Comparative Study of Self-Efficacy and Perceived Stress Among Physiotherapy Interns in Turkey and Egypt

This study is a cross-sectional, comparative, observational investigation designed to evaluate and compare the levels of self-efficacy and perceived stress among physiotherapy interns in Turkey and Egypt. The study focuses on understanding how differences in clinical education structure, timing of practical exposure, and learning environments influence the professional confidence and stress management of physiotherapy students transitioning into clinical practice.

Background and Rationale

The transition from academic learning to independent clinical practice represents a critical developmental stage for healthcare professionals, particularly physiotherapists. During this phase, students must apply theoretical knowledge and practical skills in real clinical settings, which can often be demanding and stressful. While technical competence is essential, a key factor influencing success in this stage is psychological readiness-specifically, the belief in one's own capability to manage clinical tasks, known as self-efficacy.

Grounded in Bandura's Social Cognitive Theory, self-efficacy reflects confidence in performing specific actions to achieve desired outcomes. In physiotherapy education, high self-efficacy correlates with better clinical reasoning, patient communication, treatment planning, and professional collaboration. Conversely, low self-efficacy can hinder learning and performance.

Perceived stress is another crucial factor that can influence self-efficacy and clinical competence. Elevated stress levels among interns can negatively affect their confidence, decision-making, and patient interactions. Assessing both self-efficacy and perceived stress offers a comprehensive understanding of physiotherapy students' preparedness for professional practice.

Turkey and Egypt have distinct physiotherapy education models. Turkish programs follow a four-year structure with early and progressive clinical exposure, while Egyptian programs typically last five years, with a mandatory one-year clinical internship after graduation. These structural differences may result in varying levels of clinical confidence and stress among interns. This study aims to explore how these educational variations impact self-efficacy and perceived stress.

Study Objectives

To compare self-efficacy levels between physiotherapy interns in Turkey and Egypt.

To compare perceived stress levels between physiotherapy interns in both countries.

To explore the relationship between perceived stress and self-efficacy.

To identify how differences in educational structures influence professional confidence.

Hypotheses:

H1: Physiotherapy interns in Turkey will report significantly higher self-efficacy scores than those in Egypt.

H2: Physiotherapy interns in Turkey will report significantly lower perceived stress scores than those in Egypt.

Study Design

The study will employ a cross-sectional observational model. Data will be collected through an online survey distributed to physiotherapy interns currently enrolled in accredited universities in Turkey and Egypt.

Participants:

A total of 200 participants (100 from Turkey and 100 from Egypt) will be recruited. Eligible participants must be final-year physiotherapy students currently completing a supervised clinical internship.

Inclusion Criteria:

Currently engaged in a supervised clinical internship.

Sufficient fluency in Turkish or English (depending on the questionnaire language).

Provided informed consent to participate.

Exclusion Criteria:

Already graduated or licensed physiotherapists.

Incomplete responses exceeding 10% of questionnaire items.

Data Collection Instruments

Demographic and Educational Background Form - collects information such as age, gender, university, program type (public/private), total clinical hours, timing of first patient contact, prior healthcare experience, and GPA.

Physiotherapy Intern Self-Efficacy Scale - Likert Version (PISE-L) - a validated 30-item instrument assessing self-efficacy across five domains: clinical reasoning, patient assessment, treatment planning, patient education and communication, and interprofessional collaboration.

Perceived Stress Scale (PSS-10) - a 10-item validated measure assessing individuals' perceived stress over the previous month.

The Turkish version of both scales will be used for Turkish participants, and the English version for Egyptian participants. The translation followed standard forward-backward translation and expert validation procedures to ensure linguistic and conceptual equivalence.

Statistical Analysis

Data will be analyzed using SPSS version 23. Descriptive statistics (mean, standard deviation, frequency, percentage) will summarize participant characteristics. Normality of data distribution will be assessed. Independent t-tests or Mann-Whitney U tests will be used for between-group comparisons depending on data distribution. Correlation analysis will explore relationships between self-efficacy and perceived stress. Significance will be set at p \< 0.05.

Ethical Considerations

Ethical approval was obtained from Istanbul Medipol University Non-Interventional Clinical Research Ethics Committee (Decision No. E-10840098-202.3.02-3979, dated June 19, 2025). Participation in the study is voluntary. Informed consent will be obtained electronically before data collection. All data will remain anonymous and confidential, and participants may withdraw at any time without penalty. No personal or identifying information will be collected.

Expected Outcomes

It is anticipated that Turkish physiotherapy interns will demonstrate higher self-efficacy and lower perceived stress levels compared to Egyptian interns, reflecting the differences in educational models and clinical exposure timing. The results are expected to provide insights into optimizing physiotherapy curricula to enhance students' confidence and readiness for clinical practice in both countries.

Significance

The findings will contribute to the body of knowledge on physiotherapy education by identifying key factors that shape clinical preparedness. This research may guide curriculum developers, educators, and policymakers in designing interventions that promote psychological readiness and reduce stress among physiotherapy students worldwide.

• Perceived Stress Level [Time frame: At the time of survey completion (Baseline)]