Factors Contributing to the Academic Challenges Faced by South African Physiotherapy, Occupational Therapy and Biokinetics Students

Abstract

Students of the Health Science professions of Physiotherapy, Occupational Therapy, and Biokinetics share mutual subjects detailing human bodily functions, as well as their pathology and subsequent rehabilitation, as such sharing similarly factors influencing academic success. Factors influencing students’ academic success include matriculation scores, pedagogic techniques, successful integration into the university environment, self-efficacy, finances, and the language of instruction/teaching. While the three professions share similar prerequisite matriculation subjects, their university admission point scores vary, generating a degree of concern within a number of higher education institutions (HEIs). The global need to provide liberal access to HEIs has encouraged many tertiary institutions to adopt a policy of affirmative action that encompasses two fundamental strategies; the provision of financial support for deserving undergraduate students from previously disadvantaged communities, and the lowering of prerequisite admission scores. Despite these attempts at the creation of higher education equity, many students’ academic performance is poor. The primary objective of this chapter is to review the factors, which influence the academic success rate of students engaged in a course of study geared at entry into the Physiotherapy, Occupational Therapy, or Biokinetics professions at a South African HEI. This paper chapter seeks to recommend potential strategies to improve student academic performance.

1. Introduction

“Higher Education Institutions” (HEIs) refers to tertiary educational institutions which provide and confer advanced credentials such as certificates, higher certificates, diplomas, advance diplomas, undergraduate/bachelor degrees, and post graduate degrees (honours, masters and doctoral degrees) in specific professions and/or disciplines [1]. The practice of equity and liberal access to HEIs is associated with the socialist philosophical ideology of justice and democracy. Mkude, Cooksey, and Levey suggested that equity and liberal access to HEIs contributes to the growth of a progressive society by encouraging social inclusiveness, thereby instilling national camaraderie [2].

South Africa is a nation composed of four primary ethnic groups: Black, Coloured, White, and Indian reflecting great socioeconomic diversity both within and across groups [3]. In 1999, Professor Kadar Asmal attempted to forge a democratic and liberal ethos among South African HEIs by convening a Council on Higher Education (CHE) in order to evaluate, recommend and subsequently transform national educational policies with the goal of promoting greater impartiality and providing improved opportunities for previously disadvantaged ethnic groups, making higher education more accessible to all South Africans. The primary findings of the CHE were that disparities and diversity between the great numbers of South African HEIs were “divisive” with regards to ethnicity, geography/location, finances, and resources; they furthermore shared dissimilar administrative structures which ultimately produced gross inequalities across the board [4]. The CHE guided the process of higher education transformation, aimed at addressing questions of accessibility and inequality [5].

HEIs embraced two fundamental strategies in order to address the concerns of inaccessibility and inequality: firstly, the provision of financial aid to deserving students from low socio-economic communities; secondly, the manipulation of admission and selection policies in an attempt to accommodate students with impoverished socio-economic backgrounds [6]. This approach is referred to as affirmative action, and has been met with mixed emotions [7]. Modisha reported that affirmative action instituted among South African HEIs was geared at the decolonisation of apartheid policies of inaccessibility and inequality [8]. Affirmative action further sought to create new policies of accessibility and equality, enhancing the educational and subsequent employment prospects of students from socio-economically disadvantaged communities, and thus improving their overall quality of life. The National Student Financial Aid Scheme (NSFAS) was founded in 1996 by the Department of Higher Education and Training, so as to financially support undergraduate students. The post millennium admission criteria of South African HEIs has been amended, following global trends of affirmative action, receiving mixed reactions from the 19 South African HEIs [9].

Regardless of these attempts to eliminate gatekeeping and create higher education impartiality, the academic success of many students remains poor. Factors influencing academic success include final school year academic performance, successful integration into the university environment, self-efficacy, finances, the language of instruction/teaching, and student organisational skills [10, 11]. The primary objective of this paper is to review the factors which influence the academic success rate of students engaged in a course of study geared at entry into the Physiotherapy, Occupational Therapy, or Biokinetics professions at a South African HEI. This paper further seeks to recommend potential strategies to improve student academic performance.

