|Year : 2019 | Volume
| Issue : 4 | Page : 247-254
The role of physical therapists' knowledge, attitudes, and practices in health promotion in Arsi zone, Southeast Ethiopia
Guta Bulcha, Leta Melakud
Department of Biomedical Sciences, College of Health Sciences, Arsi University, Asella, Oromia, Ethiopia
|Date of Submission||19-Jul-2018|
|Date of Acceptance||07-Sep-2019|
|Date of Web Publication||15-Oct-2019|
Mr. Leta Melakud
Department of Biomedical Sciences, College of Health Sciences, Arsi University, Asella, Oromia
Source of Support: None, Conflict of Interest: None
BACKGROUND: Physical activity is a first-line therapy and protects against many chronic health conditions. Primary health-care practitioners are ideally positioned to promote physical activity. Physical therapy interventions should be aimed at promotion and maintenance of health, quality of life, and fitness. There is, however, a shortage of such research evidence in Ethiopia.
OBJECTIVE: We aimed to estimate the level of knowledge, attitude, and practice (KAP) of physical therapists toward health promotion in Arsi zone of Oromia, Southeast Ethiopia.
MATERIALS AND METHODS: This community-based, cross-sectional study was conducted in April 2018 among 45 physical therapists. Data were collected using pretested, structured, and self-administered questionnaires. Participants were selected by quota sampling technique. The questionnaire was drafted specifically to test the KAP. The data were double entered and analyzed by SPSS program version 20.0. Descriptive statistics were used. The KAP were estimated using proportion.
RESULTS: In the present study, the response rate was 90.0%. Ages of the respondents ranged between 24 and 87 years. Nearly 57.8% of the participants got initial physical therapy knowledge from either of their parents, 53.3% of the respondents heard about health promotion from families and friends, and 57.8% of them received health promotion at their workplace. The overall percentage of all the respondents' KAP in health promotion was 60.1%.
CONCLUSIONS: The respondents' have good KAP toward health promotion. However, there is still room for improvement. In addition, there is a lack of proper guidelines in determining the impact of physical therapy.
Keywords: Attitude, health promotion, knowledge, physical therapist, practice
|How to cite this article:|
Bulcha G, Melakud L. The role of physical therapists' knowledge, attitudes, and practices in health promotion in Arsi zone, Southeast Ethiopia. Int J Health Allied Sci 2019;8:247-54
|How to cite this URL:|
Bulcha G, Melakud L. The role of physical therapists' knowledge, attitudes, and practices in health promotion in Arsi zone, Southeast Ethiopia. Int J Health Allied Sci [serial online] 2019 [cited 2020 May 27];8:247-54. Available from: http://www.ijhas.in/text.asp?2019/8/4/247/269251
| Introduction|| |
A young adults to have a good health should be active 5 days/week and have at least 30 min of moderate-intensity activity daily. Physical activity is a first-line therapy and protects against many chronic health conditions by improving glucose uptake, enhancing insulin sensitivity, improving blood lipid profiles, lowering blood pressure, improving the health of blood vessels, and protecting against obesity., Regular physical activity decreases all-cause mortality risk by 20%–30% compared with insufficient activity. In 2010, the World Health Organization (WHO) published global recommendations on physical activity for health. These were followed, in 2011, by UK guidelines for participation in physical activity across the life course. Epidemiological studies have indicated that physical activity is accepted worldwide as a public health priority.,,,, Primary health-care practitioners are ideally positioned to promote physical activity as a health promotion measure.,, Physical therapists as a part of the health-care team play an essential role in reducing hospital stay, in providing a quicker recovery, and in rehabilitation for a better quality life., The American Physical Therapy Association Guide to Physical Therapist Practice states that a part of physical therapists' practice is to “provide prevention and promote health, wellness, and fitness.” It also suggests that physical therapists can be involved in primary, secondary, or tertiary prevention., Physical therapists have much to offer a dynamic health-care system not only in the area of rehabilitation but also in the areas of disease prevention and health promotion. The position statement by the World Confederation for Physical Therapy (WCPT) describes “as an established expectation of physical therapy practice, the position statement by the WCPT describes physical therapy interventions should be aimed at promotion and maintenance