|Year : 2019 | Volume
| Issue : 2 | Page : 95-101
Awareness, attitude, belief, and utilization of physiotherapy services among the general public in major cities of Gujarat state
Vivek H Ramanandi1, Dhara N Panchal2, Mukund M Prabhakar3, Disha J Shah4, Janki C Mavani5
1 Department of Physiotherapy, Satish Goswami College of Physiotherapy, Ahmedabad, Gujarat, India
2 Superintendent, Civil Hospital, Ahmedabad, Gujarat, India
3 Department of Physiotherapy, Pioneer Physiotherapy College, Vadodara, Gujarat, India
4 Consulting Physiotherapist, Rajkot, Gujarat, India
5 Consulting Physiotherapist, Surat, Gujarat, India
|Date of Submission||31-Jan-2019|
|Date of Acceptance||08-Jun-2019|
|Date of Web Publication||07-Oct-2019|
Dr. Vivek H Ramanandi
Satish Goswami College of Physiotherapy, Ahmedabad, Gujarat
Source of Support: None, Conflict of Interest: None
BACKGROUND AND OBJECTIVE: Physiotherapy is considered an integral part in the health-care delivery system, with the provision of services to improve the quality of life of an individual. Utilization of physiotherapy services by the general public can be influenced by knowledge of the role of physiotherapy in health-care delivery. This study investigated the awareness of, attitude toward, belief about, and utilization of physiotherapy services in the general public of four major cities of Gujarat state in India.
MATERIALS AND METHODS: A cross-sectional survey of 500 conveniently selected participants from the general public in selected areas of Ahmedabad, Vadodara, Rajkot, and Surat in Gujarat was conducted using a self-administered, validated questionnaire. Data were analyzed using descriptive statistics of mean, percentages, and standard deviation.
RESULTS: Participants (n = 245 males, n = 255 females) were aged 36.66 ± 12.2 years. A large proportion, 427 (85.4%), of the participants was aware of physiotherapy through various medium. Out of all the participants, 436 (87.2%) participants were familiar with physiotherapy services. Most of the participants, i.e., 288 (67.4%), reported that physiotherapists treat disorders affecting just bones and joints. About half (216 [49.5%]) and over one-third (157 [36%]) participants reported physiotherapy to be always and sometimes effective, respectively. Around 334 (76.6%) participants stated that they would prefer physiotherapy to Indigenous Health Services, while majority of respondents (398 [89.4%]) claimed that they would recommend physiotherapy.
CONCLUSION: A large proportion of the participants are aware of physiotherapy services. Positive attitude toward and belief about physiotherapy services were reported. Furthermore, physiotherapy services utilization of participants was fairly high.
Keywords: Attitude, awareness, belief, general public, Gujarat, physiotherapy, utilization
|How to cite this article:|
Ramanandi VH, Panchal DN, Prabhakar MM, Shah DJ, Mavani JC. Awareness, attitude, belief, and utilization of physiotherapy services among the general public in major cities of Gujarat state. Physiother - J Indian Assoc Physiother 2019;13:95-101
|How to cite this URL:|
Ramanandi VH, Panchal DN, Prabhakar MM, Shah DJ, Mavani JC. Awareness, attitude, belief, and utilization of physiotherapy services among the general public in major cities of Gujarat state. Physiother - J Indian Assoc Physiother [serial online] 2019 [cited 2020 May 28];13:95-101. Available from: http://www.pjiap.org/text.asp?2019/13/2/95/268640
| Introduction|| |
Health-care professionals play important and critical roles in improving quality health care and providing access for the population. Physiotherapists are an integral part of the team for health-care delivery such as physicians, dentists, nurses, psychologists, pharmacists, chiropractors, and others. They work in all sectors of health care, including public hospitals, private practice, rehabilitation centers, sporting clubs, and community health centers. According to Chartered Society of Physiotherapy, physiotherapists use their knowledge and skills to treat a broad range of conditions, associated with different systems of the body such as neurological, musculoskeletal, cardiovascular, and respiratory through various physiotherapy interventions. The physiotherapists use therapeutic exercise, training in self-care, electrotherapy, manual therapy (including mobilization/manipulation), prescription, application, of devices and equipment, etc., to evaluate and treat variety of conditions. With these interventions, physiotherapy profession plays a key role in the public health agenda by preventing diseases, promoting good health, improving the quality of life, ensuring community integration, and reintegration. For a profession that has such great roles to play in the public, it is of vital importance to have a clear identity in the public and high level of its awareness in the society. Awareness of the role of physiotherapy in health-care delivery may influence the public beliefs, affecting utilization of physiotherapy services, thus creating impact on effective delivery of health care. Few authors have reported the awareness, knowledge, and utilization of physiotherapy services among community dwellers in India, with the results showing low–to-moderate awareness of physiotherapy as a health profession with its identity often mistaken for that of masseurs or medical doctors., The urban community dwellers constitute larger proportion of population who utilize physiotherapy services in India., However, it appears no study has been carried out on awareness, attitude, belief, and utilization of physiotherapy among urban community dwellers in Gujarat. Therefore, this study aimed to determine the awareness, attitude, belief, and utilization of physiotherapy in four major cities of Gujarat state of India.
