The interest of Jamaican trained undergraduate physiotherapy students to provide physiotherapy services to older adults once qualified as a physiotherapist: a descriptive study

Sonja K.P. Williams¹

¹ Lecturer, Faculty of Medical Sciences, The University of the West Indies, Mona Campus, Jamaica, West Indies.

Corresponding Author:
Dr. Sonja K.P. Williams
Email: [email protected]

DOAJ: 87ff080660c94cc596a5bb6ca6e2ab9c
DOI: https://doi.org/10.48107/CMJ.2025.06.005
Published Online: July 13, 2025

Copyright: This is an open-access article under the terms of the Creative Commons Attribution License which permits use, distribution, and reproduction in any medium, provided the original work is properly cited.

©2025 The Authors. Caribbean Medical Journal published by Trinidad & Tobago Medical Association

ABSTRACT
Objective: To determine the interest of undergraduate physiotherapy students in Jamaica in providing physiotherapy services to older adults upon graduation. Understanding such interest in this student population becomes necessary as the older Jamaican adult population is growing rapidly (Statistical Institute of Jamaica, STATIN), and such interest has never been investigated.  This study also explores the differences between students’ interest and some personal characteristics.

Methods: The data used to produce this paper were part of a larger data set for a larger cross-sectional study, which had not previously been published.  Ethical approval was granted by the Mona Campus Research Ethics Committee (MCREC).   Convenience sampling was used in this census survey to recruit students for this study. All students registered in the physiotherapy undergraduate programme, were invited to participate in the study.  Those accepting the invitation gave written consent and completed the data collection instruments. Those on leave of absence would not have been registered for any course in the programme of study and were therefore excluded.

Results: 110 out of 129 students participated. The response rate was 85%.  Of the 110 students, 46% (n=51) expressed an interest in providing physiotherapy services to older adults once they qualified as a physiotherapist.  The interest in providing physiotherapy services to older adults after graduation was more likely to be seen among students who had not yet completed their gerontology course content (p = .005), who had completed fewer placements (p = 0.04), and who had not provided physiotherapy treatment to infirmed older adults (p = 0.021).  There was insignificant evidence of a difference in interest between males and females (p = 0.71).

Conclusion: Many students expressed interest in providing physiotherapy services post-graduation.  Completing the gerontology course and exposure to infirmed older adults while on clinical placement, appear negatively to influence such interest for these Jamaican-trained physiotherapy students. The implications of these findings were discussed in relation to the Jamaican-trained physiotherapy students.

INTRODUCTION
The Jamaican population is ageing.  The most current census data is the preliminary population estimate of 2019 from the Statistical Institute of Jamaica (STATIN).  It shows that the older adult population (65+ years) represents 9.7% (n = 375,700) of the total population [1]. Examination of previous Jamaican census data from the same source shows a steady rapid increase in the population of older adults in the Jamaican population [1].

The Ministry of Health and Wellness (Jamaica) in its Vision for Health 2030 – Ten Year Strategic Plan of 2019 – 2023, considers older adults to be vulnerable persons in the society [2]. Though ageing is not the cause of disease, it is associated with disease and disability, as persons have many more years to be exposed to disease risks.  Considering the documented increase in chronic diseases such as stroke, diabetes, and hypertension in the older adult population [3] [4], the rapidly changing older adult demographic in Jamaica suggests possible future demand for physiotherapy services, as the goal of healthy ageing continue to be a global priority [5] [6].  As per the WHO, healthy ageing is ‘…the process of developing and maintaining the functional ability that enables well-being in older age’ [7].  Physiotherapists receive levels of training that allow them to manage patients with complex health conditions across the lifespan.  They are therefore poised to promote healthy ageing in keeping with the global priority, thus enabling older adults to remain a resource to their families and communities.   Regular exercise is an effective strategy for reducing the impairments and functional deficits associated with natural ageing, and the superimposed effects of chronic diseases [8,9].  It is, therefore, necessary to produce a physiotherapy workforce sensitive to the needs of the older adult, which has a genuine interest in providing high-quality patient-centred physiotherapy services, with a focus beyond clinical care to wellness.

A literature search related to physiotherapy students’ interest in providing physiotherapy services to older adults post-graduation, produced one publication.  This article, published by Jackson et al. [10], examined the factors associated with the confidence and interest of healthcare students (nursing, physiotherapy, athletic training, dietetics, and social work) to offer care to older adults, post-graduation.  The authors concluded that students with such an interest were more likely to have had a rewarding experience interacting with older adults before entering the programme of study.  However, the lack of published papers on the topic signals the need for more research.  This paper, therefore, aims to assess the interest of undergraduate physiotherapy students in Jamaica, to offer physiotherapy services to older adults, post-graduation.   The results from this current study will add to the literature on undergraduate physiotherapy students’ interest in providing physiotherapy services to older adults as a professional choice.

METHODS
Study Setting
This study was conducted at a tertiary-level educational institution in Jamaica, using students enrolled in a three-year, full-time undergraduate physiotherapy programme. The student population in this programme of study was largely Jamaican, with a small number of students from other English-speaking islands in the Caribbean.