2. Methodology

2.1 Protocol

An electronic narrative literature surveillance adopting the Preferred Reporting Items for Systematic Reviews (PRISMA) benchmarks was followed.

2.2 Registration

This review protocol was not registered with the International Prospective Register of Systematic Reviews.

2.3 Search strategy and literature sources

The admission criteria for the disciplines of Physiotherapy, Occupational Therapy and Biokinetics at South African HEIs were surveyed through the examination of HEI online study prospectuses which are readily found via the Google search engine. Only HEIs offering four-year professional degrees in Physiotherapy, Occupational Therapy, and Biokinetics were considered. While 19 HEIs in South Africa offer advanced educational qualifications, not all of them offer professional four-year academic programmes. Eight HEIs offered degrees in Physiotherapy and Occupational Therapy, but only six offered degrees in Biokinetics; this chapter is thus concerned with the review of the prerequisite admission criteria of the latter sic institutions. The review of the prerequisite admission criteria reviewed 2020 HEIs admission criteria. The primary keywords in the literature search were: admission criteria, thereafter subsequent words such as Physiotherapy, Occupational Therapy, Biokinetics and South Africa were added. The selection criteria of literature was the prospectus of various South African Higher Education Institutes (HEI) that offer Physiotherapy, Occupational Therapy and Biokinetics four-year professional academic programmes.

A second electronic search was instituted to determine the academic success of Physiotherapy, Occupational Therapy and Biokinetics among South African HEIs in the search engine of Google.

2.4 Eligibility criteria

Participants were records pertaining to the admission criteria of various HEI Physiotherapy, Occupational Therapy and Biokinetics academic programmes. Pertinent themes which emerged: national senior certificate with bachelor degree endorsement, perquisite secondary schooling subjects, minimum admission point score (APS) and national benchmark test.

2.5 Research questions

The identified themes evolved research questions:

• What is the admission criteria of Physiotherapy programmes offered at South Africa Higher Education Institutions?

• What is the admission criteria of Occupational Therapy programme offered at South Africa Higher Education Institutions?

• What is the admission criteria of Biokinetics programme offered at South Africa Higher Education Institutions?

• What other factors influence Physiotherapy, Occupational Therapy and Biokinetics students’ academic success at South Africa HEI?

2.6 Omitting criteria

Records preceding to 2020, non-South African HEI admission criteria of Physiotherapy, Occupational Therapy and Biokinetics, academic programmes besides Physiotherapy, Occupational Therapy and Biokinetics programmes, factors influencing the academic success of tertiary students registered for disciplines other than Physiotherapy, Occupational Therapy and Biokinetics, and, non-English papers.

3. Results

Table 1 reflects the prerequisite admission criteria employed by South African HEIs for the admission of prospective students in the aforementioned Health Science disciplines. Mathematics, Life Science, Physical Science, and English were common matriculation subjects identified as precursors for HEI admission. However, subject prerequisite scores at each institution varied: the matriculation prerequisite score for admission to Physiotherapy ranges from 28 to 39, while that for Occupational ranges from 25 to 36 and the prerequisite scores for admission to Biokinetics vary from 24 to 37. Furthermore, while the National Benchmark Test was a popular assessment for admissions to the disciplines of Physiotherapy and Occupational Therapy, this was not the case with admissions to Biokinetics.

