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Article Number: 0849BA768880
ISSN: 2805-4202
Copyright ©2020
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African Journal of Health Sciences and
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Full Length Research Paper

Attitudes and Barriers towards Continuing Professional

Development among Physiotherapists in South-Eastern
Nigeria
Anwara SU., Nmecha CE., Moses EA., Okarekpe E., *Mgbeojedo UG., Ekechukwu END.,
Ezeukwu OA.
Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of
Nigeria, Enugu Campus, Enugu, Nigeria

Continuing professional development (CPD) programmes are important components of professional

training to maintain competence. There is insufficient information regarding physiotherapists’
participation in CPD activities in South-Eastern Nigeria. This study aimed to determine the attitude and
barriers towards CPD among Physiotherapists in South-Eastern Nigeria. A cross-sectional survey
involving 104 clinical Physiotherapists. A self-developed, content validated (CVI = 4.21) and reliable
questionnaire (Split Half = 0.83) with 5 domains and 46 items that assessed the types of CPD activities,
attitudes, barriers and benefits of physiotherapists towards continuing professional development (CPD)
was used. Ethical approval was sought and obtained from the Health and Research Review Board of the
University of Nigeria Teaching Hospital (UNTH), Enugu. Data was analyzed using descriptive statistics
and Chi-square at α = 0.05. A total 104 Physiotherapist, mostly male (53.8%), and aged ≤ 40years (81.7%)
participated in this study. They were most likely to attend seminars, congress or scientific
meetings/conferences (92.3%), and take part in a research work/ journal publication (76.0%) as CPDs.
Majority of them disagreed that topics/subjects of specialization (72.1%) and professional burnout
(66.3%) were the barriers to CPDs. Primary place of work was significantly associated with each of CPD
activities (X2 = 17.77, p < 0.001), CPD benefits (X2 = 7.48, p = 0.024), and CPD barriers (X2 = 8.23, p =
0.016).There was also a significant association between gender and CPD benefits (X2 = 6.34, p = 0.042),
and CPD barriers (X2 = 7.43, p =0.006). Physiotherapists in the Southeastern region of Nigeria have a
good attitude towards CPDs. Primary place of work and gender are significantly associated with some
measures of CPD activities, benefits of CPD and barriers to CPDs.

Key words: Continuing Professional Development, Attitudes, Barriers, Benefits, Southeastern Nigeria.

INTRODUCTION

The delivery of health care including physiotherapy is and Knowledge and continuously keep up to date with
concerned with quality and accountability (Supper et al, changes in practice. Continuing Professional
2015; Ekechukwu et al, 2019). There is a demand on Development (CPD) is central to this process (Elshami
healthcare professionals to critically review their skills et al, 2016). Continuing Professional Development

*Corresponding author. E-mail: [email protected].

Author(s) agree that this article remain permanently open access under the terms of the Creative Commons Attribution
License 4.0 International License
98 Afr. J. Health Sci. Technol.