Study Design
The data used to produce this current paper, was not previously published, and were taken from the data set of a larger original cross-sectional correlational study. This data was collected using a demographic questionnaire, which was one of three data collection instruments used in the data collection of the larger data set.  The other two instruments collected data on attitudes toward older adults.

Participants
Participants were students registered in the three-year undergraduate physiotherapy programme at a university in Jamaica.  All were invited to participate in the survey, except for any student on leave of absence.  Students on leave of absence were excluded as they were not registered in the programme at the time of data collection.  During their training, students were exposed to infirmed older adults while on clinical placements.  These were scheduled at the end of the first and second years of training and during the second and summer semesters of the third year of training.  Students completed course content in gerontology content in the first semester of the second year of their training.

Data Collection
Access to the students for data collection was granted by the Programme Director (physiotherapy).  They were briefed face-to-face about the study and its procedure, had their questions answered, and were invited to participate by a trained research assistant.  They gave signed consent, and most completed and returned the questionnaires at the time of issuance.  Due to time constraints, some students could not complete the questionnaires during issuance.  These students were allowed to take the questionnaires home, with instructions on how to return completed questionnaires to the research assistant.  Students who had not returned questionnaires within a week were reminded to do so by phone.  No more than two reminders were given to avoid intruding on students’ free choice to participate.  Data collection was conducted between December 2018 and February 2019 and completed questionnaires were stored in a filing cabinet in the office of the Principal Investigator.  Ethical considerations were exercised to ensure confidentiality and data anonymity during data collection and storage.  Identifiable participant data were not collected and the persons who collected the data were not involved in the data analysis.

Data Analysis
Descriptive statistics were generated using the Statistical Package for the Social Sciences (SPSS) version 20.  Chi-square tests of independence were performed to explore differences between students’ expressed interest in providing physiotherapy services to older adults post-graduation (yes/no) and the variables of sex (male/female); completed course content in gerontology (yes/no); the number of clinical placements completed (none, 1 or 2); providing physiotherapy to infirmed older adults while on clinical placement (yes/no); social interaction with well older adults [family, neighbour, at church] (yes/no).  The statistical significance was set at 0.05 and there were no missing data.

RESULTS
A total of 129 questionnaires were administered and 110 were returned resulting in an 85% response rate.  Most students were females (72.7%, n=80); were between the ages of 20 to 23 years old (69.1%, n=76), and had reported socially fulfilling interactions with well community-dwelling [family, neighbour at church] older adults (65.5%, n=72).  Most had completed the gerontology course content (63.7%, n=70) and had provided physiotherapy services to older adults while on clinical placement (57.3%, n=63).  Of the 110 students, 51 (46.4%) expressed interest in providing physiotherapy services to older adults once they qualified as physiotherapists; 36 (32.7%) were unsure of such interest, while 23 (20.9%) expressed no such interest. Most of the 110 physiotherapy students (54%, n=59) were either not interested, or were unsure if they had such an interest.

Examining interest by sex, it was observed that 50% (n=15) of the 30 male students, and 45% (n =36) of the 80 female students, expressed an interest in providing physiotherapy services to older adults once they [the students] qualified as physiotherapists.  Some students (32.7%, n=36) were unsure of such interest with the female students (35.0%, n= 28) being more likely to express such uncertainty than the male students (26.7%, n =8). These differences however were not found to be of statistical significance (p = 0.71) (Table 1).

Table 1:  Difference between sex and interest

X² = 6.97; df = 2; p = 0.17

Examining interest by completion of studies in gerontology, students who had not yet completed the gerontology course content were likely to express an interest. Those who had covered this course material were more likely not to express such interest, or to be unsure of such interest (p= .005) (Table 2). By the time the students had completed two placements, they were more likely not to be interested (p=.04), (Table 2).  Students who had not done any clinical placements were more likely to be interested in offering such care and less likely to be uncertain about such interest (Table 3).  Students who had not provided physiotherapy treatment to infirmed older adult patients, were more likely to be interested in offering such care after graduation, compared to those who had offered this care while in the clinical space (Table 4).  Students who had interacted with well older community-dwelling adults [family, neighbour/friend, at church] were more likely to express interest in providing physiotherapy services post-graduation to older adults, (Table 5).

Table 2:  Difference between completing the gerontology course and interest

X² = 10.77, df = 2, p = 0.005    

Table 3:  Difference between number of clinical placements completed and interest

X² = 9.96, df = 4, p = 0.04

Table 4:  Difference between the provision of physiotherapy care to older adults and interest

X² = 7.718, df =2, p = 0.021

Table 5: Difference between interest and social interaction with well older adults

DISCUSSION
Interest is an inevitable product of internal and external experiences.  The healthcare provider’s interest in older adults allows for their better perspectives, thus putting the patient’s welfare at the forefront in the patient/therapist interaction.  Students’ interest or lack thereof can be developed based on their enduring emotions towards older adults, knowledge of gerontology, and exposure to older infirm adults in the clinical space [hospital ward or out-patient department] while on clinical placement (experiential learning).  With the continued ageing of the Jamaican population, there is an integral need for patient-centred physiotherapy services to support the global goal of ‘healthy ageing.’  Physiotherapy students, therefore, should be ready to provide unbiased, quality care.  They should be moving beyond responding to clinical pathology, impairments, and disability to preventive care and wellness.

Age bias/ageism is common in society and identifies older adults as being frail and non-productive.  These biases, conscious or unconscious, have been known in the literature over the years, to influence the quality of the healthcare intervention offered to older adults [11].   It was observed from the results of this current study, that less than half of the physiotherapy students expressed interest in providing service to older adults, post-graduation.  The other students, who were in the majority, were either not sure about their interests or had no such interest. Such a professional choice may have been influenced by the students’ perceptions/attitudes to ageing and the older adult, and their exposure to well or infirmed older adults [12].  If present, issues like older adults’ loneliness and social disengagement can negatively impact patients’ physical performance [13], increase patient difficulty with adherence/compliance, and fuel the lack of interest seen in the students. These factors could explain the lack of interest, expressed by many students who reported treating older adults while on clinical placement.  Stevens [14] in his work on the career choices of nursing students, commented that the possible socialising factors, negative clinical experiences, and the possibility of ageist biases could influence students’ interest in working with older adults, post-graduation. It was noted that students in this current study, who expressed an interest in providing physiotherapy services to older adults, post-graduation were more likely not to have covered course content on gerontology; had not done clinical placements, and; had not managed older adult patients while on clinical placement; and had reported good social interactions with well community-dwelling older adults.  Students who were likely to report being unsure of their interest in working with older adults, and who reported no such interest, were likely to have completed the gerontology course content, had done one or two clinical placements, and had been exposed to infirmed older adults in hospital/clinical settings.

The focus of physiotherapy for the older adult population sub-group, is to overcome the unique physical, mental, and social challenges associated with ageing. There is the need to manage pain, improve mobility, prevent falls, and enhance overall well-being of older adults. Managing the older adult patient requires a shift from the traditional reactive approach of impairment recovery and discharge after an injury (e.g. fracture) or an event (e.g. stroke), to a more promotive enhancement of quality of life and wellness maintenance. Such an approach when observed and used by students on clinical placement could create for them, a better concept of elder care. Students could gain a more positive perspective on older adult patients and treatment outcomes as they seek to maximize independence, promote recovery, and optimize the quality of life for seniors and to reduce dependency.

Finally, though not of statistical significance in this study, it was observed from the results that marginally more male physiotherapy students had expressed an interest in providing physiotherapy services to older adults.  This may seem contrary to current sociocultural expectations and perceptions of caregiving as ‘women’s work.’  However, the limited literature on the emerging practice of males assuming caring roles and /or responsibilities for ageing adults, especially their aging mothers [15] [16].  This suggests that the societal norms regarding  male/female roles and responsibilities are changing, and should be considered in academic and clinical interventions to enhance student interest in providing physiotherapy services to older adults.

Limitations
The loss of 19 students from this study (non-response bias) is a limitation to this study as the census of students across the three years of the physiotherapy undergraduate programme was already small at 129 students. Also, social desirability bias should be considered for this current paper as it directly affects the truthfulness of students’ responses. The Chi-square test is sensitive to small numbers and requires a minimum of five counts in each cell of the contingency table to be reliable.  As a result of this, data related to students’ social interaction with well community-dwelling older adults (neighbour and at church), and interests could not be analysed, and should be interpreted with caution.

CONCLUSION
This descriptive study has provided some preliminary information suggesting that physiotherapy students studying in Jamaica, become less interested in managing older adult patients as they complete the gerontology course content and complete clinical placements. As rapid population ageing is a reality in Jamaica, adequately preparing our physiotherapy students to provide physiotherapy services that are appropriate, accessible, and acceptable to older adults is of paramount importance.  Students need to be exposed to opportunities to develop a more positive interest in ageing and older adults during their studies from the classroom to the clinical space.

The impact of the variables identified in this descriptive study needs exploration. A mixed methods approach could provide insights into the topic. In addition to exploring objective numerical data, the mixed methods approach will provide insights into students’ perspectives as they can have positive attitudes towards older adults but still not interested to embrace geriatric care [17].

Acknowledgements: We wish to acknowledge the physiotherapy students who completed and returned the research instruments and the research assistant who assisted with data collection.
Ethical approval statement: Ethical approval was received from the Mona Campus Research Ethics Committee (MCREC), University of the West Indies, Mona, Jamaica, in September 2018 (Reference number ECP160, 17/18).  Informed consent was obtained from each participant.
Financial disclosure or funding: No external funding was received to support the data collection and/or the publication of the manuscript.
Conflict of interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Informed consent: Not applicable.
Author contributions: This is a single-authored paper.

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