of health, quality of life, and fitness in all ages and populations”. In addition to the well-documented benefits of regular physical activity, urban environments and economic demands have been reported to promote sedentary rather than active lifestyles.,, In developed countries, physical inactivity accounts for 1.5%–3.0% of the total direct health-care costs. In 2006-7, physical inactivity cost an estimated £0.9 billion in the UK. In the UK, fewer than 40% of men and fewer than 30% of women met the recommended PA guidelines across the UK. Globally, in 2010, around 23% of adults aged 18+ years were insufficiently physically active. In recent decades, physical inactivity has been linked with the onset of noncommunicable diseases and risk factors such as obesity, heart disease, and cancer.,
Global estimates by the WHO have indicated that 10%–16% of cases of breast, colon, and rectal cancers; diabetes mellitus; and 22% of ischemic heart diseases are caused by physical inactivity., Overall, 1.9 million deaths are attributable to physical inactivity.,, Based on the World Report on Disability jointly issued by the World Bank and WHO, there are an estimated 15 million children, adults, and elderly persons with disabilities in Ethiopia, representing 17.6% of the population.,, The barriers to increasing health promotion and preventative care in health-care settings are consistent across professional groups and include lack of time, perceived lack of knowledge, lack of confidence, and lack of organizational support.,,, There is, however, a shortage of such research evidence in Ethiopia. Hence, this study was designed to investigate the level of knowledge, attitude, and practice (KAP) of physical therapists toward health promotion in Arsi zone of Oromia region, Ethiopia.
| Materials and Methods|| |
This community-based, cross-sectional study was conducted in Arsi zone from April 1 to 30, 2013, among sampled physical therapists using a self-administered questionnaire. The required sample size (50) was estimated using quota sampling technique. Data were collected using standard WHO questionnaire to assess the KAP with slight modifications to make the questionnaire and its content, wording, instructions, and ease of completion more understandable for the respondents. The questionnaire comprised four sections exploring sociodemographic characteristics and KAP among physical therapists in health promotion. For testing the KAP of the respondents, each correct answer was given a credit. The scores for each section were calculated individually, and a final KAP score was also obtained by calculating the total of the three sections according to a score chart. If the respondents' scores were ≥80%, 60%–79%, 50%–59%, and <49%, they were categorized as desirable, good, fair, and unsatisfactory for KAP among physical therapists, respectively. The questionnaire was pretested on five randomly selected physical therapists of Adama town. After checking the collected data for completeness, it was double entered into Epi-data version 3.1 (McGraw-Hill/Irwin ©2009) and exported into SPSS version 20 (IBM Corp., Armonk, NY) for analysis. Incomplete and inconsistent data were excluded from the analysis. The data were processed by using descriptive analysis, including frequency distribution, cross tabulation, and summary measures. The KAP were estimated using proportion. Ethical support letter was obtained from Arsi University's ethical board. Informed consent was taken from all respondents during data collection, and participation was completely voluntary. Confidentiality was kept unanimously.
| Results|| |
Sociodemographic characteristics of the respondents
Out of fifty sampled physical therapists, five therapists' questionnaires were rejected for incompleteness, giving a response rate of 90.0%. Hence, out of the 45 study participants, 27 (60.0%) were males. Their ages ranged between 24 and 87 years, with a mean ± standard deviation of 36.07 ± 11.789 years. Furthermore, from the total participants, 26 (57.8%) were married. As far as their level of education was concerned, majority of them had studied up to college level. Several religions were represented in the sample: 22 (48.9%) were Orthodox Church-following Christians. With regard to their ethnicity, 33 respondents were of Oromo ethnicity [Table 1].
|Table 1: Sociodemographic characteristics of the study participants in relation to sex, Arsi zone, April 2018|
Click here to view
Source of initial knowledge and work experiences in physical therapy
Out of the study participants that were involved in this study, 41 (91.1%) had no undergraduate qualification in physical therapy. Not only that but also 57.8% of them got initial physical therapy knowledge from either of their parents [Table 2].
