Patient education best practice; enhancing physiotherapy students’ self-efficacy and skills

Abstract

Patient education is an important component of physiotherapy care and a required competency for entry-level practice. Despite its important role, how physiotherapists deliver patient education in practice and the specific competencies required to provide this effectively are currently unknown. Understanding how the current curriculum prepares graduates as patient educators and whether training can enhance self-efficacy and skills of physiotherapy students to perform patient education is an important step in advancing professional practice in this area.Following a review of the literature which demonstrates a gap in this research, this thesis incorporates five studies (five manuscripts) with the overall aims to 1) explore how patient education is practiced and perceived by physiotherapists; 2) determine key differences in practices and perceptions based on levels of clinical experience; 3) identify the competencies required for physiotherapists in the area of patient education; 4) investigate the patient education self-efficacy of new-graduates and the influence of previous training, and 5) determine the effect of a patient education training intervention on physiotherapy students’ self-efficacy and performance. Study 1 (Manuscript 1) was a cross sectional survey of practicing physiotherapists in Australia. This study investigated the self-reported practices and perceptions of physiotherapists relating to patient education, and their perception of factors that led to their development of patient education skills. Participants (n=304) reported a broad range of educational activities and approaches in their practice, it was therefore deemed important to understand how practice and perception may differ based on levels of experience.Study 2 (Manuscript 2) compared the self-reported practices and perceptions of experienced (n=204) and novice (n=52) physiotherapists. Experienced therapists reported a greater use of educational content consistent with patient-centred practice and a greater emphasis on self-management. Experienced therapists also reported a higher frequency of explicitly evaluating the effectiveness of their education than novice physiotherapists and perceived fewer patient-related factors as barriers to effective patient education. Findings from this study inform the patient education training needs of student and novice physiotherapists.Study 3 (Manuscript 3) involved a two-round Delphi approach using expert physiotherapists (n=12) to generate and reach consensus on competencies that physiotherapists require for effective patient education. This study led to the consensus of a set of 22 competencies with a high level of expert agreement. Importantly, these competencies aided the development of a self-efficacy and performance assessment measure for the following two studies as well as contributing to further understanding patient education training needs.Study 4 (Manuscript 4) used a mixed-methods design to investigate the self-efficacy of physiotherapy new-graduates (n=121) related to patient education and their perceptions of the influence of training on these practices. The results of this study highlighted the role of curricula experiences on self-efficacy to engage in patient education and the perceived importance of experience in the development of patient education skills. These findings further informed the intervention for Study 5.Study 5 (Manuscript 5) was a single blinded randomized controlled trial that investigated the effectiveness of a patient education training program for final year physiotherapy students (n=164). The design of the training intervention was informed by the existing literature and included lecture content, observation of videos of patient education, practice with simulated patients, feedback and debriefing. Specific outcome measures were developed using the competencies derived from Study 3. A step-wise process was used to determine reliability and validity of the measures. The main outcomes were self-efficacy and performance of patient education using an objective structured clinical examination (OSCE). The results demonstrated a significant improvement in self-efficacy for the intervention group, and no change for the wait-list control group. In the OSCE, the intervention group performed significantly better than the control group for nine of the eleven performance items, with significantly higher performance scores overall.This thesis provides important insights into patient education training in physiotherapy and how training can be utilised to enhance student self-efficacy and skills in this area. Furthermore, the results support the integration of patient education training into existing physiotherapy curricula, with potential for application to professional practice settings. This thesis also reflects on the limitations of this research and discusses relevant areas for further research. In relation to patient education training, there is a clear need for further research to understand the longer-term effects or maintenance of patient education self-efficacy and skills on professional practice, and the impact this may have on patient outcomes.