Occupational Therapy Students Say Their Training Leaves Them Unready for Primary Health Care

A new qualitative study from Cyprus has found that undergraduate occupational therapy students feel fundamentally unprepared for work in primary health care, despite the profession’s theoretical alignment with exactly the kind of community-based, preventive, person-centred practice that modern health systems demand. Published open access in the Scandinavian Journal of Occupational Therapy, the research by Stavros Orologas, Dikaios Sakellariou, Jeanette Reffstrup Christensen and Anita Björklund Carlstedt offers a rare, granular look at how students themselves perceive the gap between what they are taught and what emerging health systems actually require. The findings arrive at a moment when Cyprus is overhauling its entire health system around primary care, making the mismatch between curriculum and system reform especially stark.

Primary health care, anchored internationally in the Declaration of Astana, emphasizes person-centred services across the lifespan, spanning preventive, promotive, curative, rehabilitative and palliative care, alongside intersectoral action on the social determinants of health. Occupational therapy, with its holistic, client-centred and occupation-based approach, would seem a natural fit for this agenda, and the profession worldwide is gradually shifting from hospital rehabilitation toward health promotion and population health. Yet integration remains limited almost everywhere, held back by structural and historical barriers, weak funding mechanisms and the profession’s traditional orientation toward curative rehabilitation. In Cyprus these problems are amplified by an ongoing health system reform and a very young educational infrastructure, since the country’s only occupational therapy programme admitted its first cohort as recently as 2015.

The Cypriot context gives the study its urgency. Since 2019, the General Health System, known as GeSY, has reorganized care around personal doctors acting as gatekeepers, with the Health Insurance Organization purchasing services and an explicit emphasis on prevention and integrated care. Rehabilitation services, including occupational therapy, are nominally part of the GeSY benefits package. In practice, however, most occupational therapists work in hospitals, rehabilitation centres or private practice, and the most recent survey by the Council of Occupational Therapists for the European Countries counted only 43 occupational therapists employed in primary health care in Cyprus. By contrast, countries such as Norway, the Netherlands and the United Kingdom report between 700 and 1,400 occupational therapists working in primary care, supported by clear referral pathways and insurance-based funding. Meanwhile, Cyprus faces rising chronic disease, obesity, smoking and physical inactivity, including among children, trends that demand exactly the community-based preventive workforce the country lacks.

To explore how students experience this disconnect, the researchers ran a two-phase qualitative study with seven undergraduate students, four women and three men, six of them in their fourth year and one in her third, all of whom had completed at least 340 hours of clinical placement. In the first phase, a 70-minute focus group was conducted using a semi-structured guide, with participants given translated stimulus materials including the curriculum itself, the Declaration of Astana, the Cyprus Country Health Profile and the European Tuning Competency Framework for Occupational Therapy. The transcript was analysed using Framework Analysis, a method that combines predefined themes from the literature with participant-driven insights through systematic coding, charting and interpretation. In the second phase, the same students took part in a Nominal Group Technique session, a structured consensus method in which participants silently generate ideas, share them in round-robin fashion, discuss and clarify them, and then rank their top five choices using a weighted point system.

The focus group findings coalesced around five themes, and their content is striking. Students described a curriculum rich in theory but heavily skewed toward paediatric and adult neurological rehabilitation, with minimal exposure to older adults, palliative care, prevention or underserved populations. One participant noted that courses discuss stroke extensively but never what someone can do to avoid having a stroke in the first place. Students felt confident managing conditions after onset but unprepared for proactive and end-of-life interventions, a serious gap in a country with a rapidly ageing population and high rates of chronic disease. They also reported that their skills were concentrated in one-to-one and small-group clinical work, leaving them unsure of their role in public health and population-level empowerment, even as they expressed a clear desire for project-based, community-engaged learning in which they could co-design initiatives with underserved groups.

Two further themes deepened the picture. On multisectoral action, students said they understood interdisciplinary collaboration in theory but felt practically unprepared to function within cross-sectoral systems, attributing this to the absence of shared educational experiences with other health professions. One participant observed that while occupational therapy students understand their own role, other team members cannot understand theirs, partly because the disciplines never train together, and another noted that other degrees in the faculty lack interprofessional education entirely, making collaboration structurally difficult. On autonomy, students reported a persistent gap between knowing and doing: theoretical concepts from occupational science were intellectually valuable but hard to internalize without application, and even laboratory exams remained, in their words, entirely theoretical. This lack of integration undermined their clinical reasoning, professional autonomy and confidence in unfamiliar settings.

The Nominal Group Technique session translated these frustrations into a ranked set of fifteen concrete recommendations, which clustered into three pedagogical categories. Feedback-based teaching received the highest priority, with students demanding specific, meaningful feedback delivered at multiple stages of each course, in both written and verbal form, rather than generic comments. Applied learning came next: case studies integrated across all courses, simulation-based learning incorporating tools such as artificial intelligence and trained actors for realism, and project-based learning involving design-thinking activities in real-world contexts. One participant pointedly invoked medical education’s simulation dolls, where students examine, diagnose and decide on the spot, and asked why occupational therapy students should not train the same way. Collaborative, interprofessional teaching ranked third, reflecting a strong desire to learn alongside nurses, general practitioners and other peers in structured ways that build genuine teamwork capacity. Peer mentoring, in which senior students guide juniors, was also valued as a scaffold for professional development.

The authors situate these findings within a broader international debate. Students in other countries have similarly reported feeling underprepared for community-based roles because curricula remain grounded in biomedical rehabilitation models, and global frameworks, including the World Federation of Occupational Therapists’ workforce strategy and the WHO Rehabilitation Competency Framework, all call for competencies in community engagement, interprofessional collaboration, leadership and advocacy. Examples from the Global South show what transformation can look like: Brazil’s reforms emphasize community-based practice aligned with national health goals, while South Africa’s occupation-based community development framework positions therapists as partners who co-design interventions with communities to address occupational injustice. The study also highlights a pragmatic tension that risks reinforcing the status quo: even when broader learning opportunities exist, students feel compelled to pursue conventional placements because jobs in prevention and health promotion simply do not exist, meaning idealistic curriculum choices carry no labour-market reward.

The study’s limitations are acknowledged candidly. With only seven participants from a single institution, transferability is constrained, and the exclusive reliance on student perspectives, without triangulation with educators or curriculum documents, limits confirmability, while the absence of longitudinal follow-up leaves open how perceptions of readiness might evolve. Nevertheless, the researchers argue the message is clear and consequential: occupational therapy education in Cyprus is theoretically strong but misaligned with evolving societal health priorities, and reform is needed to embed primary health care competencies, experiential and interprofessional learning, and community engagement throughout the curriculum. As one participant put it, if the university does not change how it prepares students to work in prevention and health promotion in areas where the profession is still underdeveloped, then change will never happen. For a profession whose founding values align so closely with primary health care, the students’ verdict amounts to a challenge not just to one small programme, but to occupational therapy education everywhere.

Subject of Research: Occupational therapy students' perceptions of their readiness for primary health care and curriculum reform

Article Title: Student’s views on their education – Are they ready for primary health care?

Article References: Orologas, S., Sakellariou, D., Christensen, J. R., & Björklund Carlstedt, A. (2025). Student’s views on their education – Are they ready for primary health care?. Scandinavian Journal of Occupational Therapy, 32(1), Article 2597208. https://doi.org/10.1080/11038128.2025.2597208

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2597208

Keywords: occupational therapy, primary health care, curriculum development, health professional education, Cyprus, interprofessional education, simulation-based learning, community-based practice, health promotion, professional identity, qualitative research, Nominal Group Technique