Attitudes towards research in graduate-entry Australian physiotherapy students: a survey
Peter W Stubbs 
1, Christopher Altre 1, Arianne P
Verhagen 1, Nicci Bartley 2, Alana B McCambridge 3, Jereme M Borja1, Lauren S Haylock1, Kayla Dang1, Joshua W Pate 1
Abstract
Purpose:
To assess the attitudes towards research in a two-year, graduate-entry Master of Physiotherapy course.
Methodology:
All students starting (T0) and ending (T1) their degrees in 2020 and
2021 were invited to complete the revised Attitudes Towards Research
Questionnaire. This is a three-factor instrument with 13 statements
assessing Research Usefulness (four statements, scores ranging from 4 to
28), Research Anxiety (five statements, scores ranging from 5 to 35),
and Positive Research Predispositions (four statements, scores ranging
from 4 to 28). Each statement was scored using a seven-item Likert
scale ranging from 'Strongly Agree' (1) to 'Strongly Disagree' (7).
Student responses between T1 and T0 for factor scores were compared
using independent samples t-tests and summarised using mean differences
(95% CIs). We defined the minimally important difference as 15% of the
scale range.
Findings:
Ninety-seven percent (n=124/129) of students completed the survey at T0
and 57% (n=79/125) at T1.
We found no difference between T0 and T1 in research anxiety (0.2
points, 95% CI: -1.5 to 2.0) and research usefulness (-0.9 points, 95%
CI: -1.8 to 0.1), but a significant (although not meaningful) decrease
in positive research predispositions between T0 and T1 (-1.7 points,
95% CI -3.2 to -0.2).
Research implications:
Qualitative research could complement these quantitative findings and
provide in-depth reasons for student scores.
Practical implications:
Educators need more active strategies to improve attitudes and
engagement in research-focused subjects to further engage students.
Originality/value:
This is the first study to document attitudes towards research in an
Australian graduate-entry Master of Physiotherapy program.
Limitations:
There is likely bias (unclear in which direction) at T1 given that 57%
of students completed the survey. Surveys were not linked, so group
differences were assessed independently.
Keywords:
Evidence-based practice; research methods; Master of Physiotherapy, UTS
Physiotherapy Student surveys (PHYSS) study
1 Discipline of Physiotherapy, Graduate School of Health,
Faculty of Health, University of Technology Sydney, Australia
2 School of Psychology, Faculty of Science, University of Sydney,
Australia
3 Centre for Person Centred Research, Faculty of Health and
Environmental Sciences, Auckland University of Technology, New Zealand.
Corresponding author: Dr Peter W Stubbs, Graduate School
of Health, Discipline of Physiotherapy, Faculty of Health, University of
Technology Sydney, Australia, [email protected]
Background
Research skills are taught in many health-related degrees with the hope
that graduates will be able to find, appraise, and apply research when
practicing clinically (Riiser et al. 2023). Students need to have positive
attitudes towards research so that up-to-date research is incorporated into
clinical practice (Helgøy et al. 2020). Students in health science degrees
sometimes struggle to transfer research education to clinical practice
(Olsen et al. 2013). During clinical placements, there is a prioritisation
of practice-based knowledge, rather than research or evidence-based
knowledge, with students reporting that some educators believe that
students don't have the 'time or energy to focus on EBP [evidence-based
practice]' (Olsen et al. 2013, p. 10). Some students are stressed and
anxious when beginning research subjects (Papanastasiou & Zembylas
2008) and some students struggle with performing research projects and the
quantity and difficulty of the material (Wilson & Onwuegbuzie 2001;
Yousefi‐Nooraie et al. 2007). Anxiety towards research, along with the
high perceived time commitment is a barrier to learning and acquiring
research skills (Kakupa & Xue 2019) and may affect future research
behaviours (Papanastasiou & Zembylas 2008). Therefore, it is important
that students have positive attitudes towards research.
The revised Attitudes Towards Research Questionnaire (rATRQ) is a 13-item
questionnaire that assesses student attitudes towards research subjects. It
includes the factors Research Usefulness(four items),
Anxiety Towards Research Courses
(five items) and Positive Research Predispositions(four items). A
three-factor structure has been confirmed in the redevelopment of the scale
(Papanastasiou, 2014).