University	National Senior Certificate with bachelor’s degree endorsement	Prerequisite Secondary Schooling subject level				Minimum Admission Point Score	National Benchmark Test
		Mathematics	Life Science	Physical Science	English
Physiotherapy
Kwa-Zulu Natal	✓	4	4	4	4	30	X
Sefako Makgatho	✓	4	4	4	4	28	X
Witwatersrand	✓	5	5	5	5		✓
Western Cape	✓	4	4	4	4	39	X
Stellenbosh		4	4		4		X
Cape Town	✓	5	5	5	5	36	✓
Pretoria	✓	4		4	4	30	✓
Free State	✓	5	5	5	5	36	✓
Average	✓	4.4	4.4	4.4	4.4	33.5	✓
Occupational Therapy
Kwa-Zulu Natal	✓	3	3	3	4	30	X
Sefako Makgatho	✓	4	4	4	4	25	X
Witwatersrand	✓	4	4	4	4		✓
Western Cape	✓	3	4		4	33	X
Stellenbosh	✓	3	4				✓
Cape Town	✓	5	5	5	5	34	✓
Pretoria	✓	4		4	4	30	✓
Free State	✓	5	5	5		36	✓
Average	✓	3.9	4.1	4.1	4.1	31	✓
Biokinetics
Venda	✓					34	X
Johannesburg	✓	4	5	5	5	30	X
North-West	✓	3	4	4		32	X
Nelson Mandela	✓	4	4			37	X
Tshwane	✓	4	4		4	24	X
Free State	✓	5	5	5		34	X
Mean	✓	4	4.4	4.7	4.5	31.8	X

Table 1.

South African university admission requirements for physiotherapy, occupational therapy, and biokinetics as of 2020 [12].

* Post 2007 admission criteria was derived from 2020 prospectuses.

* While a Biokinetics programme is offered by 12 universities, only the aforementioned six offer a four-year integrated professional degree.

Other factors influencing the success of Physiotherapy, Occupational Therapy and Biokinetics students studying among South African HEIs include lower academic matriculation scores, supportive social infra-structure (family and friends) and attentive listening challenging when students attend lectures (refer to Table 2).

Authors (year) (reference)	Findings
Grigorenko et al. (2009) [13]	This study describes the predicting index of secondary academic success relating to tertiary academic success
Govender et al. (2015)	First year students experienced personal stressors as being the most significant stressor while second, third and fourth students reported academic stressors to be significant.
Kuznekoff et al. (2015) [14]	This study demonstrated that sending and/or receiving mobile messages unrelated to class content negatively influences learning and note-taking.
Li et al. (2015) [15]	Individuals submitting too greater external locus of control experience a greater challenge to control the mobile phone use at inopportune times, which negative effects important cognitive tasks.
Gordon et al. (2020) [16]	University students spend more class time using their mobile phones (up to 20% of their classroom time) texting, emailing, surfing the web, checking social media, and even playing games, which negatively influence their academic performance.
Mabizela et al. (2020) [17]	Academic success is related to the NBT and Physical Sciences matriculation results. Clinical implications of this finding suggests that support programmes (supplementary tutorials and language supplementation programmes) in the first year of university study are required to augment student success
Henderson et al. (2021) [18]	Health science students experience stress due to academic tasks, interpersonal stress and clinical experiential learning stresses.

Table 2.

Factors influencing academic success of tertiary students.

4. Discussion

The discussion is focused on the following themes: commonality among the professions of Physiotherapy, Occupational Therapy, and Biokinetics; the influence of final school year academic performance on subsequent tertiary academic success; other factors influencing academic tertiary performance; and strategies for the improvement of tertiary academic success.

4.1 Commonality among the professions of physiotherapy, occupational therapy and biokinetics

The professions of Physiotherapy, Occupational Therapy, and Biokinetics are concerned with the rehabilitation of human pathology at various stages of healing, thus requiring the study of similar academic literature. These professions treat pathologies that range from neuro-musculoskeletal pathologies to non-communicable diseases, operating in both the pathogenic (illness) and fortogenic (apparently healthy) healthcare paradigms [12, 19]. Practitioners require a sound knowledge of human anatomy, physiology, kinesiology and biomechanics. In some South African HEIs Physiotherapy, Occupational Therapy, and Biokinetics students attend the same fundamental modules, underlining the commonality between the disciplines. Furthermore, the prerequisite academic modules are identical: English, Mathematics, Life Science, and Physical Science (Table 1). However, the admission scores varies (Table 1). Moreover, these professions follow similarly structured residency and work-integrated learning programmes which are synthesised by their respective HEIs.

