Factors influencing student choice of a degree in physiotherapy: a population-based study in Catalonia (Spain)

Introduction

Physiotherapy student numbers seem to be rapidly growing in Spain. Entry-level physiotherapy studies in this country currently consist of a 4-year, undergraduate university programme, comprising 240 ECTS (European Credit Transfer Accumulation System) (Asociación Española de Fisioterapeutas, 2019). This fulfils the recommendations by the World Confederation of Physical Therapy, which establishes that physiotherapy “educational programmes be based on university or university level studies, of a minimum of four years, independently validated and accredited as being at a standard that accords graduates full statutory and professional recognition” (World Confederation of Physical Therapy, 2019).

In other healthcare professions, there has been extensive research into students’ motivations, but studies aiming to determine what leads individuals to choose a degree in physiotherapy are scarce. In 2017, research was published which examined the preferences and expectations of 11,072 medicine students, 7,238 of which were in their first year (Mayta-Tristán et al., 2017). The volume of related research in medicine studies recently led Goel et al. (2018) to the publication of a systematic review. In physiotherapy, one of the few available indexed studies on the matter is that of Gotlib et al. (2011) which involved 667 students from different European countries, including Spain. This was, to the best of our knowledge, the largest multicentre study of its kind having been published on the topic. As far as we know, there are no studies comparing genders and nationalities on the field of physiotherapy undergraduate students. Understanding factors that contribute to students’ selection of a physiotherapy degree may be important to student success, higher education and industry.

The main objective of this study was to determine the factors that lead individuals to enrol in an undergraduate physiotherapy programme in Catalonia, Spain. The study also aimed to obtain a sociodemographic profile of participants, as well as to detect potential differences in motivations, based on gender and origin of the students (France versus Spain).

Materials and Methods

Results

The sample consisted of 519 (55.2%) men and 421 (44.8%) women. The average age was 20.7 (SD: 3.44). Student ages ranged from 18 to 49, with most individuals (81.6%) falling within the 18–21 range. 490 (52.4%) of the surveyed students came from Spain, while 425 (45.5%) came from France and 20 (2.1%) from other territories; the latter were not considered for bivariate analysis according to origin. 330 (35.1%) respondents did not have to change their habitual residence, whereas 160 (17.0%) of the respondents, despite living regularly in Spain, had to move to study at their current university. Overall, 64.3% of the total respondents were displaced from their usual residence.

For 616 (65.5%) students this was their first time at university, whereas 324 (34.4%) of them had previously undertaken some kind of university studies. 82 students (8.8%) held a previous university diploma, prior to enrolling in their current physiotherapy studies. 704 (74.9%) individuals were full-time students, while 236 (25.1%) additionally had a job. With regard to their financing sources, 563 (59.8%) students primarily received funding from their parents. 145 (15.4%) had a bank loan; 89 (9.5%) students paid for their studies themselves; and 28 (3%) were on a student grant. Sociodemographic characteristics of the participants are displayed in Table 1.

Table 2 shows absolute and relative frequencies on students’ responses regarding how different decision factors influenced their choice of study. In absolute numbers, the most determinant factors (expressed from 1–5) for men were: helping others (4.54), relation to sports (4.28), interest in the sciences (3.48) and social recognition (3.23). The main factors for women were: helping others (4.69), manual work (4.03), multiple job opportunities (3.95) and relation to sports (3.91).

It can be determined that 95.6% were driven by a will to help others; 79% were influenced by physiotherapy having a strong relation to the sports world; 76.4% were strongly driven towards a degree that involved manual work; 75.9% were driven by expectations of multiple job opportunities; 56.2% stated that their decision was strongly based on their interest in the sciences; admiring a known physiotherapist was determinant for 51.9% of surveyed students; 40.6% thought that a good future income was determinant; 37.8% felt a wish to be physiotherapists since childhood; 40.6% said easy employability was a determinant factor; 39.1% said it was important that the profession is highly respected socially; 31.7% were influenced by physiotherapy being a convenient complement to their past studies/career; 13.5% chose physiotherapy because it was recommended to them; 6.7% enrolled physiotherapy even though they would have preferred to study something else and physiotherapy was not their first choice; 2% said it was important to study physiotherapy in order to accompany a friend in college; 0.7% chose physiotherapy on the grounds that it was an easy study degree.