Numerous studies have investigated attitudes towards research, including in
physiotherapy students (Mazher et al. 2022; Sanjaykumar & Shah 2022),
education students (Akour et al. 2023; Papanastasiou 2014), architecture
students (Jansen et al. 2022) and research-intensive (Masters and PhD)
students (Kakupa & Xue, 2019). Undergraduate students have poorer
attitudes towards research than postgraduate coursework students (Mazher
et al. 2022) and students in research-intensive degrees (Kakupa & Xue
2019). Although numerous studies have collected student attitudes towards
research at one time point in a degree, none have assessed student
attitudes at the start and at the end of a health sciences degree. It is
important to assess research attitudes on more than one occasion, as this
may change throughout the degree. Measuring students at the entry and exit
timepoints to the degree provides a measure of whether attitudes differ as
a result of the degree. It also provides information on student attitudes
as they enter the workforce as physiotherapists.
As universities have a pivotal role in ensuring students have positive
attitudes towards research, a first step in optimising the delivery of
research subjects is to understand student attitude towards research and
assess if this differs between the start and end of the degree. The purpose
of this study was to assess student perceptions of research using the rATRQ
at the start and end of the degree and assess differences between the
timepoints.
Methods
Design
An anonymous survey was taken at two timepoints including all students
starting their degree in 2020 and 2021 (T0) and ending their degree in 2020
and 2021 (T1). The study was approved by the University of Technology
Sydney Human Research Ethics Committee (ETH19-4542).
Context
The Master of Physiotherapy course at the University of Technology Sydney
is a two-year graduate-entry Masters-by-coursework degree. Students
complete four 10-to-14-week semesters and four five-week clinical
placements in a range of physiotherapy areas. All subjects are
research-informed and have a significant research aspect embedded into
subject content and delivery. In addition, students have one five-week
introductory research-specific module in Semester 1 (embedded within a
Professional Practice subject) as well as research-focused subjects in
Semester 3 (6 credit points) and Semester 4 (6 credit points). In Semesters
3 and 4, as part of the research-focused subjects, students complete a
research project, in groups of four-to-six students, under the supervision
of an academic, with the goal of publishing a manuscript on completion.
Students also receive one lecture and one tutorial per week over a 12-week
(Semester 3) and a 10-week (Semester 4) semester, as well as meeting with
their research project supervisor and conducting their research. Throughout
Semesters 3 and 4, students have assessments related to the research
process. Lectures focus on topics such as research design (randomised
controlled trials, systematic reviews, prognostic, diagnostic and
qualitative research), the strength of the evidence using various designs,
quality appraisal tools for studies of different designs, and statistics.
Tutorials focus on providing guidance for the group research project and
applying some of the methodologies used in the lectures.
Participants
All students at T0 (n=129) and all students at T1 (n=125) were invited to
participate in the anonymous surveys. The surveys at T0 were performed in
orientation week, the week prior to the start of Semester 1. The surveys at
T1 were performed in the last tutorial in the final week of the degree.
Participation was voluntary and all participants provided written informed
consent. Students were provided a web link and QR code to complete the
survey. The data reported in this study are a subset of the questionnaires
used from the UTS Physiotherapy Student Surveys (PHYSS) study. The
PHYSS-study is a 20-minute questionnaire about pain, pain beliefs and
confidence in interacting with patients, as well as attitudes towards
research (Pate et al. 2023; Stubbs & Verhagen 2023). This manuscript
only reports data on the rATRQ.
Demographic variables
Reported demographic data include gender, age (using ranges) and graduation
year.
Revised attitudes towards research questionnaire (rATRQ)
The rATRQ measures student attitudes towards research (Papanastasiou 2014).
It is a 13-item questionnaire with Likert response scales that assesses
attitudes towards research methods. For each item, attitudes to each
statement were allocated integers from 1-7 corresponding to answers of
Strongly Disagree (1), Disagree (2), Somewhat Disagree (3), Neither Agree
nor Disagree (4), Somewhat Agree (5), Agree (6) and Strongly Agree (7).
Scores for the factor Anxiety Towards Research Courses were reverse
coded (i.e. Strongly Agree = 1 and Strongly Disagree = 7). The rATRQ is a
revision of the original 32 item (five factor) questionnaire (Papanastasiou
2005) to the current questionnaire (13 items, three factors) following a
confirmatory factor analysis (Papanastasiou 2014) with the factors
Research Usefulness
(four items, α=0.92),
Anxiety Towards Research Courses
(five items, α=0.86), and Positive Research Predispositions (four
items, α=0.92). Each factor shows discriminant validity against the other
factors (r=0.18 to r=0.54). To date, no study has reported responsiveness,
minimal detectable change, or minimally important difference (MID). As
such, we have determined the MID as 15% of the scale range. This means the
MID for the four item factors ( Research Usefulness and
Positive Research Predispositions
) is 3.6 points and for the five-item factor (Anxiety Towards Research
Courses) is 4.5 points.