4.2 The prerequisite matriculation subjects for admission to physiotherapy, occupational therapy, and biokinetics

Final school year academic performance is positively correlated with strong tertiary academic prowess in so far as the final school year is an essential foundation for subsequent education [13, 20, 21]. Good results enhance the admissions eligibility of prospective students enabling them to pursue studies in their chosen career-path at HEIs [21]. The aforementioned Health Science professions have identified the need for satisfactory mastery of Mathematics, Life Science, Physical Science, and English (Table 1), and these subject requirements are in line with international prerequisites for analogous professions [22].

1. McNaught and Hoyne have suggested that secondary schooling Mathematical prowess can be applied to many collegiate academic programmes that require critical analysis and problem solving, such as Health Sciences and Engineering [23]. However, many South African matric scholars experience challenges that adversely impact upon their Mathematics performance [24]. The 2019 results reflected a dip in Mathematics performance where the academic pass rate dropped by 4%, falling from 58% the previous year [24]. In 2018, 6763 scholars achieved distinctions in Mathematics, as compared to the 4415 Mathematics distinctions which were awarded to the 2019 class, yielding an average 2% decrease in performance [24]. The South African Mathematics class of 2019 was furthermore significantly (17.9%) smaller than the 2018 class, indicating that fewer students are pursuing secondary school Mathematics [24].

2. The Physical Science prerequisite reflects a need for the comprehension of fundamental internal human biochemical reactions caused by injury, medication and/or physical rehabilitation. Physical Science is the cornerstone of modern technology and empowers students to comprehend various therapeutic technologies, as well as enabling them to ultimately develop new rehabilitation devices. As with the 2019 Mathematics matriculation results, Physical Science results have also declined with 24.5% of scholars failing the 2019 national senior certificate examination [25]. Comparing the 2019 results to those of the previous year, 3700 fewer scholars were able to secure pass marks in this subject [26].

3. English proficiency is needed in so far as it is the predominant language of tuition among South African HEIs. English proficiency has been correlated with strong academic performance due to the fact that students are thus better able to comprehend the subject matter. While English is widely spoken, it is nevertheless not the first language of many South African students, a factor which limits their proficiency and places them at a disadvantage [8].

Academic performances in Mathematics, Life and Physical Sciences and English in the course of the final school year are strong predictors of the tertiary academic performance of prospective Health Science students [21, 22, 26]. Many South African scholars struggle to achieve strong grades in Mathematics, Physical Science, and English, which eventually adversely impact on their tertiary academic performance [24]. Many South African tertiary students studying Physiotherapy and Occupational Therapy experience academic challenges as evidenced by Govender et al who reported that Occupational Therapy students with lower academic matriculation admission scores took longer to complete their degrees as compared to students who possessed higher academic matriculation scores and maintained better grade average scores in the course of their studies [27]. Similarly Mabizela et al concur that secondary school competency strongly influences the academic success of Physiotherapy students [17].

4.3 The variation of the prerequisite matriculation scores allowing admittance into physiotherapy, occupational therapy and biokinetics

The minimum matriculation prerequisite admission scores allowing entry to the aforementioned South African HEIs for the study of Physiotherapy, Occupational Therapy, and Biokinetics vary (Table 1). While some South African HEIs have adopted a policy of lowering academic prerequisite scores in order to provide equitable access to tertiary education, this has not been favourably accepted by all HEIs [7, 9]. Varying prerequisite academic scores for admission have raised concerns regarding the integrity and the quality of the programmes offered at tertiary institutions who propose lower admission scores. This is especially relevant in so far as the various programmes share common prerequisite secondary school subjects, as well as common tertiary subjects (Human Anatomy, Physiology, Kinesiology, Biomechanics, Clinical and Orthopaedic Pathology, and Principles of Rehabilitation). Unequal prerequisite admission scores for Physiotherapy, Occupational Therapy and Biokinetics among HEIs who ostensibly offer the same academic content, all of which is regulated and endorsed by the Health Professions of Council (HPCSA), show 9, 11, and 13 point variances [28]. The post millennium HEI policy of accessibility and equality has universally lowered prerequisite admission scores and is aimed at increasing overall student intake from socioeconomically disadvantaged communities. Further discrepancies among the already lowered prerequisite scores is therefore concerning. Rather than lowering their admissions criteria, South African HEIs should standardise their entry requirements, aligning the requirements to the mean score required for entry into the aforementioned vocations across the board, thereby accommodating previously disadvantaged students. This will serve to provide equity and liberal access to all eligible prospective students. However, not all HEIs are pleased to lower their prerequisite admission scores, in so far as they feel that it raises questions regarding the quality of the education provided by the university and consequently of the degree that is conferred upon the student [9]. Standardising entry requirements using mean scores effectively represents a compromise between the imperative to offer greater access and opportunities to students, and the maintenance of degree integrity and quality.

