Observational studyBMC public health2025
Knowledge and integration of social determinants of health among physiotherapists in Spain: a cross-sectional study.
Observational study in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSocial determinants of health (SDH) significantly influence morbidity, mortality, and health equity. Although physiotherapy in Spain is mandated to address biopsychosocial factors, little is known about physiotherapists' knowledge and integration of SDH into practice.
objectiveTo describe Spanish physiotherapists' knowledge of SDH, their perceived relationship to health, and the extent to which these determinants are integrated into clinical practice.
methodsAn observational cross-sectional study was conducted using an ad hoc online questionnaire based on the PROGRESS-Plus framework and adapted from previous validated instruments. A convenience sample of registered physiotherapists in Spain was recruited via professional associations and social media (June-July 2023). Descriptive statistics, correlation analyses, and association tests were performed.
resultsOf 456 respondents, 412 met eligibility criteria (59% women; 44.7% ≤10 years' experience). While 89.3% had heard of SDH, only 11.7% had received specific training. Occupation (8.78 ± 1.21), social support (8.74 ± 1.31), and socioeconomic status (8.54 ± 1.61) were perceived as most strongly related to health, whereas sexual orientation (3.31 ± 3.07), religion (4.51 ± 2.80), and gender (6.16 ± 2.63) ranked lowest. Values are expressed as mean ± standard deviation (SD). Integration into clinical practice was generally lower than perceived relevance, with the highest for occupation (8.68 ± 1.39) and the lowest for sexual orientation (1.45 ± 2.42). Perceived relevance and integration were positively correlated (rho = 0.353-0.556, all p < 0.001). Higher integration was associated with postgraduate SDH training, prior community health activity, and higher perceived relevance (p < 0.05).
conclusionSpanish physiotherapists recognize certain SDH, particularly occupation, social support, and socioeconomic status, as highly relevant to health, but often underintegrate them into clinical reasoning-especially determinants such as sexual orientation, religion, and gender. Findings suggest that postgraduate training and community activities are associated with higher integration; these may be targets for future interventions.These strategies could strengthen the biopsychosocial approach in physiotherapy, improve equity in patient care, and align practice with public health priorities.
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