Data analysis and statistics
A complete case analysis was performed. Demographic information and items
scores at T0 and T1 were summarised using descriptive statistics. As data
were parametric, independent sample t-tests were performed on factor scores
between T0 and T1. Data were analysed using SPSS (version 27) and excel
(version 2016).
Results
The students that completed the surveys (percentage of total students) was
n=124 (97%) at T0 and n=79 (57%) at T1. Sixty-two percent of respondents
were female at T0, and 61% were female at T1. Most respondents were in the
age group of 19-24 years at T0 and 22-27 years at T1 (Table 1).
Table 1: Demographic information of students that completed the surveys
|
Characteristics and demographic information
|
T0
n = 124 (%)
|
T1
n = 79 (%)
|
|
Graduation year
|
|
|
|
2020
|
-
|
33 (42%)
|
|
2021
|
62 (50%)
|
46 (58%)
|
|
2022
|
62 (50%)
|
-
|
|
Gender
|
|
|
|
Female
|
77 (62%)
|
48 (61%)
|
|
Male
|
48 (38%)
|
30 (38%)
|
|
Gender Fluid
|
0
|
1 (1%)
|
|
Non-binary
|
0
|
0
|
|
Age (years)
|
|
|
|
19-21
|
46 (37%)
|
0
|
|
22-24
|
63 (51%)
|
54 (68%)
|
|
25-27
|
11 (9%)
|
20 (25%)
|
|
28+
|
4 (3%)
|
5 (6%)
|
The mean (SD) scores for each factor at T0 and T1 are presented in Table 2.
We found no differences between T0 and T1 for the factors
Research Usefulness
and
Anxiety Towards Research Courses (
Table 2). The difference between T0 and T1 for the factor
Positive Research Predispositions
was statistically significant but did not reach our MID (Table 2). Mean
item rATRQ scores were 6.3 ± 0.6 (T0), 6.1 ± 0.9 (T1) for
Research Usefulness
, 3.3 ± 1.2 (T0) and 3.4 ± 1.3 (T1) for
Anxiety Towards Research Courses
and 4.3 ± 1.1 (T0) and 3.9 ± 1.4 (T1) for
Positive Research Predispositions
.
Table 2: Mean (SD) of total rATRQ scores and factor scores at T0 and T1
|
Factor
|
T0
mean ± SD
|
T1
mean ± SD
|
Mean difference (95% CI's)
|
|
Research Usefulness
|
25.1 ± 2.5
|
24.2 ± 3.7
|
-0.9 (-1.8 to 0.1)
|
|
Anxiety Towards Research Courses
|
16.7 ± 5.8
|
16.9 ± 6.5
|
0.2 (-1.5 to 2.0)
|
|
Positive Research Predispositions
|
17.3 ± 4.5
|
15.6 ± 6.7
|
-1.7 (-3.2 to -0.2)*
|
|
Total scores
|
59.1 ± 10.1
|
56.8 ± 11.5
|
-
|
*Factors with 95% Confidence Intervals that do not include zero.
The percentage of 'Strongly Agree' to 'Strongly Disagree' responses for
each item for T0 and T1 are shown in Figure 1.
Figure 1: Itemised rATRQ responses for students completing the survey
at T0 (left side) and T1 (right side)
The factors associated with each item below are bolded. Response categories
were 'Strongly Agree' (dark green), 'Agree' (green), 'Somewhat Agree'
(light green), 'Neither Agree nor Disagree' (yellow), 'Somewhat Disagree'
(light orange), 'Disagree' (orange) and 'Strongly Disagree' (red). Items
for the factor 'Anxiety Towards Research Courses' are reverse coded.
Discussion
On entry to the course, most students believed that research was useful for
their career, and this remained stable at the end of the degree. Students
had moderately positive research predispositions, which decreased over the
degree. Students were anxious about research courses, and this factor did
not change between the start and end of the degree. We found no difference
in scores between T0 and T1 in Anxiety Towards Research Courses and
Research Usefulness with narrow 95% confidence intervals not
crossing the meaningful difference. There was a decrease in
Positive Research Predispositions
between T0 to T1 which was statistically significant, but not meaningful.
Overall, there was little difference in research attitudes at T0 and T1.