Another variation is the national benchmark test (NBT) that most HEIs offering Physiotherapy and Occupational Therapy require, and which is not required for entry into the study of Biokinetics. The NBT is a uniform South African test that all Grade 12 learners or any other prospective candidate intending to secure university admission have to complete, assessing Mathematical and Language Literacy together with overall readiness for tertiary-level education. This test measures the acumen of the candidate [29]. Given that Mathematics and English literacy are already prerequisites for admission to the aforementioned courses of study, the compulsory inclusion of the NBT will consolidate and standardise the prospective candidate’s HEI application.

4.4 Other factors influencing academic tertiary performance

Academic success is further influenced by psychosocial factors including student self-efficacy and strong supportive social infrastructure (family and friends) [13]. Student self-efficacy is an intrinsic psychological motivation driving students to succeed academically with strong repercussions on tertiary academic accomplishment, lowering HEI drop-out rates. Strong academic success in the final year of schooling augments the confidence of prospective students thereby reinforcing their self-efficacy, engendering stronger tertiary academic success. Elements of self-efficacy include wisdom, intelligence and creative synthesis [13]. Additional factors influencing academic success include self-responsibility, regular class attendance, and attentive listening in class. Poor academic achievement is accomplished by students who attend class but rarely focus on what is said in class due to attentive listening challenges during lectures including students’ preoccupation with their mobile phones [14, 15, 16]. Attentive listening is an essential soft skill imperative to problem solving, and which enables a person to become a strong leader and solid team member in so far as it improves their interpersonal communication skills. In the aforementioned professions, being able to attentively listen to a patient is imperative for successful rehabilitation. Kuznekoff et al and Gordon reported that the use of mobile phones to surf the internet, and to send and receive messages unconnected to the lecture at hand negatively impacted learning and note-taking [14, 16]. This is a worrisome concern.

4.5 Pedagogic strategies to augment academic success

The authors agree with concept of creating HEI equity and liberal access to all eligible prospective students. However, strategies aimed at overcoming the generally poor academic performances in South African HEIs need to be employed. South African HEIs should therefore enact strategies designed to augment their students’ academic success. The following strategies have found success at other global HEIs, and these can serve as models for future pedagogic strategies adapted to specific institutional contexts:

1. Change from traditional teaching methods to more conventional approaches has proven to increase academic success [30, 31].

2. Superficial learning of basic knowledge needs to be replaced with deeper understanding, which should be articulated through innovative pedagogic strategies. Educators have moved away from surface learning (the rote of memorization of knowledge) to deeper understanding, which is honed through active processes. Roehl et al. have recommended the idea of active learning through individual learning, paired groups, small informal groups, and larger co-operative student projects [31]. This approach encourages brain-storming, conceptual mapping, co-operative learning, and collaborative peer teaching. The student is no longer a spectator and becomes an active participant involved in the pedagogic process. During a single contact lecture, the students must be exposed to a traditional lecture format, coupled with individual problem solving, peer and group interaction, and learning which embraces the concept of active learning [31].

3. The use of the flipped classroom model, whereby lecture content is assigned as homework, and which students are required to complete prior to the lecture, is also a recent and successful pedagogic strategy. This strategy allows students to familiarise themselves with the literature before attending class. Tucker contends that the adoption of the flipped classroom model allows the lecturer and students to use contact time for the discussion of advanced concepts, problem solving, and engagement in collaborative learning with colleagues. The flipped classroom model makes students active participants of the lecture [30].