includes areas of personal and professional development Ethical Issues

that usually starts with undergraduate training (Grant and
Ethical approval was sought and obtained from the Health and
Zilling, 2017). It incorporates clinical proficiency as well Research Review Board of the University of Nigeria Teaching
as non-clinical activities such as information technology, Hospital (UNTH), Ituku-Ozalla, Enugu, Nigeria. Informed consent
management, leadership and communication skills. It is was also sought and obtained from the participants. The study also
dependent on the ability to critically evaluate through adhered strictly to the Helsinki’s declaration (Adeniyi et al, 2014;
clinical reasoning and reflection (Bengtsson and Carlson, Odetola et al, 2020).
2015).
Conversely, continuing education can be viewed as a Instrument
means of updating knowledge through passive learning
and didactic teaching models; this marginalizes the A self developed questionnaire with 5 domains (Socio-
significant learning and development that occurs in daily demographics, Job/Occupational characteristics, CPD Attendance,
practice (Grant, 1994; Jarvis, 2013). Consequently, a Attitude/Benefits of CPDs, and Barriers to CPDs) and 46 items.
Adjectival scales and Likert scales were used for rating the
shift has occurred from continuing education to
participant’s responses. A two stage content validation was done
continuing professional development, where passive using 8 experts and a content validity index (CVI) of 4.21 was
learning has been replaced by active and experiential obtained. The reliability of the instrument was done using the
learning. Continuing professional development requires responses of 20 pilot-test participants who were eligible to
individuals to take personal responsibility for identifying participate in the main study. Internal consistency of items for the
their learning needs and evaluating if those needs have domains varied between a Cronbach’s Alpha of 0.72 – 0.89. The
total reliability (split half) for the whole instrument was 0.83.
been met (Alsop, 2013). This includes an awareness of
learning needs and self-directed learning based on
experience and perceived responsibility (Kitto et al, 2018) Data Analysis
and has been embraced internationally by numerous
physiotherapy professional bodies. The data obtained was analyzed using statistical package for social
Nigerian Physiotherapists are encouraged to attend sciences, version 20.0(SPSS Inc. Chicago, IL, USA). Descriptive
statistics of frequency, percentage, mean, standard deviation were
continuing professional development programme. It is in used to describe the participants. Inferential statistics of chi-square
fact, a prerequisite for the annual renewing of test was used to determine the association variables. Level of
professional license from the Medical Rehabilitation significance was set at 0.05.
Therapist Board of Nigeria (MRTBN). However, there
appear to be a dearth of empirical literature concerning
the attitudes of Physiotherapists in Nigeria concerning
RESULTS
continuing professional development programmes as well
as the possible barriers that militates against their
Socio-Demographic Characteristics
participation in these programme. This study therefore
assessed the attitudes and barriers to continuing
A total 104 Physiotherapist who met the inclusion criteria
professional development among Physiotherapists in the
participated in this study. Most of the participants were
Southeastern region of Nigeria.
male (53.8%), aged ≤ 40years (81.7%) and had only a
first degree (70.2%) mostly from the University of Nigeria
(75.0%). Majority of the participants were primarily
METHODS
Clinicians (89.4%) and had neither masters (71.2%) nor a
doctoral (91.2) postgraduate training as shown in Table
Subject Description
1.
The participants were Physiotherapists from the five South East
states in Nigeria. Only Physiotherapists who have been actively Job/Occupational Characteristics
involved with patient treatment / management not more than two
months ago as at the time of this study were included in this study. Most of the participants were either Intern
Physiotherapists (28.8%) or Senior Physiotherapists
(33.7%). Majority of the participants specialized in
Study Design
Orthopaedics/Sports Physiotherapy (29.8%) but only few
This study utilized a cross-sectional descriptive survey design. This had a postgraduate degree in their areas of specialization
design was chosen as it intends to gain immediate knowledge and (21.2%). Also, Majority of the participants had ≤10years
information on the attitudes and barriers towards continuing clinical experience as shown in Table 2.
professional development (CPD) among physiotherapist in South-
Eastern Nigeria. The design was useful in that it allowed collection
of information on the attitudes and barriers towards continuing
professional development (CPD) among physiotherapist in South- Continuing Professional Developments Attended
Eastern Nigeria from a relatively large number of subjects to allow
for generalization. The participants reported that they were most likely to
 Mgbeojedo et al 99

Table 1: Socio-Demographic Characteristics of Participants (N = 104)

Variables Categories Frequency Percentage
<30 42 40.4
Age(years) 31-40 43 41.3
41-50 15 14.4
>50 4 3.8
Male 56 53.8
Gender
Female 48 46.2
First degree 73 70.2
Honorary doctorate 2 1.9
highest level of
Master’s degree 24 23.1
education attained
Professional doctorate 3 2.9
Academic doctorate degree 2 1.9
University of Nigeria 78 75.0
University of Ibadan 4 3.8
Institution of training for Obafemi Awolowo
4 3.8
First degree University
Nnamdi Azikiwe University 15 14.4
Universities Outside Nigeria 3 2.9
University of Nigeria 14 13.5
Nnamdi Azikiwe University 1 1.0
University of Lagos 1 1.0
Institution of training for Obafemi Awolowo
2 1.9
Masters University
University of Ibadan 3 2.9
Other Universities 5 4.8
Universities Outside Nigeria 4 3.8
None 74 71.2
University of Nigeria 1 1.0
Nnamdi Azikiwe University 1 1.0
Institution of training for
University of Benin 1 1.0
Doctorate
Universities Outside Nigeria 2 1.9
None 99 95.2
Primary place of work Academic based 11 10.6
Clinical based 93 89.4