Research Usefulness
Our students rated research as more useful (24.2 at T1 and 25.1 at T0) than
students in previous studies (Akour et al. 2023; Jansen et al. 2022; Mazher
et al. 2022; Papanastasiou 2014; Sanjaykumar & Shah 2022). Three
previous studies have mean factor scores of 19.9 (Papanastasiou 2014), 20.4
(Jansen et al. 2022) and 19.2 (Akour et al. 2023) which exceed our MID of
3.6. Two studies have higher mean factor scores of 21.2 and 22.1 (Mazher et
al. 2022; Sanjaykumar & Shah 2022). The lower scoring studies were in
undergraduate student populations in the areas of education (Akour et al.
2023), architecture (Jansen et al. 2022) and educational research
(Papanastasiou 2014). Both higher scoring studies surveyed physiotherapy
students who were either postgraduate (Sanjaykumar & Shah 2022) or
undergraduate and postgraduate (Mazher et al. 2022). Mazher et al. (2022)
compared undergraduate students to postgraduate students and found
significantly higher scores for postgraduate students (21.9 vs 20.5), which
may or may not be meaningful, indicating that stage of study (undergraduate
compared to Masters) may have a small effect on perceived research
usefulness.
Reasons for our high scores at T0 and T1 could be the very competitive
requirements for course entry at this university. This includes successful
completion of a health/science related undergraduate degree, a high GPA
requirement, six prerequisites (including a research subject) and good
performance in a semi-structured interview prior to an offer to the course.
In addition, the financial cost of the course (~$80,000 AUD) means that
students are often highly motivated. In addition, our course is Level 9 in
the Australian Qualifications Framework and students can directly apply for
a PhD on completion. Another study that surveyed Masters-by-research and
PhD students also found high (25.0) research usefulness scores, which
suggests that our students may perceive research usefulness similarly to
higher-degree-research students (Kakupa & Xue 2019). In our population,
there is possibly a ceiling effect from T0 to T1 that limits an increase in
scores, with ≈90% of students scoring 'Agree' or 'Strongly Agree' for three
items (Pate et al. 2023) and 68% scoring 'Agree' or 'Strongly Agree' in the
other item. Given this, future research could qualify this factor within
the survey, assess the factor using different surveys (Baloğlu 2002; Melnyk
et al. 2008) or assess the factor in another way, such as using qualitative
research.
Anxiety Towards Research Courses
Our students had high anxiety towards research at T0 (16.7) which remained
high at T1 (16.9). A previous study has also found high anxiety towards
research courses in undergraduate and postgraduate students, with a score
of 15.9 (Mazher et al. 2022), and postgraduate physiotherapy students
having more anxiety than undergraduate students. Other studies show much
lower anxiety about research, with scores of 22.4 (Sanjaykumar & Shah
2022), 23.3 (Akour et al. 2023) and 22.8 (Jansen et al. 2022). Due to the
lack of entry requirements and course-related details provided by other
studies, it is difficult to ascertain why there is such a wide disparity
between studies. For our students, it is possible that the responses may be
due to the high statistics component within the prerequisite research
courses and the requirement for statistics as part of our research
subjects, as students are often very anxious about statistics (Onwuegbuzie
and Wilson, 2003; Pan and Tang, 2004). Our scores may also reflect how the
research subjects are positioned in the course, with a research project
that must be completed in a group over 35 weeks with only 22 weeks of
scheduled classes between multiple placements. Students often struggle when
performing research projects, especially when the difficulty and quantity
of material is high (Wilson & Onwuegbuzie 2001; Yousefi‐Nooraie et al.
2007). The high anxiety is concerning from a student well-being
perspective, and we will need to further investigate the reasons for the
high anxiety experienced. Further investigations could be performed using
qualitative research methods (focus groups or interviews) and may
potentially inform interventions to reduce anxiety.
