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Knowledge of physiotherapy services among hospital-based health care

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PNG Med J 2015 Mar-Dec;58(1-4): 55-60

Knowledge of physiotherapy services among hospital-based health care

professionals in Papua New Guinea

Priya Karthikeyan1 and Anne Jones2

Department of Physiotherapy, Divine Word University, Madang, Papua New Guinea and
Discipline of Physiotherapy, James Cook University, Townsville, Australia

SUMMARY

It is not clear to what extent the health care professionals in Papua New Guinean
hospitals are aware of the physiotherapy and rehabilitation services available to them.
A study was conducted aimed at assessing the level of knowledge and perception of
physiotherapy by hospital-based health professionals using a simple self-administered
closed and open-ended questionnaire. 200 questionnaires were sent to each of five major
hospitals but only 145 responses (15%) were received from different cadres of health
professionals. Responses from nursing officers accounted for 46% (n = 67) while those
from medical officers accounted for only 10% (n = 14). The respondents generally showed
a lack of knowledge about physiotherapy services. It is suggested that inter-professional
training and communication should be given greater attention during medical and health
professional training to ensure that all health professionals are aware of the role and
importance of physiotherapy services.

Introduction some physiotherapists are in the public sector,

Physiotherapy in Papua New Guinea (PNG)
was first documented in 1955. There was
only one physiotherapist for the population of
19,000 people (15,000 native population and
4000 expatriates) in Port Moresby (1). By the
early 1980s, the National Health Department
(NDoH) had created 11 physiotherapy
positions within the department and in the
same year 3 students were sent to New
Zealand to undertake a three-year diploma
program (2). By the beginning of the 1990s,
there were only two Papua New Guinean
physiotherapists working in hospitals, with a
number of overseas volunteers (3). A need
for physiotherapy training was identified and
a three-year diploma program was initiated at
Divine Word University (DWU) in 2003 (4,5)
with the first batch of Papua New Guinean
physiotherapists graduating in 2006. In 2008,
the physiotherapy program was upgraded
to a degree (Bachelor’s level), requiring
four years of undergraduate studies (5). At
present most of the provincial hospitals have
a physiotherapy department and are staffed
by nationally trained physiotherapists. Whilst
some are employed in the private sector,
including private health facilities and sporting
institutions.
Physiotherapy is an established and
regulated profession, but its training and
practice differ in different countries, depending
on the health needs, economic, health care
and educational systems and demographic
characteristics of the country (6). The current
global paradigm for health care systems is
towards the prevention of illness, rather than
curing of individuals (6). Given physiotherapy’s
role in the prevention and minimization of
disability, physiotherapists have a major role
to play in rehabilitation and promotion of health
awareness in communities. The World Health
Organization (WHO) in its report on disability
in 2004 was not able to provide the prevalence
of disability in PNG, but in 2011 the indicator
of ‘years of health lost due to disability’ was
reported to be 9.4 per 100 persons (7). In
2003, Ramu in Madang Province and Wosera
in East Sepik Province reported that 3.2% of
their populations were living with some kind
of disability (8). Therefore physiotherapy

1 Department of Physiotherapy, Divine Word University, PO Box 483, Madang, Madang Province, Papua New Guinea
pkarthi@dwu.ac.pg
2 Discipline of Physiotherapy, James Cook University, Townsville, Queensland 4811, Australia