| Materials and Methods|| |
Five-hundred participants were recruited conveniently from Ahmedabad, Vadodara, Surat, and Rajkot from Gujarat state. The inclusion criterion was that they were individuals who are literate in English. Data were collected using a validated questionnaire on awareness, attitude, belief, and utilization of physiotherapy services. The questionnaire is in two sections: Section A contains sociodemographic information of the participants such as age, sex, highest educational level, and occupation, while Section B consists of four major parts: Part 1 contains five items on awareness of physiotherapy services, Part 2 contains seven items on belief about physiotherapy services, Part 3 contains nine items on utilization of physiotherapy services, while Part 4 contains four items on attitude toward physiotherapy services. Participants were allowed to pick more than one option in some items on the questionnaire. The questionnaire was available in both English and was self-administered. Individuals who were aged 20–75 years were included in this stud, and individuals who are health or allied health-care professionals were excluded from the study. The purpose and procedure for the study was explained to the participants and their informed consent was sought and obtained before participation in the study.
| Results|| |
Sociodemographic characteristics of participants
Participants (female: 255 and male: 245) aged 36.66 ± 12.2 years (range 20–75 years) were involved in the survey. Majority (80.0%) of the respondents were <50 years. A third (66.4%) of the participants had tertiary educational qualification. A total of 265 (53%) participants were professionals [Table 1].
Awareness of physiotherapy services
Four hundred and twenty-seven (85.4%) participants reported awareness of the existence of physiotherapy [Table 2]. Majority (86.2%) of the participants were familiar with physiotherapy services [Table 2]. Participants reported that they obtained information about physiotherapy from hospitals (25.5%), media (24.1%), physiotherapists (19.7%), and schools (20.8%) [Table 2]. The majority of respondents reported physiotherapists as mostly treating bone fracture or joint dislocation – 288 (64.7%), movement problems – 244 (54.8%), stroke – 201 (42.5%), while heart and lung problems – 32 (7.2%) was the least reported [Figure 1].
|Table 2: Distribution of participants' responses to questions on awareness|
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|Figure 1: Distribution of participants' awareness about areas of treatment by physiotherapists|
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Belief about physiotherapy services
Majority of the participants believed that creation of awareness about physiotherapy to the public was to be the responsibility of Government (197 [45.7%]). However, expectations from media- 141 (32.7%), hospitals- 134 (31.1%), and physiotherapists- 121 (28.1%) were also high regarding the creation of awareness about physiotherapy in society [Table 3]. A total of 194 (45%) participants strongly agreed that their current awareness of physiotherapy was sufficient to advise a patient in need of physiotherapy services to seek a trained physiotherapist [Table 3], while more than half of the participants (62.4%) felt that physiotherapy was necessary [Figure 2]. A total of 263 (61%) of participants thought that physiotherapists contribute to the well-being of individuals who seek their services [Table 3]. Furthermore, approximately half (49.7%) of the participants believed that physiotherapists can make diagnosis as well as treat individuals who seek their services and 259 (60.1%) of participants thought that physiotherapist should be in all hospitals [Table 3].
