Exploring health literacy levels in pre-registration physiotherapy students in the United Kingdom

Purpose: Between 42% and 61% of the UK population are estimated to have low health literacy (HL), a modifiable social determinant of health defined as the ability to access, understand, appraise and use information and services to promote and maintain health and well-being. People with low HL are at greater risk of poorer health outcomes, higher healthcare costs and reduced engagement with healthcare services.
Good HL is important for healthcare professionals (HCPs) because it directly influences the quality, safety and effectiveness of the care provided, by improving communication, enhancing outcomes and reducing health disparities. Despite this, HL training in pre-registration curricula is inadequate and inconsistent. Furthermore, most research into HL has been conducted on the general population, with little evidence evaluating the HL of HCPs, including pre-registration HCPs, the future workforce.
This study aims to evaluate the health literacy levels of pre-registration Physiotherapy students in the United Kingdom.
Methods: A cross-sectional, quantitative survey of pre-registration Physiotherapy students at Coventry University (CU) was conducted using the Health Literacy Questionnaire (HLQ). Participants were recruited via an online education platform between 9th February and 31st March 2025, answering the HLQ anonymously using Microsoft Forms.
Descriptive analysis identified mean (±SD) HL scores across the HLQ’s nine scales. A cluster analysis assessed for distinct subgroups based on participant demographics and statistical analysis assessed for statistical significance between demographic groups (p<0.05).
Results: 32 CU Physiotherapy students completed the HLQ (82% BSc full-time students. 63% female, mean age 26.3 years (±8.6), 57% born in the UK, 91% English first language).
HL limitations were identified within this sample’s ability to navigate the healthcare system (3.4, ±0.6, 67%), to engage with HCPs (3.5, ±0.7, 70%) and feeling understood and supported by HCPs (2.8, ±0.5, 70%).
HL strengths were actively managing their health (3.2, ±0.4, 81%) and understanding health information (4.0, ±0.5, 80%).
Cluster analysis revealed two main clusters with three participant outliers.
Participants born outside the UK (n=14, 43%) had statistically significant (p=0.026) higher HL levels linked to appraising health information (3.4, ±0.5, 85%) compared to those born in the UK (2.9, ±0.7, 73%).
Conclusion(s): This is the first study to evaluate HL levels of Physiotherapy students in the UK.
These results highlight the need for education providers to consider further measures to develop Physiotherapy students’ ability to navigate healthcare systems and to effectively engage with other HCPs to enhance HL levels. Without attention, these factors may have a negative impact on future interactions with patients and their experiences with healthcare.
Suggested areas for future research include a larger follow-up study of student HCP HL to improve the reliability of the initial CU findings. Research into the effect of HCP HL training interventions on patient outcomes in the UK would be useful to evaluate the downstream effects of HL training.
Impact: These results highlight areas for future development for educators to enhance the HL levels of their students and the future physiotherapy workforce. This, in turn, should enhance patient care and communication, leading to improved clinical outcomes.