attend seminars, congress or scientific meetings / aspect of being a modern day healthcare provider
conferences (92.3%), attend workshops (72.1%), (61.5%) as well as those practitioners should be
participate in self-directed learning (72.1%), and take part motivated to engage in CPDs (63.6%). Comparatively,
in a research work/ journal publication (76.0%) than to fewer participants agreed that CPD is another
attend journal clubs, self-study or organized groups perspective of clinical effectiveness (50.0%) as well as
(55.8%) as well as make presentations at credited that it incorporates clinical proficiency into clinical practice
meetings/conference (59.6%) as shown in Table 3. (55.8%). Conversely, majority of the participants
disagreed that CPD is useful to only the Physiotherapists
Benefits Continuing Professional Developments in academics (87.5%) while relatively fewer participants
also disagreed that CPD improves demands on
Majority of the participants agreed that CPDs improve Overloaded clinicians (53.8%) as well as implies a day-to
their performance in their current roles (75.0%), enhance day experience at work (51.0%) as shown in Table 5
the status of Physiotherapy with respect to other Health
Professions (67.3%). Contrarily, few agreed that CPDs
Barriers to Continuing Professional Developments
enhance their career prospects (56.7%) as well as
enhance the status of profession with the public (48.1%).
However, majority of the participants disagreed that there Majority of the participants disagreed that topics/subjects
was no benefit from CPDs (90.4%) as shown in Table 4. of specialization (72.1%), professional burnout (66.3%)
access to internet (62.5%) were the barriers to CPD.
Attitude towards Continuing Professional Relatively fewer participants also disagreed that family
Developments Constraint (55.8%), lack relevant learning
opportunities(55.8%) low personal priority in relation to
Most of the participants agreed that CPD is an integral their activities (54.8%) lack time (51.9%) and
100 Afr. J. Health Sci. Technol.

Table 2: Job/occupational characteristics of participants (n=104)

Variables Categories Frequency Percentage
Intern PT 30 28.8
Youth Corper 4 3.8
Senior PT 35 33.7
Principal PT 16 15.4
Assistant Chief PT 7 6.7
Job rank
Chief PT 2 1.9
Assistant Director 1 1.0
Director 4 3.8
G/A – Lecturer I 4 3.8
Senior Lecturer 1 1.0
Orthopaedics / Sports 31 29.8
Musculoskeletal 15 14.4
Nuerology 13 13.5
Area of specialty
Women’s Health 9 8.7
Cardiopulmonary 5 4.8
None 31 29.8
Yes 24 21.2
Degree in area of specialty
No 80 76.9
M.Sc. 22 21.2
Types of Postgraduate Degree Ph.D. 1 1.0
None 81 77.9
1-5 46 44.2
6-10 29 27.9
11-15 16 15.4
Year of clinical experience 16-20 5 4.8
21-25 6 5.8
26-30 1 1.0
Over 30 1 1.0
PT = Physiotherapist, G/A = Graduate Assistant