|Figure 2: Distribution of participants' belief about the necessity for physiotherapy|
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Utilization of physiotherapy services
Out of 431 participants that were familiar with physiotherapy services, more than half (56.1%) had received or had relatives that have received services for one of the conditions treated by physiotherapists. Doctor's referral 264 (61.3%) and going to a hospital 140 (32.5%) were the most frequently reported ways to obtain the services of a physiotherapist [Table 4].
|Table 4: Distribution of participants' responses on utilization of physiotherapy services|
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Majority of participants (395 [91.6%]) would recommend physiotherapy services to an individual who may be having a condition which can be treated by a physiotherapist, while 338 (78.4%) would prefer physiotherapy services to Indigenous Health Services (IHS) and 58 (65.9%) would not discourage individuals who prefer physiotherapy to IHS [Table 4]. Mostly, ignorance 185 (42.9%) and cost 175 (40.6%) were reported as the reasons that may contribute to preference for IHS by individuals [Table 4]. Majority of the respondents 237 (55%) believed that physiotherapy services are preferable to IHS in terms of cost and effectiveness [Figure 3].
|Figure 3: Distribution of physiotherapy services preference to Indigenous Health Services in terms of cost and effectiveness|
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Attitude toward physiotherapy services
A total of 248 (57.5%) participants responded that they would like to be or would encourage any of their relatives to be a physiotherapist. Majority (254 [58.9%]) participants considered the place of physiotherapy to be very important in the health-care system [Table 5].
|Table 5: Distribution of participants' responses to questions on attitude|
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Two hundred and nine (48.5%) and 165 (38.3%) participants reported that they perceive the physiotherapy services are always or sometimes effective, respectively [Figure 4].
|Figure 4: Distribution on perception of effectiveness of physiotherapy services|
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| Discussion|| |
The study included a convenient group of the participants with majority young and professionals with minimum secondary and graduate level education, thereby representing the population from urban areas of Gujarat.
The awareness of physiotherapy practice in India among the general public of major cities of Gujarat state is high. This may be because the educational status of the majority of the proportion who participated in this study is postsecondary education. A study by Olawale and Adjabeng in an urban community in Accra Ghana also reported high level of awareness of physiotherapy. Meanwhile, a low level of awareness about physiotherapy among rural high school students of Anand was reported by Patel. A study by Mbada et al. conducted among rural community dwellers of Nigeria, where the majority of the participants had below secondary education reported the awareness levels to be only 16.8%. Level of education and exposure to physiotherapy services may, therefore, be considered as one of the significant predictors of the ability to recognize physical therapy scope of practice. Similar findings were also reported by Kacie and Yvonne, where individual with higher educational level was more knowledgeable about physical therapy.
In our study, the findings suggest that the participants, who were familiar with physiotherapy services, obtained their information mainly from hospitals and media. The findings are in congruence with the findings reported by Harikrishnan and Kamalambal in their study titled “Awareness and Attitude towards Physiotherapy among Higher Secondary Students: A Pilot Survey Study.” Similar findings were reported by Maruf et al. in their study of residents of Southeastern Nigeria. The possible reason for this can be because physiotherapy is not yet a first contact service in the respective countries, and the patients are referred for physiotherapy in the hospitals by the medical doctors. In this study, physiotherapists were one of the least reported sources of information about awareness of physiotherapy practice in India. This finding is similar to the finding by Maruf et al. which also reported that physiotherapists were least of the sources of information on awareness of physiotherapy practice in Nigeria. The fact that physiotherapists in India do not practice on a first contact basis could be the reason why they are not one of the most reported sources on awareness about physiotherapy services. Thus, these findings should stimulate the professional body of physiotherapy in Gujarat and India along with Indian physiotherapists to increase their efforts at creating awareness about physiotherapy.