4. The luxury of readily available internet access is a common occurrence at most sites on HEIs campuses and should be readily adopted in so far as it allows for dynamic pedagogic strategic initiatives in order to encourage learning. Lecture notes, PowerPoint presentations and other materials should be uploaded onto the relevant teaching platforms so that each student is able to review the class material in their own time and at their own pace. This will ensure that teaching, and learning, can take place outside the classroom [31]. Classroom and lecture activities should include the use of smartphones and electronic tablets, thereby ensuring that student know how to use technology to supplement their learning. The use of mobile devices during the lecture for pedagogic purposes, will eliminate unwanted personal messaging.

5. The question of the translation of the primary language of instruction from English into one or many of the indigenous South African languages remains of concern. Many South Africans do not speak English as their first language and they furthermore lack proficiency in English (especially as regards the reading, writing and discussion of advanced academic topics), this consequently may limit their comprehension of both academic literature and of their lessons [32]. The translation of the language of instruction into their indigenous language will better facilitate comprehension of subject content as discussed in class [32]. At North-West University of South Africa the introduction of translators, who accompany the lecturer has proven successful. The lecturer is thus able to present the lecture in their preferred language, while the translator simultaneously provides students with an opportunity to garner a greater understanding of the matter in so far as the lecture is directly translated into their native language. Unfortunately, this service is available only for Sesotho and Afrikaans and there is a pressing need for the simultaneous translation of lectures into other indigenous South African languages in order to uniformly accommodate all students. Furthermore, while all theoretical tests and examinations should be translated into indigenous languages, the ever present question of the finances available for such initiatives means that certain languages will need to be prioritised over others. The authors recommend that the most commonly spoken indigenous language of each HEI should be identified. If a third or more of the student body speak the language as their first language, then this language should be identified and recognised as an indigenous language of the particular institution and attempts at establishing simultaneous translations of lectures should be considered. South African students should also realise that English is the primary global language and they should therefore also make a personal attempt to become proficient so as to enhance their educational outcomes.

6. The use of student mentors in order to facilitate both the successful transition from secondary schooling to HEIs, as well as the progressive annual succession within each course of study has proven beneficial [11]. Lavhelani et al. have reported that the poor academic performance of many South African students is associated with the failure of academic support [33]. Vitali et al. reported that regular consultation with student mentors has assisted students in better organising their daily schedules, enabling them to balance their study and extra-curricular activities, positively impacting their academic performance [11]. Each semester, following the first round of assessments, all students should be strongly encouraged to consult the student mentor within their given discipline in order to seek advice regarding the way forward. This will help to identify students who are struggling to comply with study requirements. The earlier that student receive academic support, the greater their probability of success [34]. It is further recommended that NBT results should be reviewed at the beginning of the first semester in order to identify at risk students. This chapter concurs with the recommendations of Gultice et al. who state that new pedagogic criteria enabling the identification of at risk students should be invented [34].

5. Conclusion

Many factors influence tertiary academic performance; these include matriculation prerequisite results, the language of instruction, pedagogical methods and student mentoring. Physiotherapy, Occupational Therapy, and Biokinetics share communal matriculation subject prerequisites and professional subject content, but their university admission prerequisite scores differ. Consistent matriculation prerequisite admission scores are thus needed, given the overall similarity between the programmes. The authors recommend that the mean admission prerequisite score of the various HEIs be standardised across the board, allowing the aforementioned disciplines to satisfy both the need for HEI equity and maintaining educational quality. Furthermore, scholars interested in studying in these fields need to enhance their Mathematics and Physical Science marks as these serve as cornerstones of the aforementioned disciplines. The strategic use of predictive psychometric testing to identify the risk profile of prospective students is imperative for the provision of effective academic support programmes. Moreover, the need to prescribe and employ indigenous languages that students are familiar with is worth considering in an attempt to improve the overall quality of education.

Conflict of interest

None.