|Table 2: Qualification, source of initial knowledge, and work experiences of the study participants, Arsi zone, April, 2018|
Click here to view
Role of physical therapists and physical therapy in health promotion
Results from this study had shown that 53.3% (24/45) of the respondents came to know or heard about health promotion from families and friends, and 22.2% (10/45) of them had heard about health promotion from health workers [Figure 1].
|Figure 1: Sources where respondents first heard about health promotion, Arsi zone, April 2018|
Click here to view
Concerning health promotion, 26 (57.8%) respondents received health promotion at their workplace. Concerning the respondents' practice in the provision of health promotion, the correct answer for the questions 1–6 was yes and for question 7 was no. Out of the total respondents, 48.9% and 77.8% of them responded yes on physical therapy services and their intervention, respectively. However, when asked about “exercises are the only means of promoting health in all conditions treated,” 55.6% of them responded incorrectly [Table 3].
|Table 3: Role of physical therapists' practice in health promotion (n=45), Arsi zone, April 2018|
Click here to view
Attitude of physical therapists toward health promotion
Regarding attitudes, 51.1% (23/45) and 48.9% (22/45) of the respondents felt that their attitudes were good and excellent, respectively, from the provided list of options (excellent, good, and poor). Concerning the respondents' attitude in the provision of health promotion, the correct answer for all questions was yes, except for the seventh, ninth, and eleventh questions. Out of the total participants, 82.2% responded by indicating that they would educate all their clients on healthy diet and need for exercise. Conversely, 77.8% of study participants responded negatively for the question that asked about the most appropriate role for physiotherapist is a health educator [Table 4].
|Table 4: Physical therapists' attitude on health promotion (n=45), Arsi zone, April 2018|
Click here to view
Knowledge of physical therapists regarding health promotion
Concerning the respondents' knowledge in the provision of health promotion, the correct answer for all questions was yes, except for the second, third, sixth, and ninth questions. Out of the total respondents, 86.7% responded yes when asked whether health promotion activity involves strengthening community action to prevent disease and improve health. In addition, 93.7% of the respondents responded correctly to the provision of basic services such as housing, clean water, sanitation, and adequate nutrition as part of a health promotion program. On the other hand, 66.7% of the respondents responded wrongly to the question that whether health promotion activity involves early detection and treatment of disease [Table 5].
|Table 5: Physical therapists' knowledge on health promotion (n=45), Arsi zone, April 2018|
Click here to view
The overall percentage of knowledge, attitude, and practice of physical therapists toward health promotion
As per the WHO score chart for KAP, the average scores for each section [Table 3], [Table 4], [Table 5] of KAP were calculated individually first, and then the overall KAP of the respondents toward health promotion were obtained by calculating the average of all the three sections together. Therefore, the average scores for each section of KAP were rated as 68.0% (good), 57.4% (fair), and 55.0% (fair), respectively, and the overall percentage was 60.1%, which was regarded as good.
