1. information and communication technology by South African
The use of
information and communication
technology by
South African
physiotherapy students
Michael Rowe (Msc Physiotherapy)‏
Department of Physiotherapy
University of the Western Cape
Good morning. My name is Michael Rowe and I'm a new lecturer in the Physiotherapy Department at the University of the Western Cape. Obviously, my background is in physiotherapy not education, so I'm quite new to this space. Earlier this year I completed a masters degree where I looked at the use of information and communication technology (or ICT) as a means of providing support to physiotherapy students. Since then, my interest has turned to the use of the so-called web 2.0 technologies and how they can be used to enhance teaching and learning.
Today I'll be presenting some of the results of my study, with a focus on aspects of the research that related to how South African physiotherapy students use ICT as part of their education and how they are supported using ICT. The study has so far resulted in 2 articles submitted for review, one of which formed the basis for this presentation and a third article is in development.
I'll talk a little about the literature around ICT in both healthcare and education, provide some background on the students of today and look briefly at the objectives of the study. I'll go into a little bit of detail with regards the method and results and finally discuss the implications of the study.

2. Global shift towards the use of ICT in healthcare and education
So, over the past few decades there's been a global shift toward the use of information and communication technology in healthcare and education, most apparent in North America and Europe but increasingly seen in Asia and some African countries. This move has, in many cases, been shown to enhance both the educational opportunities and the support provided to students and healthcare professionals.

3. Social media and networks
Social networking, consumer-related online forum discussion and multimedia on demand
Social networks are their frames of reference
In the past couple of years in South Africa, we've seen this trend grow, particularly with the adoption of increasingly affordable broadband Internet connections. These high speed access points have ushered in the rise of social networking, online discussion forums and multimedia on demand services like YouTube, that show how South Africans are embracing this technology on an increasingly large scale.
It's also becoming evident that online social networks are the lens through which today's students view the world. This is no different from the past, only now the networks are vast and no longer limited to those in their immediate vicinity.

4. The Net Generation
The net generation has unprecedented access to technology and are comfortable using it
Evidence suggests that they may be different in how they think, communicate and learn
Sometimes referred to as the Net Generation, this cohort was the first to grow up in a period of unprecedented access to information and computer use, they are more comfortable with it and use it almost constantly. Always connected through either 24/7 Internet access at home, or via their cellphones, they use their social networks constantly, to inform nearly every aspect of their lives, both educational and social.
Some evidence also suggests that they have distinctive ways of thinking, communicating and learning, which will have an impact not only in the way they live, but also the ways in which they choose to learn, as well as how they will one day practice their profession.

5. Question and problem
Little evidence could be found on the use of ICT by South African physiotherapy students
Massification and Internationalisation
How can ICT be used to educate and support this new generation of future healthcare professionals?
The problem is that although there is a significant worldwide shift towards the use of digital technology in education and healthcare, little evidence could be found on its use by South African physiotherapy students.
And with the trends in higher education towards enrolling more students and from more countries, ICT seems ideally placed to address at least some of the issues decisions create, especially in terms of communication with greater numbers of students and employing collaborative learning with distributed workspaces.
Thus, it becomes important to determine how ICT is currently being used by this generation of future healthcare professionals to enhance their education and to seek and receive support.

6. Aim and Objectives Aim: Objectives:
To investigate the use of ICT by South African physiotherapy students, as a means of enhancing their education, as well as the experiences and perceptions of these students pertaining to the use of ICT as a means of seeking and receiving support.
Objectives:
What ICT resources are available to students;
What ICT is being used for;
Students' experiences and perceptions of ICT;
How students are being supported;
Are they adequately prepared to access support post-graduation;
What differences exist?
This problem led to the formation of the research Aim and Objectives. The aim of the study was:
“To investigate the use of ICT by South African physiotherapy students, as a means of enhancing their education, as well as the experiences and perceptions of these students pertaining to the use of ICT as a means of seeking and receiving support”.
The objectives developed to achieve this aim include:
1. Determining what ICT facilities are available to physiotherapy students in South Africa, as well as the reasons for its use.
2. To determine physiotherapy students' experiences and perceptions of ICT as a means of seeking and receiving support, as well as to identify how students are currently being supported.
3. Finally, to determine if physiotherapy students are adequately prepared to use ICT to access support after graduating, as well as noting any differences between those who use ICT for support, and those who do not.