Table 3 shows how 10 out of the 15 motivational factors that were analysed showed statistically significant differences, when analysed by gender. Men favoured the following selection factors over women: accompanying a friend (MD = 0.192, p < 0.001), admiring a known physiotherapist (MD = 0.223, p = 0.006), having been recommended to study physiotherapy (MD = 0.234, p = 0.001), it being an easy degree (MD = 0.148, p < 0.001), there being lots of employment opportunities (MD = 0.297, p < 0.001), obtaining social recognition (MD = 0.164, p = 0.011), complementing their previous studies/career (MD = 0.237, p = 0.016), good salary expectations, (MD = 0.190, p = 0.002) and its relation to sports (MD = 0.369, p < 0.001). In comparison to men, women were significantly more prone to choosing physiotherapy because of their interest in the sciences (MD = −0.164, p = 0.030) and willingness to help others (MD = −0.149, p < 0.001).

Eleven out of 15 factors showed statistically significant differences, according to origin. French students were significantly more inclined to choose physiotherapy due to a childhood calling (MD = 0.595, p < 0.001), a willingness to do a manual work (MD = 0.286, p < 0.001), admiration for a known physiotherapist (MD = 0.265, p = 0.001), good employment opportunities (MD = 0.706, p < 0.001), social recognition (MD = 0.286, p < 0.001) and relation to sports (MD = 0.130, p = 0.027). Students from France were also significantly more likely to wish to accompany a friend in college (MD = 0.150, p = 0.001) and to pursue an easy study degree (MD = 0.091, p = 0.037), and less inclined to choose it as a complement (MD = −1.122, p < 0.001), although these three factors presented low scores and small MDs.

On a 1-to-5 Likert scale, students from Spain were in general driven to study physiotherapy for the following reasons: to help others (3.60), to involve manual work (2.83), multiple job opportunities (2.80), interest in the sciences (2.56). Students from France opted for physiotherapy, primarily, for the following reasons: to help others (3.62), multiple job opportunities (3.23), relation to sports (3.18) and manual work (3.12).

Discussion

This study managed to obtain a demographic profile of first year students of physiotherapy in Catalonia. In spite of women having historically outnumbered men in healthcare (Öhman, Solomon & Finch, 2002; Quattrin et al., 2010; Vázquez Vega, 2010; Gomá Lanzón, 2014), our study reflects a fairly balanced distribution between male and female students (55% and 45%, respectively). This could be explained by a tendency towards increasing numbers of male students in the classrooms, as previously observed by Norris et al. (2018).

According to our results, almost half of the physiotherapy students in Catalonia are foreigners; this proportion is much larger to that found in Italian classrooms (47% vs 12%, respectively) (Quattrin et al., 2010). Previous data suggests that as many as 1,000 French students of physiotherapy study abroad, yearly (Ordre des Masseurs Kinésitherapéutes, 2019). This could partially be explained by the difficulty students in France have in accessing a physiotherapy degree in their home country. It is likely that affordable pricing and geographical proximity make Spain an appealing destination.

In addition, approximately 65% of students had moved into the university city in order to follow their academic path and more than 1 out of 5 students already had jobs during the first few weeks of the semester. It is known that working students are more subject to stress, due to the reduced time available for studying (Oliván Blazquez, Boira Sartro & López del Hoyo, 2011), so this fact could be worth taking into consideration by educators.