55
Papua New Guinea Medical Journal
should be an important part of rehabilitation
to prevent and manage the people with
disabilities. Literature from the United States
of America (USA) suggests that when health
care professionals, including doctors, are well
informed on the role of physiotherapy there is
better utilization of physiotherapy services (9).
Information on PNG health care professionals’
knowledge of physiotherapy and its roles has
been lacking. The aim of this study was to
assess the level of knowledge and perception
of physiotherapy by health care professionals
in selected major hospitals.
Materials and Methods
Study design and sampling
A descriptive cross-sectional observational
study was conducted using a self-administered
survey questionnaire focussing on the
perception of physiotherapy among health
care professionals in PNG. Five hospitals
were purposely selected (Figure 1) as they are
the major hospitals with the highest number
of referrals from rural health facilities. All
cadres of health care professionals, including
doctors, health extension officers, nursing
officers and community health workers
(CHWs), and the residents from the respective
above-mentioned professions were invited to
participate in this study.
Questionnaire development
The questionnaire was developed based
Figure 1. The five hospitals used for the survey.
56
Volume 58, No 1-4, Mar-Dec 2015
on similar studies conducted in the USA and
Australia (10-13). The questions were adapted
to suit the PNG context. The questionnaire
consisted of closed and open-ended questions
that included demographic information,
current knowledge of physiotherapy, referral
patterns, communication between health
professionals and the need for and methods
to increase knowledge of physiotherapy. The
questionnaire was initially piloted among health
care professionals during the 48th Annual
Medical Symposium held in September 2012
in Port Moresby. Data obtained from the pilot
study allowed researchers to make changes
to improve the clarity of questions, hence
improving content and face validity (14).
Data collection and analysis
A total of 1000 questionnaires (a pack of
200 questionnaires for each selected hospital)
were dispatched to the physiotherapy
officer-in-charge (OIC) of each hospital.
Each pack was numbered and colour-
coded to define respondents by region and
hospital. Data were collected over an eight-
week period under the supervision of the
OIC. The completed questionnaires were
collected and placed in a sealed envelope,
maintaining anonymity, and returned to the
researchers from the hospitals via mail. When
the questionnaires were received, the data
were checked for completeness and then
entered into Microsoft Excel spreadsheet and
subsequently exported to IBM-SPSS version
21 for analysis. Quantitative data were used
Papua New Guinea Medical Journal Volume 58, No 1-4, Mar-Dec 2015

for descriptive statistics while qualitative data
were reviewed for content analysis and the
frequency of responses reported.
Ethical approval for this study was obtained
from DWU Research Ethics Committee and
the Human Research Ethics Committee
of James Cook University. The return of a
completed questionnaire was considered as
an implied consent from participants.
Results
Of the 1000 questionnaires dispatched,
170 questionnaires (17%) were returned
in sealed and secured envelopes but only
145 (15%) were analysable, the remaining
25 being incomplete. 46 responses were
received from the Port Moresby General
Hospital (PMGH), 41 from Angau Memorial
Hospital, 38 from Modilon General Hospital
(Madang) and 20 from Goroka General
Hospital. 67 (46%) of the responses were
from nursing officers, including midwives
and specialty nurses, 41 (28%) from CHWs,
20 (14%) from hospital resident trainees and
14 (10%) from doctors, including specialists.
Overall, despite a general lack of knowledge
and awareness of the role of physiotherapy
services in the hospitals, a good number of
respondents were aware of the existence of
rehabilitation services within their respective
hospitals (Table 1). There was a lack of clear
understanding of the relationship between
rehabilitation services and physiotherapy
services. Partly this may be due to lack of

TABLE 1

Knowledge and awareness of physiotherapy

Description Yes Not applicable

(n) (n)
% %

Do you have a rehabilitation team in your hospital? 120 -

82.7%
Have you worked with a rehabilitation team? 40 -
27.6%
Are there any rehabilitation services for people with 122 -
disabilities in PNG? 84.1%
Do you know how to refer patients for physiotherapy? 76 35
52.4% 24.1%
Have you referred any patients for physiotherapy? 55 -
37.9%
Have you discussed the need for physiotherapy 55 -
intervention with your colleagues? 37.9%
Do the physiotherapists communicate regarding the 52 40
patients that you referred for physiotherapy? 35.9% 27.6%
Do you agree with physiotherapists’ suggestions? 58 48
40.0% 33.1%
Do you think physiotherapy professionals create 64 -
awareness of physiotherapy? 44.1%
Do you have enough information about physiotherapy? 46 -
31.7%
Would you like to know about physiotherapy? 140 -
96.6%
Do you think you need training to understand 139 -
physiotherapy? 95.9%

