Chiropractic students’ perception and practice of patient education on management of musculoskeletal conditions at a tertiary education teaching clinic
Authors:   , Nieuwenhuis Hardus 
Published: August 2023

Background Modern healthcare is characterised by patient-centred care, which requires that healthcare professionals have equal proficiency in communication and practical skills. As part of their duty as healthcare professionals, chiropractors must show patients how to help themselves through patient education, which requires communication skills. Patient education no longer solely involves or refers to knowledge transfer alone, but rather working with patients in their specific context to build knowledge together from a partnership perspective and to share power in this dynamic. From this perspective, patient education becomes a tool to empower patients and improve their self-efficacy and coping habits, without constantly relying on passive care. This study presents a detailed evaluation of patient education within a South African chiropractic student context at the Durban University of Technology. Aims and Objectives This study aimed to describe chiropractic students’ perceptions and practice of patient education of musculoskeletal conditions at a teaching clinic. The objectives were to evaluate the students’ perception of patient education and the strategies they use; their self-reported practice of patient education; barriers that students face when educating patients; factors that contribute to their patient education skills development, and to determine whether there is an association between demographics, their perception and practice. Methods The study was an anonymous web-based questionnaire with a cross-sectional design within a quantitative paradigm. The survey used in this study stems from a physiotherapist study. Permission was obtained from the author to replicate the study in a South African context at the Durban University of Technology Chiropractic Day Clinic (DUT CDC). The original survey was then put through a focus group and pilot study and subsequently adapted to include questions related explicitly to chiropractic and the student population at the Durban University of Technology. Weekly reminders were sent via email to class representatives to distribute among their respective classes. A total of 42 completed questionnaires were used for analysis in this study. Cronbach’s alpha was used to assess internal consistency of scales. The scale scores were computed by averaging the 18 items for Question 6 and Question 5 respectively where Ttests were used to compare these scores between the demographic variables for binary data, ANOVA for ordinal data and Pearson’s correlation analysis, where the demographic variable was quantitative and normally distributed. A Wilcoxon signed ranks test was used for the comparison of time spent on patient education at initial consults and time spent on patient education at follow-up consults Results Overall, the students viewed most of the patient education items to be important and should be discussed with patients. In practice, however, the frequency of their practice did not correspond to the perceived importance. Only a few items were practised to the same extent as the perceived importance thereof. The chiropractic students’ discussions with their patients tend to focus on the main complaint of patients. In most cases, students educate their patients through one-on-one discussions, physical demonstration and anatomy models. During initial visits, students usually spend between 6–15 minutes educating their patients; in follow-up visits, the time is reduced to 6–10 minutes. In most cases, students cited patient characteristics as a barrier to effective patient education. For the chiropractic students, developing their patient education skills was largely dependent on their interactions with supervising clinicians. There was no association between demographics, perceived importance, and practice behaviour in this study. Conclusion Although the patient education topics were generally deemed important by chiropractic students, the topics considered most important are directly related to the main complaints of their patients, with more complex topics not being perceived as necessary as those directly related to the complaint, such as diagnosis. Like their perceptions, the students most frequently addressed the topics they deemed important; thus, their perceptions and practice were congruent (for issues related to the main complaint of the patients). An important finding of this study was that, although DUT follows an evidence-based paradigm, many students perceived pathoanatomical explanations to be important and, thus, provided their patients with such explanations, even though the literature does not support it. In addition, the students reported several methods through which they educate their patients. However, the assessment of whether it was successful was mainly centred around physical activity rather than the patients’ understanding of the information discussed. The results indicate an opportunity to improve the patient education skills of students, as they appear to have difficulty adjusting to difficult situations, and thereby perceive factors to be barriers that are not actual barriers but rather challenges.