| Discussion|| |
Health is an abstract, polyinterpretable concept whose interpretation is influenced by people's social, cultural, and historical perspectives. The WHO had developed what has now become the most commonly referenced definition of health, as follows: “a state of complete physical, mental and social well-being and not merely the absence of disease.”, In the context of health, physical therapists provide services to people and populations to develop, maintain, and restore maximum movement and functional ability throughout their lifespan.,, The WCPT argues that physical therapists are ideally placed to promote, guide, and prescribe safe physical activity. Majority of the respondents (53.3%) in the present study indicated that they came to know about health promotion from families and friends. Similarly, 57.8% of them received initial physical therapy knowledge from either of their parents. This result is consistent with the finding of Mokwena et al. which stated that training and increasing the number of health-care personnel, therefore, remain a priority in African countries. In the present study, 91.2% of the respondents had undergone informal training in health promotion. This finding is consistent with the idea which imply that physical therapists can act as first-contact practitioners and patients/clients may seek direct services without referral to another health-care professional., Furthermore, 48.9% of the respondents had a working experience in physical therapy of <5 years. The result is in line with the result of Rea et al. that studied the role of health promotion in physical therapy in California, New York, and Tennessee, and their results confirmed the need for physical therapists to address health promotion. The finding was also supported by the study of Sheedy et al. which implied that identification of barriers to physical activity was a key attribute of health promotion. In the present study, 57.8% of the respondents received health promotion at their workplace. This can be consistent with the finding of Francis who stated that there is a strong association between physical activity and optimal health and as a result, physical activity and fitness were placed as the first priority of the health promotion goal. This finding is also in line with the conclusion of Hall, that stated inclusiveness of health promotion courses in the physiotherapy curriculum has made a significant contribution to the development of entry-level physical therapists that will be prepared to assume health promotion professional role for the public. However, in the present study, the level of awareness of health promotion by physical therapists was only 55%.
This result is consistent with the finding of Ramklass which stated that the curriculum design is strongly aligned with the policy document for educating and training physical therapists. Ergonomic is closely related to health, safety, and efficiency and plays an essential role in accident prevention, promotion of health, and the prevention of ill health., However, in the present study, due to lack of knowledge, money, or government attention, only 42.2% of the respondents were provided ergonomically appropriate work environment at their workplace. Chernoff stated that changes in dietary and exercise patterns are most effective in the prevention of nutrition-related conditions when they are instituted early, which will eventually lead to a decrease or delayed onset of various health conditions. In the present study, however, only 48.9% of the respondents were educating their clients on not to use sweetened beverages in order to prevent diabetes. This gap was created due to difference in the study area and number of participants involved in the study. However, the finding is to a lesser extent supported by the study of Ford et al. which stated that lifestyle changes may not necessarily need to be dramatic to achieve good health. In the present study, 77.8% of the respondents were aware that physical therapy interventions must include training of patients, caregivers, and families to apply preventative, curative, and promotive measures. This finding is in line with Chernoff's study which stated that the use of a variety of adult education theories and models will enhance behavioral changes that lead to more healthy habits and enable a health educator to be successful in effecting change. Kaliyaperumal stated that attitude refers to the participants' feelings toward a particular subject or any preconceived ideas that they may have toward it. Although 51.1% and 48.9% of the respondents in the present study rated their attitude toward health promotion as excellent and good, respectively, they did not partake in developing health and safety regulation to prevent silicosis. Furthermore, 82.2% of the respondents in the present study are working within the district health system for providing health promotion in their services. The results also indicated that 57.8% of the respondents had a positive attitude toward practicing health promotion as another concept by leading the public/society to a healthier lifestyle. This finding is in line with the study of Higgs et al. that stated in addition to promoting health and wellbeing for individuals and the general public/society, the role of the physical therapists should be also provision of health education for the patient and their families about the condition. Rehabilitation professionals are challenged to assume the roles of educators, researchers, and program providers and having a strong potential as a collaborator in the process of making health promotion people centered.
