Going Green: Environmental Curriculum Within Entry‐Level Physiotherapy Programs in Australia and New Zealand—A Mixed Method Study

ABSTRACT

Background and Purpose

There is an increasing awareness about the impact of climate change on public health and the potential role that health professionals, including physiotherapists, may play in mitigating this. It is not known whether environmental education is a part of physiotherapy curricula in Australia and New Zealand. This study explored the views about, and suitability of, embedding environmental curriculum within entry‐level physiotherapy programs in Australia and New Zealand.

Methods

A mixed method study consisting of a quantitative survey and qualitative semi‐structured interviews (SSI) was undertaken. The survey was disseminated to 20 Program Directors (PD) or Heads of Discipline (HoD) of entry‐level undergraduate physiotherapy programs in Australia and New Zealand. Quantitative data were summarised descriptively, and qualitative data were transcribed verbatim and analysed thematically.

Results

Thirteen participants (65% response rate) completed the survey, four of whom also participated in SSI. Eight participants (61.6%) collectively agreed that physiotherapy students should be educated about the causes and impact of climate change (six participants (46.2%) ‘somewhat agreed’ and two (15.4%) ‘strongly agreed’). Common barriers to implementing curriculum changes were the lack of accreditation requirements to do so (40%) and time constraints (33.3%). Three themes were derived from qualitative data namely: (a) Interconnectedness of climate, and health (b) knowledge, attitudes, and beliefs, and (c) curriculum integration factors.

Conclusions

Most entry‐level physiotherapy PD and HoD in Australia and New Zealand believe that climate change is happening and impacts human health. However, there is a lack of consensus regarding whether an environmental curriculum should be included in physiotherapy programs. Future research in this field is recommended, and collaboration among various physiotherapy stakeholders, including regulatory bodies and physiotherapy associations, is essential to facilitate the inclusion of climate change and sustainable development content within undergraduate physiotherapy programs.

1. Introduction

Climate change refers to long‐term shifts in temperature and weather patterns (Commonwealth Scientific and Industrial Research Organisation ²⁰²⁴). Global warming has accelerated, raising the global mean surface temperature by 1.7 ± 0.1°C above pre‐industrial levels and is projected to be over 2.5°C by 2035 (McCulloch et al. ²⁰²⁴). Consequently, there are predictions of extreme weather events, water scarcity, rising sea levels, floods, droughts, and the emergence of novel diseases (Intergovernmental Panel on Climate Change (IPCC), 2023). Vulnerable groups, including young children, older adults, those living in remote communities, people with chronic diseases, and Aboriginal and Torres Strait Islander and Māori peoples, are disproportionately affected by climate change (Chi et al. 2024; Jones et al. ²⁰²²; Pendrey et al. ²⁰²³). Taking immediate action is crucial to mitigate these impacts and achieve the Sustainable Development Goals (World Health Organization ²⁰¹⁷).

Healthcare systems likely contribute to 4.4% of global greenhouse gas (GHG) emissions worldwide (Hu et al. 2022; Intergovernmental Panel on Climate Change ²⁰²³). Health professionals worldwide have recently increased their concern about the impact of climate change on health and the health industry's contribution to climate change (Chi et al. 2024; Kotcher et al. ²⁰²¹). Health professionals, including physiotherapists, could play a collective role in mitigating the impact of climate change. At the individual level, physiotherapists could advocate for physically active lifestyle choices, with improved health resulting in less reliance on the healthcare system and fewer resources consumed (Duindam et al. 2023; Kotcher et al. ²⁰²¹; Li et al. ²⁰²⁴; Palstam et al. ²⁰²¹). Additionally, physiotherapists can address climate change concerns at the societal level through public health promotion, community consultation, and policy development (Stanhope et al. 2023).

Planetary health and sustainable development education is crucial in addressing climate change and might help convey the urgency of climate action (Aasheim et al. 2023; MacKenzie‐Shalders et al. ²⁰²³; Swardh et al. ²⁰²⁴). Many institutions have recently advocated planetary health and environmental education into health‐related curricula, including the United Kingdom's (UK) General Medical Council, the Association for Medical Education in Europe, the Europe Region World Physiotherapy, the American Medical Association, and the Australian Medical Council (General Medical Council ²⁰¹⁸; Hampshire et al. ²⁰²²; