Evaluating physiotherapy students’ clinical reasoning skills on clients’ activity-related behaviour and behaviour change: A comparative study in South Africa using Swedish reference data
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Behaviour-focused clinical reasoning is essential for effective physiotherapy practice. Physiotherapy education must equip students with competencies in psychosocial and behavioural aspects of assessment and intervention. Evidence of South African physiotherapy students’ knowledge and competencies in behavioural medicine remains unexplored. Objectives: To assess behaviour-focused clinical reasoning competencies among final-year physiotherapy students at a South African university and compare these competencies with those of final-year students from two Swedish universities with integrated behavioural medicine curricula. Method: A cross-sectional comparative study design was employed. Final-year physiotherapy students (N = 38) from a South African university completed the Reasoning 4 Change (R4C) questionnaire. Swedish comparative data (N = 61) were included. Data were analysed using frequencies, percentages and independent t-tests. Cohen’s d with 95% confidence intervals (CIs) was calculated. Results: The South African cohort scored significantly lower for knowledge (mean 32.6, standard deviation [s.d.] ± 5.1 vs. 35.7 ± 4.8; p = 0.003; d = −0.63), cognition (31.7 ± 6.0 vs. 34.9 ± 5.8; p = 0.012; d = −0.53), input from client (34.2 ± 6.3 vs. 38.5 ± 7.2; p = 0.003; d = −0.62), functional behaviour analysis (21.8 ± 2.6 vs. 23.8 ± 2.9; p < 0.001; d = −0.71) and strategies for behaviour change (16.2 ± 1.9 vs. 19.6 ± 3.7; p < 0.001; d = −1.07), but scored significantly higher for self-efficacy (77.8 ± 12.5 vs. 70.4 ± 12.6; p = 0.005; d = 0.59) and contextual factors (20.2 ± 2.7 vs. 14.9 ± 4.7; p < 0.001; d = 1.31). Conclusion: Explicit behavioural medicine integration within physiotherapy education may strengthen behaviour-focused clinical reasoning competencies. Clinical Implications: Longitudinal integration of behavioural medicine content may strengthen students’ behaviour-focused clinical reasoning, client engagement and behaviour change competencies in physiotherapy practice.
Institutions: University of the Western Cape, Mälardalen University
Language: English
Subfield: Family Practice
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $434
OpenAlex ID: W7220376198