to capture KAP in OBP in South African hand therapists. Method: Questionnaire development followed the Burns et al (2008) methodology. Items were identified following a comprehensive literature search. Face and content validity, clinical utility, and validation of the subsequent Afrikaans translation were undertaken by two purposively-selected sets of participants (experts and peers). Data collection involved cognitive interviewing, iterative email correspondence, face-to-face discussions, and member checking. Final adjustments to questionnaire wording were made through consensus discussion between the first and second authors. Results: Four therapists participated. Seventy-nine questionnaire items were retained, with three items being removed as they were unclear, or did not measure constructs appropriately for context. The final survey instrument had face and content validity and consisted of 63 KAP items and 16 demographic questions. Conclusion: This is believed to be the first instrument designed to capture valid information on KAP in OBP in hand therapy in South Africa. It will assist in identifying gaps in practice quality, and underpin design of effective strategies for education about, and implementation of, OBP within hand therapy. The instrument is suitable for adaptation to other fields of occupational therapy practice in South Africa, and internationally.