understanding of subjects/topics (51.1%) were the gender and primary place of work (p > 0.05) as shown in
barriers to CPDs. Table 8.
On the contrary, most of the participants were
indifferent, regarding job constraints (56.7%) and Association between Attitudes towards CPD and Age,
accessibility in terms to location/distance (54.8%) as Gender, Primary Place of Work
barriers to CDPs as shown in Table 6.
There was no significant association between all the
Association between CPD Activities and each of Age, descriptors of attitude towards CPD and each of age,
Gender and Primary Place of Work gender and primary place of work (p > 0.05) as shown in
There was a significant association between primary Table 9.
place of work and the choice of seminars, congress,
scientific meetings/ conferences as CPD activities (X2 =
17.77, p < 0.001). Conversely, there was no significant Association between Barriers to CPD and each of
association between the other possible CPD activities Age, Gender and Primary Place of Work
and each of age, gender and primary place of work (p >
0.05) as shown in Table 7. There was a significant association between each of
accessibility in terms of location/ distance (X2 = 6.69, p =
Association between Benefits of CPD and Age, 0.035) and access to bibliographic databases (X2 = 8.23,p
Gender, Primary Place of Work = 0.016) as barriers to CPD and primary place of work.
There was also a significant association between cost of
There was a significant association between improved transportation and each of gender (X2 = 6.02, p = 0.049),
performance as a benefit of CPD and each of gender (X2 and primary place of work (X2 = 6.87, p = 0.032).
= 6.34, p = 0.042), and primary place of work (X2 = 7.48, Similarly, there was a significant association between
p = 0.024) but not with age (X2 = 3.43, p = 0.753). each of the information hoarding (X2 = 7.43, p =0.006)
However, there was no significant association between and low standard programme (X2 = 5.89, p = 0.015) as
the other possible benefits of CPD and each of age, barriers to CPD and gender as shown in Table 10.
 Mgbeojedo et al 101

Table 3: Types of CPD activities attended by participants (n=104)

Frequency (Percentage)
Variables
Likely Neutral Unlikely

Seminars/ congress/ scientific meetings/ conferences 96(92.3) 6(5.8) 2(1.9)

Courses/ hands-on practical courses/ in-house training 63(65.4) 26(25.0) 9.6(9.6)

Workshops 76(73.1) 21(20.2) 7(6.7)

Discussion with other healthcare providers. 63(60.6) 29(27.9) 12(11.5)

Postgraduate programme 75(72.1) 23(22.1) 6(5.8)

Self-directed learning eg, reading journal articles, distance learning 75(72) 18(17.3) 10.6(10.6)

Journal clubs/ self-study group/ organized group discussion under

58(55.8) 31(29.8) 15(14.4)
accredited coordinator

Presenter at credited meeting or conference 62(59.6) 32(30.89 10(9.6)

Participating in research work/ publication journal articles report on book

79(76.0) 14(13.5) 11(10.6)
chapters.

Table 4: Benefits of CPD (N=104)

Variables Agree Indifferent Disagree

Improves my performance in current role 78(75.0) 22(21.2) 4(3.8)

Enhances status of physiotherapy with other health

70(67.3) 25(24.0) 9(8.7)
profession

Enhances my career prospect 59(56.7) 32(30.8) 13(12.5)

Enhances status of profession with the public 50(48.1) 37(35.6) 17(16.3)

I see no benefits from CPD 6(5.8) 4(3.8) 94(90.4)

Table 5: Attitude of Participants towards CPD. (N=104)

Variables Agree Indifferent Disagree

CPD is another perspective of clinical effectiveness 52(50.0) 38(36.5) 14(13.5)

CPD is an integral aspect of being a modern day health care

64(61.5) 34(32.7) 6(5.8)
professional

Practitioners should be motivated to engage in CPD 60(63.6) 30(28.8) 11(6.2)

CPD incorporates clinical proficiency into clinical practice 58(55.8) 33(31.7) 13(12.5)

CPD improves demand on overloaded clinicians 19(18.3) 29(27.9) 56(53.8)

CPD implies a day to day experience at work place 19(18.3) 32(30.8) 53(51.0)

CPD is useful to only physiotherapist in academics 6(5.8) 7(6.7) 91(87.5)

102 Afr. J. Health Sci. Technol.

Table 6: Barriers to CPD among Participants (N = 104)

variables Agree Indifferent Disagree

Accessibility (location/distance) 27(26.0) 57(54.8) 20(19.29

Job constraints 22(21.2) 59(56.7) 23(22.1)

Access to bibliographic database (e.g. PEDro, Medline, Physiobase) 22(21.2) 34(32.79 48(46.2)

Access to internet 9(8.7) 30(28.8) 65(62.5)

Lack of time 12(11.5) 38(36.5) 54(51.9)

Cost of participation 39(37.5) 46(44.2) 19(18.3)

Lack of relevant learning opportunities 15(14.4) 31(29.8) 58(55.8)

Lack of quality learning activities 13(12.5) 41(39.4) 50(48.1)

Uninteresting subjects/ topics 10(9.6) 40(38.5) 54(51.1)

