This study represents the first attempt to investigate the perceived occupational prestige of physiotherapy in relation to other professions among Nigerian physiotherapy undergraduates. Considering the response rate for this study was (95.2%), the sample could represent physiotherapy students in Nigeria because responses were obtained from the four universities that offer physiotherapy and have both the pre-clinical and clinical phases in Nigeria. Furthermore, there were more male participants than female ones (61.1 to 38.9%), implying that there are probably more male physiotherapy students in Southwest Nigeria.
The overall findings from the study showed that physiotherapy is of intermediate occupational prestige, ranked fourth below the occupations considered to be the “big three” in Nigeria (Medicine, Engineering, and Law in decreasing order). These findings agree with a similar study conducted by Akinpelu et al. (2011) among practising physiotherapists in Nigeria, where physiotherapy was also rated intermediate [12]. This is in contrast to the study conducted by Akodu et al. (2018) among secondary students that reported a high occupational prestige of physiotherapy [13], which may be indicative that practising physiotherapists, as a result of being in the profession, have a better knowledge of physiotherapy, the services and the environment they work in more than secondary school students. These findings agree with another Nigerian study [12] representing their self-worth as students, which could affect their decision to practice after graduation [18]. However, it is essential to note that physiotherapy is ranked 4th instead of 5th [12]. Therefore, it can be inferred that physiotherapy is either moving up the scale or participants do not have adequate knowledge to judge physiotherapy occupational prestige because they are undergraduate students.
The focus group discussion findings reveal that most participants perceive the occupational prestige of physiotherapy to be of intermediate status, corroborating the quantitative component of this study. The intermediate status ascribed to physiotherapy during the qualitative study was noted to be a result of public view or perception of the profession. Within the profession, the students perceive their profession to be prestigious, but in relation to other professions, especially within the health care team, they rated their profession lower. Akinpelu et al. (2011) study's finding among Nigerian physiotherapists also corroborates these findings that physiotherapists regard the profession with high prestige [12]; however, the public and Nigerian health system or professionals do not have the same perception. However, the participants limited this perception to Nigeria and stated that they perceive the profession’s occupational prestige to be higher in developed countries.
There was no significant difference between the perceived occupational prestige of physiotherapy among participants in the pre-clinical and clinical phases of the study, in contrast to medical laboratory science, engineering, police, law, nursing, pharmacy, journalism, and secondary school teaching, where there were differences in the perceived occupational prestige. This could be because orientations and seminars are organised every session for pre-clinical and clinical physiotherapy students, giving each group a privilege to gain more insight into the profession, thereby ensuring that every student, regardless of their stage of training, has a minimum of the basic knowledge of the profession.
Using the criteria of determining occupational prestige of physiotherapy, the level of income of the physiotherapy profession relative to other professions was rated fifth, following Medicine, Engineering, Architecture, and law. This result agrees with the findings from a similar study conducted in Nigeria among secondary school students, another one conducted among practising physiotherapists [12, 13] in relation to other occupations. In decreasing order, the different occupations that ranked higher were engineering, architecture and law. This could be due to the extensive public knowledge of these professions and the seemingly high income generated in these professions because of their tendencies towards being in private and industrialised sectors, unlike physiotherapists employed mainly by the government who pays fixed salaries and expect full commitment.
Also, the level of education of physiotherapy relative to other professions was rated third place, which is the same as the same rating of Engineering and Pharmacy, following Medicine and Law, and followed by Architecture. This finding is similar to the studies conducted in Nigeria and England among practising physiotherapists and physiotherapy students, respectively, where physiotherapy was rated second; rated third in Australia among physiotherapy students and fourth in another study in England among physiotherapy students [6, 8, 10, 12]. It is interesting that physiotherapy students rate their profession below Law and above Nursing, Medical Laboratory Science (MLS), and Veterinary Medicine. There is a possibility that physiotherapy students rate their profession below law because of the additional 1 year spent by law students before they get called to the bar; however, physiotherapy students also rate their profession above nursing, MLS, Veterinary Medicine, and Architecture, even though they require 5 years of study with nursing and MLS, 6 years of study, for veterinary medicine at the university level, and M.sc as a minimum requirement for architecture practice. This may suggest that the number of years required at the university level did not influence their perception of education, but public perception and the general belief that students of medical sciences have a higher level of education above other professions were considered more than years spent in school.
Furthermore, physiotherapy’s level of usefulness and responsibility relative to other professions was rated second alongside Nursing, following medicine, which had the highest score. This finding agrees with the findings among secondary school students in Nigeria [13] and the findings among physiotherapy students in Albania [9], where physiotherapy was also placed second on the level of responsibility. It is also similar to the study by Turner in 2001 among physiotherapy students in Australia [8]. The high ratings of physiotherapy students perceive their level of usefulness and responsibilities in society as healthy. These could be a result of their understanding of the role and importance of physiotherapy since they are training to become physiotherapists. Therefore, they are more likely to be more knowledgeable about its usefulness and responsibilities in society. However, this rating above their counterpart in medical sciences is a subject of interest that may be further looked into.
In addition, the social standing of the physiotherapy profession relative to other professions was rated eight, preceded by Medicine, Law, Engineering, Pharmacy, Nursing, and Accountancy, in decreasing order. Despite the high ratings of the other factors, the social standing of the physiotherapy profession in relation to other professions, as perceived by physiotherapy students, is low. This may be because these occupations are better known in society because they have existed for a longer period in Nigeria and have experienced faster professional growth than physiotherapy. Hence, the public is more familiar with other professions than physiotherapy.
Findings from the qualitative study show that participants had a good understanding of occupational prestige. Occupational prestige is one of the factors considered when making carrier choices. Therefore, a good grasp of the meaning of occupational prestige seen among the discussants is likely a show level of accuracy in their perception of the physiotherapy profession while making decisions on the choice of their course of study in the university. Furthermore, poor knowledge of physiotherapy and physiotherapy services among the public was identified as the paramount determining factor of occupational prestige in Nigeria. Other factors include unhealthy inter-professional rivalry and competition, lack of inclusion of physiotherapists in the mainstream politics of the nation and poor remuneration. These qualitative findings reveal that physiotherapy students rated their profession lower majorly as a result of the public view of the profession and not necessarily from their own personal view, which was higher. This shows that the participants used more of an objective approach in their responses than a subjective one. The participants, during the course of the qualitative study, provided possible and problem-directed solutions. The factors listed by the participants can be said to be “extrinsic”, differing from the “intrinsic” recommendation made in a study among Nigerian physiotherapists [12]. The recommendation suggested that a way to improve the occupational prestige and self-worth of physiotherapy professionals is a better understanding of the role and value of physiotherapy by the public, other health care professionals and mainstreaming of physiotherapists in the national politics to inform policy that will enhance the professional image of physiotherapy.