57
Papua New Guinea Medical Journal
awareness or lack of appropriate information
during training. Figure 2 outlines themes
generated from open-ended enquiry. Lack
of education and lack of reinforcement for
a multidisciplinary approach to health care
services in hospital are some of the key
factors contributing to lack of knowledge
and awareness of physiotherapy services in
hospitals.
Discussion
The very disappointing response rate is a
major limitation to the study. Nevertheless
the results show that there is a general lack of
knowledge on the role of physiotherapy and
rehabilitation services, despite these services
being available within the hospitals. Whilst
83% of respondents indicated that they are
aware of rehabilitation services available in
the hospital in which they work only about a
third (28%) indicated interacting with these
services. These findings are likely to have
practical implications in terms of utility of these
services at the hospitals. It is recognized
that lack of knowledge of physiotherapy and
rehabilitation services leads to underutilization
of these services (15,16). Physiotherapy is an
essential and well-utilized part of the health
Figure 2. Themes developed from content analysis of qualitative data.
58
Volume 58, No 1-4, Mar-Dec 2015
care system in most developed countries.
In developing countries, such as PNG and
countries in Africa, Asia and the Western
Pacific, the role of physiotherapy is less
developed (6) and physiotherapy services
are underutilized (15). Understanding why
underutilization occurs in PNG is important.
Our research is the first of its kind and more
research in this area is needed.
The results of our study show that although
physiotherapy and rehabilitation services
were available, knowledge of the function
and scope of physiotherapy among those
surveyed was poor. An earlier PNG study
in 1982 found that simple physiotherapy
techniques, demonstrations and lectures were
provided to trainee nurses at PMGH (2). In the
current study only one-third of respondents
felt that they had enough information about
physiotherapy and almost all indicated that they
required training to understand physiotherapy
and its role. Doctor’s lack of knowledge of the
rehabilitation process leads to underutilization
of services provided by rehabilitation medicine
(17). Respondents in this study stated that
including teaching about physiotherapy in
their undergraduate training or during clinical
opportunities would help to provide a better
Papua New Guinea Medical Journal
understanding of physiotherapy and its role
in PNG, a finding similar to that in a study
amongst Australian medical undergraduates
(13). Lack of knowledge about the role of
physiotherapy among health professionals
may lead to lack of interest in creating
physiotherapy positions in hospitals (18).
Doctors and other health professionals who
do not have enough information about the
service and the profession of physiotherapy
cannot make appropriate referrals (13).
Our study found that 97% of health care
professionals would like more information
regarding physiotherapy. Physiotherapists
have to take the lead in this area. It is
the responsibility of physiotherapists,
physiotherapy educational programs and the
physiotherapy associations to promote the
profession and its status among other health
professions and the general public (12).
Developing countries such as Afghanistan
(19), Vietnam (20), Kenya, Uganda, Malawi
and Tanzania are facing similar challenges
regarding the lack of awareness of the
physiotherapy profession (21).
Communication is the key factor in improving
collaboration between physiotherapists and
other health professionals for the benefit of
the community (16) and to improve the referral
process (11). Reported ways to improve
doctors’ interactions with physiotherapists
are by attending medical rounds, giving
presentations and involvement in research
projects (9). Respondents in our study
also suggested similar ways of increasing
health professional knowledge, including
ward rounds, communicating plans for
treatment, and in-service and basic training.
Only 36% of the health care professionals
in our study stated that they communicate
with physiotherapists. Similar findings
were reported in a recent study of general
practitioners’ perspectives of education
and collaboration with physiotherapists in
primary health care (16). To improve the
knowledge of physiotherapy and its role
(and subsequent increased and improved
utilization in clinical practice) it would be
appropriate to include some physiotherapy
training in the undergraduate curricula of all
health professionals – the concept of inter-
professional education (16). Physiotherapy
placements in training programs have been
shown to be valuable in general practice and
in undergraduate medical training (13,22).
59
Volume 58, No 1-4, Mar-Dec 2015
Conclusion
Our study has identified a lack of knowledge
of physiotherapy and its role among the health
professionals surveyed which is likely to reflect
the situation in the wider health professional
community. There is therefore an urgent need
to improve education regarding physiotherapy
and rehabilitation services for all cadres of
health workers. Physiotherapists need to be
proactive in this area and need the support
of health service and training institutions and
government.
acknowledgements
We acknowledge the financial, academic
and technical support of James Cook
University and Divine Word University and their
staff. We thank the physiotherapists, resident
physiotherapists and hospital administration
staff for their assistance, and the participants
in our survey, who have willingly shared their
precious time to complete the questionnaires.
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