The results of the present study showed that 22.2% of the participants portrayed a positive attitude toward the role of physical therapists, not just regarded as health educators but also as health promoters. Recent research conducted by Perreault had indeed highlighted the interest of integrating health promotion in rehabilitation interventions and research. Rimmer stated that the emerging paradigm shift from disease and disability prevention to the prevention of secondary conditions in people with disabilities, physical therapists, and other rehabilitation professionals can play an important role in the integration of health promotion. Physical therapists can also play an active role by extending their expertise beyond tertiary prevention to avenues of primary and secondary prevention where physiotherapy is not yet engaged in. In the present study, 82.2% of the respondents indicated that physical therapy is more than just curing the symptoms of the patient. This result shows the positive attitude of physical therapists as well as their potential in extending their skill and expertise by promoting health through primary and secondary prevention before curing the symptom of diseases, which is regarded tertiary prevention. Primary health-care (PHC) services that have been provided through the district health system had identified rehabilitation and physical therapy services to play a greater role in PHC success. This study showed that among 62.2% of the physical therapists, there was the belief of not just regarding themselves as health educators in the biomedical field but that they can also play a crucial role in health promotion by further planning and strategizing programs to promote a healthy lifestyle to the community or public. Explicit guidelines for re-orienting physical therapy curricula and practice for PHC have been limited, and this has implications for changing the practice of physiotherapists who remain grounded in the traditional physiotherapy practice model. Hall reported that students need the important knowledge and practical experience in developing and implementing health promotion and disease/injury prevention programs in the community to meet this practice expectation. As rehabilitation professionals, physical therapists, who can be consulted directly without medical referral, are well suited to integrate health promotion in their field of practice. In the present study, 51.1% of the respondents responded incorrectly by saying that health promotion involves the distribution of prophylactic medication to prevent disease. This finding is similar to the study of Rea et al., which found that the practice of health promotion among physical therapists was less than the desirable level and improvement in these practices would realize the full potential of physiotherapists' role in health promotion.
According to the biomedical model, health constitutes the freedom from disease, pain, or defect, thus making the normal human condition healthy. The results of the present study also showed that there are some physical therapists who do not understand how health promotion differs from a biomedical perspective and that further education and training activities are also part of health promotion. An overwhelming majority, i.e., 80% of the respondents, indicated that health promotion calls for re-orientation of health services beyond the clinical and curative services. Zimmer et al. stated that the standards of practice for health promotion in higher education provide a quality improvement tool for strengthening the current and future health of the nation, linking academic success and the mission of higher education with national health priorities. There is no working model of good practice in capacity building for health promotion in developing countries. In the present study, 68% of the respondents had good knowledge, 57.4% had a fair attitude, and 55% of them were fairly practiced health promotion appropriately. An increase in the knowledge and skill levels of individual practitioners is a key success with regard to capacity building of health promotion. In the present study, overall, 60.1% of the respondents were deemed to have good KAP toward health promotion. This finding is similar to the Tang et al study that reveled the expertise of individual practitioners alone will not lead to effective health promotion practice without strong support from the different interrelated organization from their working area or/and local political leaders and senior managers.
| Conclusions|| |
Physical therapists have good KAP toward health promotion in Arsi zone, Ethiopia. Knowledge and correct attitude are prerequisites for the practice of health promotion. However, there is still room for improvement in acquiring more in-depth knowledge about health promotion principles and if this can be achieved, more physical therapists will be able to practice health promotion correctly. This is an indication that physical therapists still require further training in implementing and understanding their role toward health promotion. Efforts should be made to further link and integrate the principles and practices of health promotion in the field of physical therapy to improve interventions at the individual, community, and population levels.
The authors are grateful to Arsi University for its support.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al.
Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007;39:1423-34.
Bauman AE. Updating the evidence that physical activity is good for health: An epidemiological review 2000-2003. J Sci Med Sport 2004;7:6-19.
Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, et al.
Physical activity and public health. A recommendation from the centers for disease control and prevention and the American College of Sports Medicine. JAMA 1995;273:402-7.
Lee IM. Dose-response relation between physical activity and fitness: Even a little is good; more is better. JAMA 2007;297:2137-9.
World Health Organization. Global Recommendations on Physical Activity for Health. Geneva, Switzerland: WHO Press; 2010.
Department of Health. Start Active, Stay Active: A Report on Physical Activity for Health from the Four Home Countries' Chief Medical Officers. Department of Health; 2011. Available from: http://www.england.nhs.uk/ourwork/futurenhs
. [Last accessed on 2018 Apr 16].
Kruk J. Physical activity and health. Asian Pac J Cancer Prev 2009;10:721-8.
Reiner M, Niermann C, Jekauc D, Woll A. Long-term health benefits of physical activity – a systematic review of longitudinal studies. BMC Public Health 2013;13:813.
Bize R, Johnson JA, Plotnikoff RC. Physical activity level and health-related quality of life in the general adult population: A systematic review. Prev Med 2007;45:401-15.