The study was also able to establish how determinant given factors are in leading individuals towards a physiotherapy study programme. We now have objective data that a desire to help is what primarily moves entry-level students, followed by a perceived relation between sports and physiotherapy, using their hands and accessing a flexible work market. Helping others is a typical trait of professionals in healthcare (Quattrin et al., 2010; Vázquez Vega, 2010; Arrigoni et al., 2014). According to Camps, this is highly significant in a world where other goals -such as thriving for success, fame or wealth- are often present and can potentially harm the ultimate purpose of physiotherapy (Camps, 2007; Camps, 2015). According to Camps, the core elements to vocation include having the necessary skills (interest in experimental and human sciences, practical skills) and ethics (desire to care for others) (Camps, 2015). Our results show that these elements are robustly present in first year students. From a gender perspective, women seem to be more vocational since they presented a higher interest in the sciences and were more influenced than men by their desire to help others, which is indicative of higher altruism. Men respond more noticeably to socioeconomic motivations revolving around the workplace and economic interests, such as interest for high income or employability. In comparison to women, men are also noticeably more influenced by social determinants, such as admiration for physiotherapists, social recognition, recommendation of third parties or friendship with another student.

This data is consistent with that found by Rand et al. (2016) about social roles in the USA, as well as Rodríguez-Martínez, Sánchez-Rivas & Labajos-Manzanares (2017) on career vocation in Spain. Our findings are also in line with the reputed studies by Carol Gilligan on moral development, which showed that women have a more relational identity which makes them more prone than men to taking care of others and thus, to choose caring professions, compared to men (Gilligan, 1998). This may somehow also be related to prior findings indicating that men expect to have a higher income in the first year of employment (Johanson, 2007) and have a greater desire to own or manage a business (Öhman, Solomon & Finch, 2002; Johanson, 2007) than women.

According to our results, male students are also more interested in the relationship between physiotherapy and sports, value more studying it as a complement to previous studies and have higher expectations of it being an easy degree than female students. This desire to pursue a degree that is related to sports is also noticeably higher in French students, but they are overall less interested in studying physiotherapy as a complement to previous studies or work. The latter can be attributed to the fact that physiotherapy constitutes the first undergraduate studies for most French students.

Like men, social and economic determinants such as social recognition of the physiotherapist, expectations of high employability and income or admiration of a physiotherapist are also more noticeable among French students of both sexes. They also express a higher desire to pursue a career with “freedom” and flexible work opportunities. There are a number of aspects that could explain these cultural differences. One simple inference could be the fact that French students in Spain could already be showing a trend towards travelling and non-conventional living, thus seeking a more flexible career. But better reputation of the physiotherapy profession is also likely to be related to sociohistorical factors. Official undergraduate studies in France began in the decade of 1960s, whereas in Spain, physiotherapy did not reach the university level until 1981 (Universidad de Murcia, 2019). Moreover, the per 10,000 inhabitants ratio of physiotherapists in France is 12.6 and it is only 8.6 in Spain (Ministerio de Educación, Cultura y Deporte, 2019). Additionally, expected income in France and Spain seems to greatly differ, in favour of France and Spanish unemployment rates surpass 10% (Instituto Nacional de Estadística, 2019).

On the other hand, French students in our study showed higher scores in some factors related to vocation, since they declared a stronger vocational call from an early age and were more strongly driven towards a profession that requires manual skills. It is not surprising that approximately 38% of all students declared to have wished to be physiotherapists from an early age. It is known that individuals typically choose their career around the age of 16 (Perales, Mendoza & Sánchez, 2013). It is not age that determines the sense of vocation, but the feelings towards a given profession (Camps, 2015; Perales, Mendoza & Sánchez, 2013).

Conclusions

The desire to help and care for others is the predominant one in choosing to pursue a degree in physiotherapy, followed by a perceived relation between sports and physiotherapy, and the latter involving manual work. Female students are motivated more by altruism and interest in the sciences, whereas male students are motivated more by the relation to sports, physiotherapy as a complement of previous studies, social factors (admiration, recommendation, friends) and socioeconomic determinants such as employability, income or recognition. Students from France, when compared to those from Spain, were more driven by the connection with sports, social and socioeconomic determinants (expectation of good salaries, employability and multiple job opportunities, recognition and admiration) and some vocational determinants such as a vocational call from an early age and interest in a manual profession. General influencing factors as well as gender and origin differences should be further researched and acknowledged. A deeper understanding of the factors leading to a degree choice should help universities to better cater for their students and the profession.

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