7. Background
Definition: the use of computers and computer software to manipulate information
WHO, UNICEF have discussed the benefits of ICT in education and healthcare
“Socially acceptable technology”
A review of the literature began by defining ICT as anything that deals with the use of computers and computer software to convert, store, protect, process, transmit and retrieve information.
The World Health Organisation and the UN children's fund support the idea of using technology to help solve problems in education and healthcare, as well as discussing the many benefits of using ICT in these fields, including allowing the transfer of clinical experience and training materials to rural areas and for communication between students and teachers.
In this country, the government has endorsed the idea of “socially acceptable technology” to improve the quality of education and training, particularly in the fields of education and healthcare. In other words, it supports the idea that the use of technology to solve problems is viable as long as it emphasises, and not replaces, the human element.

8. Benefits of ICT in education
Coursework accessible anywhere, anytime
Promotes active engagement with content
Enhances problem-based learning
Improves information gathering skills
Improves communication between lecturers and students
The literature review was then refined to specifically identify the benefits of the use of ICT in education. The predominant themes that emerged included demonstrating that...
The use of web-based learning materials (a subset of e-learning) brings several benefits to the educational process, including:
Coursework being accessible anywhere, anytime and increasingly, from any device
Promoting active student engagement with the content
Enhancing problem-based learning
Improving information gathering skills
Improving communication between lecturers and students, either asynchronously (for example through and forum discussion) or synchronously via VoIP or Instant Messenger.

9. Resources? What resources?
Some African countries have difficulty providing access to students
Healthcare students in some African countries do not enjoy the same benefits that ICT offers to the education process in America and Europe, where the majority of these studies are being done. One of the main reasons for this is a lack of access to technology, which I'll discuss shortly.

10. E-learning is not the (only) answer
E-learning must add value, not replace
Technology does not solve problems
Finally, it should be recognised that e-learning must add value to already established teaching pedagogy. ICT in education is not about replacing teachers with machines, or merely making all of your course readers available for download.
It seems that the idea that we can solve educational problems by throwing technology at them has been shown to be false. A bad teacher will always teach badly, no matter how many computers they have.

11. ICT in healthcare
Continuing professional development is facilitated and students and professionals supported clinically through ICT
Evidence based practice difficult to implement
Geographical isolation means poor support and a lack of opportunities
An estimated 30% of a doctors time will be spent using a computer. Are healthcare students ready for this?
OK, we've discussed ICT in education, how about it's use in healthcare? I'll go through this quickly since this isn't a health conference.
ICT was shown to improve the opportunities for CPD by facilitating the transfer of experience and training materials to remote areas and for enhancing communication between colleagues.
In addition to this, several studies have also shown that while most physiotherapists and physiotherapy students support the concept of EBP in principle, many found it hard to implement, mainly due to a lack of access to literature and isolation in terms of professional peer support.
In geographically isolated areas there are a lack of resources, as well as support for lifelong learning opportunities. ICT has been shown to be a feasible means of reducing isolation by providing both professional and social support through enhanced methods of communication.
It's been proposed by the NHS in the UK that within a few years, ICT will have an even greater role to play in healthcare, with an estimated 30% of a doctors time spent using computers. The question is: are healthcare students being adequately prepared to function in this environment?

12. Challenges and gaps Challenges facing adoption of ICT
Digital divide
Poor infrastructure
High costs involved
Poor ICT literacy
Lack of technical skills
Gaps in the literature
Little evidence was found on the use of ICT by
South African physiotherapy students
Challenges facing the widespread adoption of ICT in SA that were highlighted, included:
1. The argument that using ICT to solve problems in any aspect of society will increase the “digital divide” i.e. the gap between those with access to technology and those without.
2. In addition, large, rural parts of SA are without a fixed line telephone network, which is the basic infrastructure of the Internet. However, SA does have the most advanced communications infrastructure on the continent, which bodes well for development of capacity.
3. Another challenge to be overcome is the high cost of equipment, training and access. However, it was also shown that these costs can be reduced and often are not prohibitive.
4. Poor ICT literacy was another factor identified, and included not only healthcare professionals, but also support staff, who would be expected to use the technology.
5. Finally, a lack of technical skills in terms of hardware maintenance was noted. However, this could be overcome within a short period with appropriate training.
The gap identified in the literature that was of interest to me, was the lack of available evidence demonstrating the use of ICT by South African physiotherapy students.