Positive Research PREDispositions
Students had less positive research predispositions at T0 (17.3) than at T1
(15.6) however the 95% confidence interval and the minimal important
difference (3.6) suggest the difference is not meaningful. Other courses
had similar scores of 14.8 (Papanastasiou 2014), 15.2 (Jansen et al. 2022),
17.44 (Akour et al. 2023) and 18.4 (Mazher et al. 2022), with only one study
(Sanjaykumar & Shah 2022) showing highly positive research
predispositions (21.1). Although our scores are similar to most other
courses, a more positive inclination towards research may encourage the use
of research in clinical practice (Olsen et al. 2013). This could be attained
by restructuring the delivery of topics so that certain topics are avoided
as introductory content (such as statistics, diagnosis and prognosis) with
this more advanced content being provided later in the degree
(Yousefi‐Nooraie et al. 2007). Providing research content so that advanced
content is scaffolded with introductory content provides an easy
progression for students through the degree; however, it may not make
material more interesting. In our course, students also perform a research
project concurrently with research courses. As such, our scores likely come
from a combination of the content taught in the research classes and the
research project that is performed. Currently, research topics are chosen
by academics (with students choosing a topic within a range of
academic-selected topics). Allowing students to choose their own research
topic would likely increase their interest in the
topic.Although this would improve student
engagement, projects would require oversight from an academic, who may not
have content knowledge in the area. Other strategies to improve student
engagement could be journal clubs(Helgøy et al. 2022) (as marked or
unmarked assessments), with academics providing external exemplars, such as
the Physiotherapy Evidence Database (PEDro) World-Wide Journal Club (2020).
These exemplars could be helpful to students (Carless et al. 2018) and
signpost resources that could be used after their degree (Boud and
Falchikov 2006). We will be able to measure the success or failure of
strategies employed to improve attitudes to research through the rATRQ.
Limitations
There is limited information on the psychometric properties of the rATRQ,
including test-retest reliability, the smallest detectable change,
minimally important change, and responsiveness. This means that
interpretation of the magnitude of difference in responses from T0 to T1
requires caution. The low number of respondents at T1 (57%) compared to T0
(97%) could indicate both more positive and more negative reported
attitudes towards research at T1. Students who disliked the subjects may be
more likely to respond in order to voice their dissatisfaction, or less
likely to respond as they do not want to engage in a research-related
questionnaire.
One weakness of the study methodology was that it used an unlinked survey
at T0 and T1, with a partially overlapping population. A stronger design
would survey students at both timepoints with linked responses. This would
enable us to determine if there are factors, items or predictors at T0 that
may be associated with attitudes about research at T1. Unfortunately, this
was not possible with the ethical approval we had received at the time of
the study.
The survey at T0 was completed in orientation week prior to the degree.
Although the surveys are anonymous, students may have been unrealistically
optimistic at T0 as they were looking forward to the course and had just
completed a break from their previous degree. Students may be more
pessimistic at T1, as they are tired from the course, are possibly
uncertain about future employment opportunities and are excited to be
practicing clinicians and not researchers.
Future directions
Student attitudes may not necessarily relate to student abilities in
research. Regardless of their attitude towards research, they may be very
competent (and use research in practice) or very incompetent (and not use
research in practice). Student attitudes would need to be verified by
surveys or interviews when they are in clinical practice, after graduation.
The rATRQ provides an indication of the responses using a 7-point Likert
scale. Although it can provide an indication of areas of improvement, it is
limited in scope and does not provide an indication of the complexity of
learning research from a student perspective, or teaching research from an
academic's perspective. Performing qualitative semi-structured interviews
or using focus groups of academics, students and other stakeholders could
enhance the data provided here and allow a deeper understanding of issues
encountered. For this, we intend to implement a co-design element where
students, academics, patients and other stakeholders contribute as partners
in curriculum development (Healey et al. 2016). As occurs with using (for
example) a students-as-partners approach, this co-design element will
provide students with ownership of the research subjects and allow the
subjects to clearly align with their needs and requirements, in
consultation with academics (Healey et al. 2016). This may also assist in
reducing student anxiety and increasing positive predispositions.
The current study provides information about student attitudes before and
after the degree. As such, we can make changes to our courses to enable
students to be more engaged. We can assess the effectiveness of the changes
using the rATRQ or other questionnaires such as the Statistics Anxiety
Rating Scale (Baloğlu 2002) and the Evidence Based Practice Beliefs and
Implementation scale(s) (Melnyk et al. 2008). This could provide an
indication that the implemented changes improve student attitudes.
Conclusion
Our students believed research was useful, had moderately positive research
predispositions, which decreased over the degree, and were anxious about
research courses. There was no difference in
Anxiety Towards Research Courses
and Research Usefulness between T0 and T1. There was a significant
decrease in Positive Research Predispositions from T0 to T1 that
was not meaningful. Our students had similar research predispositions to
those in other courses.
Acknowledgements
We would like to thank the student cohorts starting their degree in 2020
and 2021 and a completing their degree in 2020 and 2021.
Declaration of Interest statement
We report no competing interests.
Funding statement
This work is unfunded.
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