Five-hospital Rwanda survey finds occupational therapy awareness exceeds knowledge

A cross-sectional survey of 201 healthcare professionals at five teaching hospitals in Rwanda found that 75.1% had heard of occupational therapy, yet 51.7% were classified as having poor knowledge of the profession. The study assessed familiarity with occupational therapy’s roles, scope, client groups and service settings. After multivariable adjustment, professional background, involvement in habilitation or rehabilitation services, prior practice outside Rwanda, direct experience working with occupational therapists and positive perceptions of the profession were associated with greater awareness, good knowledge or both. Because the research was observational, these relationships cannot establish that education or workplace exposure caused the differences.

Data were collected from March 25 to June 6, 2025, at Rwanda Military Referral and Teaching Hospital, Ndera Neuropsychiatric Teaching Hospital, King Faisal Hospital, Byumba Level II Teaching Hospital and Kabgayi Level II Teaching Hospital. The facilities were deliberately selected because occupational therapists were already practicing there, making them suitable for examining awareness among clinicians with some potential exposure to the profession. They do not constitute a nationally representative sample: 262 of 298 distributed questionnaires were returned, but 61 were excluded because respondents were ineligible or had not completed the survey, leaving 201 participants for analysis.

Eligible participants were adults actively providing direct clinical care, holding at least an A1-level professional qualification, having at least three months of experience and being able to answer the questionnaire in English. Occupational therapists were excluded to avoid bias, as were trainees, administrators without clinical roles and staff outside the five hospitals. The investigators used the Knowledge and Attitude Toward Occupational Therapy Practice Tool, covering professional characteristics, awareness, factual knowledge and perceptions. After expert review, a five-person pilot and an internal-consistency assessment of 50 participants, the tool produced a Cronbach’s alpha of 0.78.

The sample was almost evenly divided by sex: 102 participants, or 50.7%, were women and 99 were men. The largest age groups were 31–40 years, with 74 respondents, and 21–30 years, with 69. Mental health nurses formed the largest profession at 40 respondents, followed by general nurses with 39, medical doctors with 31, physiotherapists with 26 and ophthalmic clinical officers with nine. Overall, 113 participants, or 56%, provided habilitation or rehabilitation services. Twenty-seven respondents, 13%, had previously practiced outside Rwanda, while 140, 69.7%, reported working with an occupational therapist.

Awareness was markedly associated with professional group. It was reported by 88.5% of physiotherapists, 87.5% of mental health nurses and 87.2% of general nurses, compared with 54.8% of medical doctors. In multivariable models using medical doctors as the reference, physiotherapists had 6.3 times the odds of awareness, with a 95% confidence interval of 1.6–25.5; general nurses had 5.6 times the odds, with a 95% confidence interval of 1.7–18.1; and mental health nurses had 5.8 times the odds, with a 95% confidence interval of 1.8–18.7. Professionals providing habilitation or rehabilitation services also had higher odds of awareness than those who did not: adjusted odds ratio 3.8, 95% confidence interval 1.9–7.5.

Positive perceptions were another strong correlate of awareness. Respondents who viewed occupational therapy favorably had 4.1 times the odds of awareness compared with those who viewed it negatively, with a 95% confidence interval of 2.1–8.0. University curricula were the most frequently reported source of awareness, cited by 82 participants, or 40.8%, followed by work practice, cited by 68, or 33.8%. In the adjusted awareness model, learning from a patient, the internet or colleagues was associated with lower odds of awareness than learning through a university curriculum, although the study did not test any educational intervention.

Knowledge was measured through four questions addressing the distinction between occupational therapy and other professions, areas of practice, the people who require the service and the settings in which it is provided. Responses were totaled to a maximum score of 33. Because the instrument has no established psychometrically validated cutoffs, investigators used thresholds adapted from similar questionnaire studies: scores of 1–16 were classified as poor knowledge and 17–33 as good knowledge. On those analytical categories, 104 respondents, or 51.7%, had poor knowledge and 97, or 48.3%, had good knowledge. The cutoffs were not clinically validated and should not be interpreted as diagnostic or professional standards.

The adjusted model for good knowledge identified several statistically significant associations. Compared with medical doctors, physiotherapists had 8.2 times the odds of good knowledge, with a 95% confidence interval of 2.5–27.0; ophthalmic clinical officers had 8.6 times the odds, with a 95% confidence interval of 1.5–49.4; general nurses had 3.2 times the odds, with a 95% confidence interval of 1.2–8.6; and mental health nurses had 2.7 times the odds, with a 95% confidence interval of 1.1–7.3. Respondents who had practiced in another country had 4.5 times the odds of good knowledge than those who had practiced only in Rwanda, with a 95% confidence interval of 1.7–11.7. Some estimates had wide confidence intervals, indicating appreciable uncertainty.

Workplace exposure showed particularly strong associations with good knowledge. Professionals providing habilitation or rehabilitation services had 8.1 times the odds of good knowledge compared with those who did not, with a 95% confidence interval of 4.2–15.4. Being aware of occupational therapy was associated with 7.5 times the odds of good knowledge, with a 95% confidence interval of 3.3–17.2, while working with an occupational therapist was associated with 2.8 times the odds, with a 95% confidence interval of 1.5–5.3. The largest adjusted association involved perceptions: respondents who considered occupational therapy an important member of the healthcare team had 12.7 times the odds of good knowledge, with a 95% confidence interval of 6.3–25.9. These results describe correlations rather than causal effects.

Most respondents expressed support for the profession, even though more than half met the study’s analytical threshold for poor knowledge. A total of 144 participants, or 71.6%, agreed or strongly agreed that occupational therapy plays a significant role in their workplace, and 167, or 83.1%, agreed or strongly agreed that it deserved greater emphasis. Common reasons included improved functional outcomes, selected by 67.4% of respondents, better prognosis and greater independence in daily living, each selected by 64.8%. The findings support the authors’ call for stronger interprofessional education, continuing professional development and clearer visibility of occupational therapy’s role, but the effectiveness of those measures was not tested. Convenience sampling, self-reported responses, a final sample below the planned target, selection of hospitals with occupational therapy services and possible hospital-level clustering limit generalizability.

Subject of Research: Occupational therapy awareness and knowledge among healthcare professionals at five Rwandan teaching hospitals

Article Title: Knowledge and awareness of occupational therapy and associated factors among healthcare professionals in Rwanda: a cross-sectional study

Article References: Ishimwe, D., Nsengimana, E. A., Biracyaza, E., Turikumana, P. D., Niyonkuru, F., Uwihoreye, P., & Cloete, L. G. (2026). Knowledge and awareness of occupational therapy and associated factors among healthcare professionals in Rwanda: a cross-sectional study. Frontiers in Medicine, 13, Article 1722607. https://doi.org/10.3389/fmed.2026.1722607

Image Credits: AI Generated

DOI: 10.3389/fmed.2026.1722607

Keywords: occupational therapy, Rwanda, healthcare professionals, cross-sectional study, professional awareness, clinical knowledge, rehabilitation, interprofessional education, Knowledge, awareness, occupational, therapy