13. Methodology Study design: cross-sectional, descriptive survey
Setting: physiotherapy departments of 6 universities offering the physiotherapy degree
Sample: all undergraduate physiotherapy students who responded
Instrument design: self-developed questionnaire, focus groups, pilot study
Data analysis: OpenOffice spreadsheet and SPSS
Ethical clearance obtained
In terms of the methodology used, the study design was a cross-sectional, descriptive survey, which was both quantitative and qualitative in nature, and was implemented in 6 of the 8 physiotherapy departments in SA.
The sample included all undergraduate physiotherapy students at these 6 universities who completed and returned questionnaires. No exclusions were made.
As no validated, reliable instrument was obtained, a self-developed questionnaire was used. A pilot study and focus group were used to refine the instrument in terms of improving validity and reliability.
Methods implemented to maximise response rate included using stamped, self-addressed envelopes, cover letters and reminders, as well as offering an incentive to participate.
Data were coded using the OpenOffice spreadsheet application and statistical analysis performed using SPSS.
Ethical clearance to perform the study was obtained from the UWC Higher Degrees Committee, as well as permission from the head of each physiotherapy department that participated. Consent was implied by completing and returning the questionnaire and anonymity was ensured by not collecting personally identifiable data.

14. Procedure Identify universities Send advance letters Deliver survey
Surveys completed
Surveys returned

15. Results Demographic data
Population: 1105
Sample: 529
Response rate 48%
Age: (87%)‏
Female: 82%
White: 41%
1105 questionnaires were sent to the physiotherapy departments of 6 of the 8 universities offering the degree.
529 students responded, indicating a response rate of 48%, which wasn't as high as was hoped for, but high enough to use the data.
87% of respondents were aged years, which was within the expectations of a normal age distribution for undergraduate students, although one participant reported being 16 years old.
In general, it seems that physiotherapy is still a profession in which the majority of students are female and white, although there was one university with a female population below 75% (just under 60%).
It was also found that there was a strong association between the university a student attends and the racial demographic of that university, although some universities did have greater variation in terms of race and gender, than others.

16. Results Response rate by university
Western Cape: 12%
Stellenbosch: 9%
Other: +/- 7%
Total: 48%
This graph shows the response rate by university. As you can see, UWC (in orange) had the highest response rate as a percentage of the total, with 12%. Stellenbosch (in blue) had 9% of the total response and the other universities contributed about 7% each, making a total of 48%.
A potential determining factor in the significant difference in response rate could have been that questionnaires were not only hand-delivered to the physiotherapy departments at UWC and Stellenbosch, but physical contact was made with the class co-ordinators at these institutions, which could have implications for questionnaire survey distribution.

17. Results Frequency of use by university
Almost 40% use ICT daily, 35% use it weekly
In this graph we can see that the Universities of Stellenbosch, Cape Town and Limpopo had relatively high daily and weekly ICT use (shown in blue and green respectively), which starts to drop off sharply when we look at the Universities of Kwazulu-Natal, Western Cape and Wits.
The reasons for this stark difference were not evaluated and could possibly yield interesting results if followed up.
On the whole, approximately 40% of respondents used ICT daily on campus, while 35% more used it at least weekly.

18. Results Reasons for Internet use at university
Assignments: 83%
Academic development: 43%
Personal interest: 48%
Guidance: 23%
In terms of respondents' reasons for using the Internet at university, the most common use was for assignment preparation (in blue), followed by academic development (in green), then for personal interest (orange) and finally, the least common reason for using the Internet at university was to seek advice or guidance (yellow).

19. Results Students confidence when using ICT
High levels of confidence were reported among respondents for tasks such as online search, , printing, word processing and preparing assignments.
However, low levels of confidence were reported for tasks such as using ICT for professional development, research, and online forum discussion. This was illustrated by the fact that only 23% of students used ICT to seek advice or guidance, and only 43% used it for academic development.
The results obtained indicated a strong association between the university attended and the activities performed online by those students. More specifically, students at some universities were more confident when performing activities with a computer and used ICT more frequently than at others, although the nature of these relationships was not investigated.

20. Results Use of the Internet at university
Search: 83%
Databases / journals: +/- 50%
48% (26% for support)‏
Departmental website: 41%
Online search to find course-related information was found to be the most common use of the Internet at university (83%), and accessing the departmental website the least common use. The use of online databases and journals was found to be low, with only about half of those surveyed (53% and 48% respectively) reporting using these services. The use of at university was also reported to be low (48%), with only 26% of students reporting using it for support of some kind.

21. Experiences and perceptions of ICT among students
Students who had access to ICT at home and at high school were more likely to have used ICT at university
Most respondents agreed that ICT has a positive role to play in supporting students ( > 70%)‏
Most students were satisfied with current levels of support ( > 80%)‏
78% agree that a strong support system would positively influence their decision to work in a community post
Finally, the results pertaining to students' experiences and perceptions using ICT for support revealed that students who had had access to ICT at home (53%) and high school (48%) were more likely to use ICT at university, or at home for course-related work. A strong association was identified between race and ICT access in various settings. Results showed that Black and Indian students had the least access to ICT prior to attending university, while White students had had more.
Most students reported being satisfied with the level of support they were receiving while at university.
A large number of students felt that a good support system would positively influence their decision to work in a community post, which has serious implications for the inequitable distribution of health care services in rural parts of South Africa.