American College of Sports Medicine, Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, et al.
American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 2009;41:1510-30.
Shirley D, van der Ploeg HP, Bauman AE. Physical activity promotion in the physical therapy setting: Perspectives from practitioners and students. Phys Ther 2010;90:1311-22.
van der Ploeg HP, Streppel KR, van der Beek AJ, van der Woude LH, Vollenbroek-Hutten MM, van Harten WH, et al.
Successfully improving physical activity behavior after rehabilitation. Am J Health Promot 2007;21:153-9.
Whyte MB. Health Sciences Education Review. Canberra: Office of Tertiary Education; 1991.
Rea BL, Hopp Marshak H, Neish C, Davis N. The role of health promotion in physical therapy in California, New York, and Tennessee. Phys Ther 2004;84:510-23.
Martin P, Fell D. Beyond treatment: Patient education for health promotion and disease prevention. J Phys Ther Educ 1999;13:49-56.
Lasswell A, Smith SR. Attitudes of medical students and physician faculty members toward nonphysician health professionals. J Med Educ 1987;62:509-11.
Harro C. Overview on the guide to physical therapy practice and its implications for neurologic physical therapy. Neurol Rep 1999;23:158-61.
Verhagen E, Engbers L. The physical therapist's role in physical activity promotion. Br J Sports Med 2009;43:99-101.
World Confederation for Physical Therapy. Position Statement: WCPT Guidelines for Physical Therapist Professional Entry-Level Education. World Confederation for Physical Therapy; 2007.
Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: The evidence. CMAJ 2006;174:801-9.
American Heart Association Nutrition Committee, Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, et al.
Diet and lifestyle recommendations revision 2006: A scientific statement from the American Heart Association Nutrition Committee. Circulation 2006;114:82-96.
Dean E. Physical therapy in the 21st
century (Part I): Toward practice informed by epidemiology and the crisis of lifestyle conditions. Physiother Theory Pract 2009;25:330-53.
Dean E. Physical therapy in the 21st
century (Part II): Evidence-based practice within the context of evidence-informed practice. Physiother Theory Pract 2009;25:354-68.
Oldridge NB. Economic burden of physical inactivity: Healthcare costs associated with cardiovascular disease. Eur J Cardiovasc Prev Rehabil 2008;15:130-9.
Scarborough P, Bhatnagar P, Wickramasinghe K, Allender S, Foster C, Rayner M. The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: An update to 2006-2007 NHS costs. J Public Health 2011;33:527-35.
Townsend N, Bhatnagar P, Wickramasinghe K. Physical Activity Statistics 2012. London, England: British Heart Foundation and Oxford, England: University of Oxford; 2012.
Waxman A. WHO's global strategy on diet, physical activity and health: Response to a worldwide epidemic of non-communicable diseases. Scand J Nutr 2004;48:58-60.
Campanini B. World Health Organization, the World Health Report. Reducing Risks, Promoting Healthy Life. Geneva, Switzerland: World Health Organization; 2002. p. 47-92.
Lobelo F, de Quevedo IG. The evidence in support of physicians and health care providers as physical activity role models. Am J Lifestyle Med 2016;10:36-52.
Rubio-Valera M, Pons-Vigués M, Martínez-Andrés M, Moreno-Peral P, Berenguera A, Fernández A, et al.
Barriers and facilitators for the implementation of primary prevention and health promotion activities in primary care: A synthesis through meta-ethnography. PLoS One 2014;9:e89554.
Hébert ET, Caughy MO, Shuval K. Primary care providers' perceptions of physical activity counselling in a clinical setting: A systematic review. Br J Sports Med 2012;46:625-31.
Bodner ME, Dean E. Advice as a smoking cessation strategy: A systematic review and implications for physical therapists. Physiother Theory Pract 2009;25:369-407.
Owen N. Strategic initiatives to promote participation in physical activity. Health Promot Int 1996;11:213.