Lack of learning opportunities that match learning style 5(4.8) 34(32.7) 65(62.5)

Family constraints 15(14.4) 31(29.8) 58(55.8)

Professional burnout 7(6.7) 28(26.9) 69(66.3)

Topics/Subjects to specialize 9(8.7) 20(19.2) 75(72.1)

Low personal priority of learning in relation to other activities. 16(15.4) 31(29.8) 57(54.8)

Table 7: Association between CPD Activities and each of Age, Gender and Primary Place of Work (N = 104)
X2 (p-value)
Variables
Primary place
Age Gender
of work

Seminars, congress, scientific meeting and conferences 3.22 (0.781) 2.73 (0.255) 17.77 (<0.001)*

Courses; hands-on practical courses; in –house training 10.14 (0.119) 3.30 (0.191) 1.19 (0.553)

Workshops 11.79 (0.067) 0.93 (0.627) 0.13 (0.939)

Discussion with other healthcare providers. 3.96 (0.683) 3.46 (0.178) 3.11 (0.212)

Postgraduate programme 1.89 (0.930) 0.51 (0.774) 0.51 (0.777)

Self-directed learning eg, reading journal articles, distance learning 2.86 (0.826) 1.50 (0.473) 1.15 (0.562)

Journal clubs, self-study group; organized group discussion under

4.86 (0.562) 1.37 (0.505) 4.96 (0.084)
accredited coordinator

Presenter at credited meeting or conference 4.11 (0.661) 0.17 (0.919) 2.92 (0.233)

Participating in research work, publication journal articles report on

1.95 (0.924) 4.26 (0.119) 2.38 (0.304)
book chapters.

Key: * = significant
 Mgbeojedo et al 103

Table 8: Association between Benefits of CPD and each of Age, Gender, Primary Place of Work (N = 104)
X2 (p-value)

Variables Age Gender Primary place of work

Improves my performance 3.43 (0.753) 6.34 (0.042)* 7.48 (0.024)*

Enhances status 3.38 (0.760) 0.97 (0.616) 3.98 (0.137)

Enhances my career 4.94 (0.552) 1.46 (0.482) 0.38 (0.828)

Enhances status of profession 3.97 (0.680) 1.83 (0.401) 1.25 (0.535)

I see no benefits 6.63 (0.357) 1.74 (0.418) 0.71 (0.702)

Key: * = significant

Table 9: Association between Attitudes towards CPD and each of Age, Gender, Primary Place of Work (N = 104)
X2 (p-value)
Variables
Age Gender Primary place
of work

CPD is another perspective of clinical effectiveness 9.22 (0.161) 1.01 (0.603) 0.54 (0.762)

CPD is an integral aspect of being a modern day health

practitioner 6.84 (0.336) 2.10 (0.351) 0.36 (0.838)

Practitioners should be motivated 3.48 (0.747) 0.76 (0.685) 5.44 (0.066)

CPD incorporates clinical proficiency into clinical practice 5.96 (0.428) 0.39 (0.825) 2.46 (0.292)

CPD improves demand on overloaded clinicians 4.71 (0.582) 0.18 (0.914) 3.76 (0.152)

CPD implies a day to day experience at work place 12.04 (0.061) 3.29 (0.193) 1.21 (0.546)

CPD is useful to only physiotherapists in academics 1.50 (0.959) 0.07 (0.967) 1.08 (0.583)

DISCUSSION The results revealed that more than half of the

The quest for improving the standard of practice among participants strongly agreed that CPD is another
healthcare professionals in developing countries is often perspective of clinical effectiveness and that CPD is an
seen as an attempt to attain the progress achieved in integral aspect of being a modern day health care
healthcare outcomes in developed countries (Umar et al, professional. This may be because CPD activities
2019; Ekechukwu et al, 2020). The commonly adopted improves their performance and enhances their status
pragmatic measure by most health professionals is the with other health care professions. It may also imply that
participation in Continuing Professional Development physiotherapists in this study were aware of the concepts
(CPD) training programmes. There is insufficient and relevance of CPD as a way to improve their practice.
literature, however, relating to the factors enhancing or This is in agreement with the results of the study
militating against the level of participation in CPD among conducted by Bello and Lawson (2013) which indicated
physiotherapists in southeastern Nigeria. This study that a significant proportion of physiotherapists in Ghana
attempted to determine the attitudes of the southeastern demonstrated good attitudes on the issues pertaining to
physiotherapists towards engaging in CPD and to also CPD. However, it was reported that age, gender, primary
identify the possible barriers preventing them from place of work were not significantly associated with the
participation. attitudes towards CPD. This may imply that the
104 Afr. J. Health Sci. Technol.

