Looking Upstream: Exploring Doctor of Physical Therapy Students' Perceived Competence in Addressing Social and Structural Determinants of Health

This study explored doctor of physical therapy (DPT) students' attitudes, perceived knowledge, and perceived competence specific to social and structural determinants of health (SDOH). Current students in a DPT program housed within a college of public health in an urban research institution served as the participants for this research. The primary purpose of this study was to explore students' self-evaluation and perceptions of competence with SDOH in hopes of gaining insight into elements of their education that contributed to their preparedness and/or what strategies and resources are needed to foster competence in this area. A secondary aim of this study was to explore how individual student factors and curricular factors impact students' awareness of SDOH. A mixed methods study design employed bivariate and multivariate analysis of participants' responses to self-report Likert scale survey questions and analysis of semi-structured interviews using qualitative description and phenomenological principles. Quantitative data analysis revealed differences in perceived skills competence based on cohort (year one, two, or three in the program) with first-year students demonstrating lower perceived competence. Analysis of attitudes and knowledge demonstrated that all participants held a positive perspective regarding the importance of SDOH as well as perceived foundational knowledge for this content. Quantitative analysis also detected subtle differences in specific sample beliefs and behaviors based on demographic variables such as gender identity, race, and first-generation student status. Qualitative data supported the quantitative findings with participants articulating specific elements of their identities and the DPT curriculum that contributed to their understanding of SDOH. An iterative coding process identified two primary themes that corresponded to the research aims: 1) Learners' perceived importance of social and structural determinants of health and factors that impact how to address them; and 2) Learning about social and structural determinants of health: What learners bring with them and what they gain throughout the curriculum. These findings shed light on the elements of this educational program that foster students understanding of SDOH and the types of experiences that help clinical learners appreciate the impact of these upstream drivers of health for patients and populations. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]