Majority of the participants generally knew that physiotherapists treat orthopedic and musculoskeletal problems, muscle weakness, and movement problems and stroke. Only a few knew that physiotherapy services can also deal with heart and lung problems or pregnancy-related fitness. In a study by Dissanayaka and Banneheka, on awareness of physiotherapy among high school students, it was revealed that there was a low level of familiarity with the role of physiotherapy in chest conditions. This could be attributed to the large number of referrals from orthopedic units as compared to other units in physiotherapy departments of hospitals, making the general public view of physiotherapy services. This may also be because musculoskeletal injuries are more common among both young and older population. A study by Khalid et al. on awareness of medical professionals about physiotherapy reported that among the patients referred to the physiotherapy department most belong to the musculoskeletal unit with few patients from cardiopulmonary unit of the hospital.
As religious leaders are believed not to play a role in the health status of the population, participants showed that it was the responsibility of government, hospitals, physiotherapists, and the media to create awareness about physiotherapy as compared to the religious leaders. This study supports the findings of a study by Maruf et al. that participants' awareness of physiotherapy was sufficient to advise a patient in need of physiotherapy services to seek a trained physiotherapist. This may be because they or any of their relatives have been treated satisfactorily by a physiotherapist. Majority of the participants thought that they needed to know more about physiotherapy indicating that the knowledge of physiotherapy services still need to be raised. Furthermore, many of the respondents believed that physiotherapy is necessary, contributing to the well-being of individuals who seek its services. Various studies have concluded that physiotherapists play a vital role for the betterment and improvement of the quality of life of patients, indicating positive belief of the population toward physiotherapy.,, Contrarily, Igwesi-Chidobe reported that most of the participants felt they had no need of physiotherapy and that it was not necessary. This may be because many participants in our study were familiar and aware of physiotherapy services or have been treated by a physiotherapist.
Out of those who have suffered or have relatives who have suffered conditions which can be treated by physiotherapists, more than half sought physiotherapy services. This may be because majority of the participants had a positive belief about physiotherapy services. Here, majority of the respondents preferred physiotherapy services to IHS if they have a condition which can be treated by physiotherapy and would discourage individuals who do that which may be attributed to their preference in avoiding surgical or medical approaches. Majority of the participants identified ignorance and cost as factors contributing to the preference for IHS, suggesting that IHS has been sought by the populace probably due to its low cost or out of ignorance. It can be seen that service effectiveness by members of the public was not found to be the cause of preference to IHS. Similarly, Udosen et al. reported that superstition, ignorance, and poverty have been described as the basis for continued patronage of IHS despite complications. This may be a possible reason why majority of respondents agreed that physiotherapy services are more than IHS, in terms of cost and effectiveness.
Majority of respondents who have been treated by physiotherapists, felt satisfied, and impressed by the treatment, and this may explain why the majority of the participants would recommend physiotherapy services to those who need them and would prefer physiotherapy services to IHS if they have any condition amenable to physiotherapy. Similar finding was reported from a study by Mbada et al. who reported that the participants who were treated by a physiotherapist were satisfied with the treatment. The facts that most of the participants in this study believe that physiotherapy services are always effective and that the place of physiotherapy in the health sector is very important further buttresses these findings. In fact, majority of the participants would like to be or would encourage their relations to be a physiotherapist. Therefore, the attitude of the participants to physiotherapy can be regarded as a positive and favorable one. The positive attitude of participants in the current study can be supported by the findings from previous studies Mbada et al., Maruf et al., and Puckree et al. These authors all reported that the general public had positive attitude toward physiotherapy services.,,
| Conclusion|| |
Based on the findings from the study, it can be concluded that a large proportion of the participants in the cities of Ahmedabad, Vadodara, Rajkot, and Surat from Gujarat state are aware of physiotherapy services. Participants have positive belief and attitudes toward physiotherapy services. Participants also have fairly high utilization of physiotherapy services. The findings also suggest the need to stimulate the professional body of physiotherapy in Gujarat and India along with Indian physiotherapists to increase their efforts at creating awareness about physiotherapy.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]