Physiotherapy students’ knowledge, attitudes, and educational preparation for addressing social determinants of health

Purpose: Background: Social determinants of health (SDH) are underlying social, economic, and environmental factors that contribute to measurable disparities in health outcomes, known as health inequalities. Despite multiple national policies and initiatives placing a focus on improving SDH-related educational training for healthcare professionals, there are a limited number of studies that explore physiotherapy students’ knowledge, attitudes and perceptions of SDH.
This study aims to assess physiotherapy students’ awareness and attitudes towards SDH and their perception of related educational delivery.
Methods: A cross-sectional quantitative survey of pre-registration Physiotherapy students at Coventry University (CU) was conducted using the Physical Therapy – Social Determinants of Health Scale (PT-SDHS); a valid and reliable measure of physiotherapy students’ understanding and ability to integrate best practice regarding SDH. Participants were recruited via an online education platform in March 2025, answering the PT-SHDS anonymously using Microsoft Forms.
Descriptive statistics (mean, ±SD, mode) were used to analyse responses using a five-point Likert scale across the four domains of the PT-SDHS (knowledge, attitudes, personal barriers and beliefs about others). Question 19 was used to explore educational provisions.
Results: 20 CU Physiotherapy students completed the PT-SDHS (95% enrolled onto an Undergraduate course, 85% in their final year of study).
Participants reported overall low levels of knowledge around SDH (2.0, ±0.2, 1), particularly around resources and services available for those with housing instability (1.6 ±0.6, 1), financial resource strain (1.7 ±0.7, 1) and utility needs (1.7 ±0.7, 1).
Participants held positive attitudes towards SDH (4.5 ±0.1, 5), recognising that addressing related issues will improve clinical effectiveness (4.7 ±0.5, 5) and health outcomes (4.7 ±0.5, 5). However, students were less agreeable on whether it is their responsibility to address such issues (4.3 ±0.7, 4).
Participants were neutral in identifying personal barriers to addressing SDH with patients (2.9 ±0.2, 4). They identified resources (3.8 ±0.9, 4) and not wanting to make their patients uncomfortable (3.3 ±1.3, 4) as their main barriers.
Participants gave neutral responses when asked if they felt that other clinicians are already asking about and addressing SDH with patients (3.2 ±0.0, 4).
Overall, participants did not feel that they received enough teaching around the topic of SDH as part of their professional education (1.7 ±0.7, 1).
Conclusion(s): Physiotherapy students demonstrate a positive attitude towards, and awareness of, the importance of identifying and addressing the social determinants of health to improve health outcomes. However, they do not feel that current education equips them with the appropriate knowledge to execute this in clinical practice. These findings highlight the need for developments to the provisions of SDH-focused teaching within physiotherapy curricula. Further research is needed to examine the impact of SDH education over time, and across a broader range of institutions in the UK.
Impact: Key messages: These results highlight the need for developments to pre-registration education provisions around SDH to better equip the future physiotherapy workforce for identifying and addressing SDH in clinical practice.