Table 10: Association between Barriers to CPD and each of Age, Gender and Primary Place of Work (N = 104)
X2 (p-value)
Variables Primary Place of
Age Gender
Work

Accessibility (location/distance) 5.70 (0.457) 0.66 (0.717) 6.69 (0.035)*

Job constraints 4.03 (0.672) 0.52 (0.770) 0.31 (0.855)

Access to bibliographic database (e.g. PEDro, 4.49 (0.611) 1.93 (0.382) 8.23 (0.016)*
Medline, Physiobase)

Access to internet 6.71 (0.348) 0.20 (0.919) 2.28 (0.319)

Lack of time 3.88 (0.693) 4.48 (0.106) 4.47 (0.107)

Cost of participation 4.19 (0.651) 6.02 (0.049)* 6.87 (0.032)*

Lack of relevant learning opportunities 3.76 (0.710) 1.94 (0.379) 2.44(0.296)

Lack of quality learning activities 2.74 (0.840) 0.15 (0.927) 1.76 (0.415)

Uninteresting subjects or topics 10.16 (0.118) 0.45 (0.797) 2.34 (0.310)

Lack of learning opportunities to match 6.66 (0.354) 1.49 (0.474) 1.33 (0.515)
learning style

Family constraints 4.76 (0.574) 5.48 (0.065) 5.88 (0.053)

Professional burnout 8.16 (0.226) 0.38 (0.826) 1.25 (0.536)

Topics. Subjects to specialize 7.96 (0.241) 5.43 (0.066) 1.48 (0.477)

Low personal priority of learning in relation to 2.93 (0.818) 0.08 (0.959) 1.69 (0.430)
other activities

Cost 4.23 (0.237) 0.33 (0.565) 0.15 (0.699)

Time 6.33 (0.097) 0.08 (0.772) 1.18 (0.278)

Distance 7.64 (0.054) 2.41 (0.120) 0.01 (0.916)

Information hoarding 4.77 (0.190) 7.43 (0.006)* 0.25 (0.617)

Cocky attitudes 2.32 (0.508) 0.35 (0.554) 0.01 (0.957)

Low standard programme 3.46 (0.326) 5.89 (0.015)* 0.69 (0.405)

Key: * = significant

engagement in CPD is not a function of an individual’s with the participant’s primary place of work, while the cost
age, gender or place of work. of participation was also significantly associated with
The findings from this study also showed that, the most gender. This is in agreement with the study done by Aziz
common complaints regarding the barriers towards et al. (2012) where the majority of respondents indicated
continuing professional development from the that their job constraints, cost, and time were barriers to
physiotherapists who participated in this work were the their participation in CPDs. Similarly, Bello and Lawson
cost of participation, accessibility, job constraints and (2013) reported that the common complaints by
access to bibliographic database. It was also reported physiotherapists included the non-availability or limited
that barriers such as accessibility, access to bibliography access to libraries and online databases to access
and cost of participation were significantly associated literature at their work facilities. Conversely, this report is
 Mgbeojedo et al 105

in disagreement with Ahuja (2011) that opined that lack of Bello, A.I. and Lawson, I.G., 2013. Attitudes and barriers towards
engaging in continuing professional development among clinical
motivation, learning culture and aims of the organization
physiotherapists in Ghana. Internet Journal of Allied Health Sciences
were major barriers towards continuing professional and Practice, 11(1), p.7.
development among physiotherapists. Also, in this study, Bengtsson, M. and Carlson, E., 2015. Knowledge and skills needed to
information hoarding and low standard programme were improve as preceptor: development of a continuous professional
development course–a qualitative study part I. BMC nursing, 14(1),
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