22. Methods: face-to-face (95%), email (25%)‏
Students more likely to seek support from those most suited to provide it
Methods: face-to-face (95%), (25%)‏
In addition, it was found that students were more likely to seek support from those most suited to provide it. In other words, they would obtain clinical and educational support more often from lecturers and supervisors, while obtaining emotional and social support from friends and family. This seems to suggest that the idea that knowledge is built through interaction with ones social network may not apply to this group in terms of their professional education.
Face-to-face contact was identified as having accounted for more than 90% of the method by which students obtained support, in contrast with only 25% using for this purpose.

23. What does this all mean?
Students view ICT as a means of accessing information, rather than enhancing communication
Reduced levels of confidence using ICT for research
ICT consistently shown to enhance communication, yet students fail to use it for this purpose
Many physiotherapy students have had limited or no access to ICT resources prior to attending university
So what does all of that mean? When discussing these results in the light of the literature, the following key points should be highlighted.
Most students view ICT as a means of accessing information, rather than obtaining support. In fact, the least common use of ICT by students was to seek support or guidance. This is in contrast with the literature, which identified ICT as offering a significant advantage in this regard.
It's a concern that even though online social networks like MySpace, Mxit and Facebook are so prolific among students, they don't use these spaces as environments in which to enhance their learning.
Even though ICT was shown consistently throughout the literature to enhance communication, SA physiotherapy students fail to use it in this way, at least in terms of their studies. This, despite the fact that 87% of students believed that ICT would make communication easier, as well as reporting a high level of confidence in the use of to communicate.
With the move towards EBP in healthcare, it is of significant concern that research was highlighted as the area in which more than a third of students were least confident.

24. What have we learnt?
ICT has been shown to be a feasible means of supporting physiotherapy students
Students have the skills to use ICT to seek support and to enhance their studies, but do not apply them
Inequality in access to technology is still present in South Africa
The use of ICT in communication, research and CPD (lifelong learning), was low
In conclusion, ICT has been shown to be a feasible means of providing educational and professional support to physiotherapy students, both internationally and in South Africa.
While students reported having the skills to use ICT to seek support and to enhance their studies, they do not apply these skills.
There is still inequality in access to ICT prior to attending university, which was shown to have implications for its use at university.
Furthermore, the use of ICT in communication, research and continuing professional development, or lifelong learning, was low, which raises concerns with the shift in healthcare education toward evidence-based practices.
In conclusion, there is a concern that with the move toward community based service delivery in South Africa, certain groups of physiotherapy students may not be well placed to make use of ICT services as a means of improving communication, enhancing education, participating in lifelong learning opportunities and accessing support.

25. How should we proceed?
Physiotherapy departments should consider developing and implementing a comprehensive ICT strategy
Use ICT to facilitate communication between students and lecturers
Encourage the use of ICT to encourage undergraduate research and evidence based practice
A recommendation that emerged from this study was that physiotherapy departments should consider developing and implementing a comprehensive ICT strategy, that should focus on the use of ICT to facilitate communication between students and lecturers. It should enable undergraduate students to implement the ICT skills they already have, in order to enhance the learning process, particularly with regards research and EBP.

26. What are we doing about it?
OpenPhysio - free, open content physiotherapy resource

27. What are we doing about it?
Begun planning of an online, social space for UWC physiotherapy students, called Touch
Begun the development and planning of an online, social space for UWC physiotherapy students, which will be called Touch. One of the potential platforms that Touch may be built on is the open source learning management system called KEWL that is being developed partly by UWC.
Touch is a student-led initiative that is looking at creating an online, social space that makes use of the so-called web 2.0 technologies to provide an environment for physiotherapy students to interact in relation to the issues that are important to them. The student who proposed the idea following a series of discussions, liked the idea of enabling students to communicate through multiple channels, not only while they're students, but also after they graduate. The slogan he chose is: “Keeping in Touch, staying in Touch.”
One important advantage of a project like Touch, is that, if it's adopted by the students and becomes the place they socialise in the context of their education, we can avoid the inherent problems with privacy and copyright that exist with services like Facebook and MySpace.

28. Thank you Contact mrowe@uwc.ac.za http://www.mrowe.co.za/blog
Thanks for listening. If you'd like to contact me, here are some details.
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