Huber M, Knottnerus J, Green L, Van der H, Jadad A, Kromhout D, et al
. How should we define health? BMJ 2011;343:4163.
International Health Conference. Preamble to the Constitution of the World Health Organization Signed by the Representatives of 61 States and Entered into Force on April 7, 1948. New York, USA: Official Records of the World Health Organization; 1946. p. 19-22.
Adams T, Bezner J, Steinhardt M. The conceptualization and measurement of perceived wellness: Integrating balance across and within dimensions. Am J Health Promot 1997;11:208-18.
World Confederation for Physical Therapy. Policy Statement: Description of Physical Therapy. London, UK: World Confederation for Physical Therapy; 2011. Available from: http://www.wcpt.org/policy/ps-descriptionPT
. [Last accessed on 2018 Apr 16].
Bouchard C, Shephard R, Stephens T. Physical activity, fitness and health. In: Consensus Statement. Champaign IL: Human Kinetics Publisher; 2003.
Mokwena K, Mokgatle-Nthabu M, Madiba S, Lewis H, Ntuli-Ngcobo B. Training of public health workforce at the national school of public health: Meeting Africa's needs. Bull World Health Organ 2007;85:949-54.
World Confederation for Physical Therapy. Policy Statement: Direct Access and Patient/Client Self-Referral to Physical Therapy. London, UK: World Confederation for Physical Therapy; 2011. Available from: http://www.wcpt.org/policy/ps-direct-access
. [Last accessed on 2018 Apr 16].
World Confederation for Physical Therapy. Policy Statement: Autonomy. London, UK: World Confederation for Physical Therapy; 2011. Available from: http://www.wcpt.org/policy/ps-autonomy
. [Last accessed on 2018 Apr 16].
Sheedy J, Smith B, Bauman A, Barnett A, Calderan A, Culbert J, et al.
Acontrolled trial of behavioural education to promote exercise among physiotherapy outpatients. Aust J Physiother 2000;46:281-9.
Francis KT. Status of the year 2000 health goals for physical activity and fitness. Phys Ther 1999;79:405-14.
Hall K. Health promotion in the community: Practical experience for physical therapy students. Phys Ther 1999;79:S61.
Ramklass SS. An investigation into the alignment of a South African physiotherapy curriculum and the expectations of the healthcare system. Physiotherapy 2009;95:216-23.
Higgs J, Refshauge K, Ellis E. Portrait of the physiotherapy profession. J Interprof Care 2001;15:79-89.
Hattingh S, Acutt J. Occupational Health, Management and Practice for Health Practitioners. 3rd
ed. Lansdowne: Juta; 2003. p. 110-1.
Chernoff R. Nutrition and health promotion in older adults. J Gerontol A Biol Sci Med Sci 2001;56:47-53.
Ford ES, Bergmann MM, Kröger J, Schienkiewitz A, Weikert C, Boeing H, et al.
Healthy living is the best revenge: Findings from the European prospective investigation into cancer and nutrition-Potsdam study. Arch Intern Med 2009;169:1355-62.
Kaliyaperumal K. Guideline for conducting a knowledge, attitude and practice (KAP) study. Community Ophthalmol 2004;6:7-9.
Rimmer JH. Health promotion for people with disabilities: The emerging paradigm shift from disability prevention to prevention of secondary conditions. Phys Ther 1999;79:495-502.
Perreault K. Linking health promotion with physiotherapy for low back pain: A review. J Rehabil Med 2008;40:401-9.
Fricke M. Physiotherapy and Primary Health Care: Evolving Opportunities. Manitoba: University of Manitoba; 2005 p. 1-62.
Mbambo N. The changing role of physiotherapy in South Africa. S Afr J Physiother 2005;61:2-6.
Zimmer CG, Hill MH, Sonnad SR. A scope-of-practice survey leading to the development of standards of practice for health promotion in higher education. J Am Coll Health 2003;51:247-54.
Tang KC, Nutbeam D, Kong L, Wang R, Yan J. Building capacity for health promotion – A case study from china. Health Promot Int 2005;20:285-95.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]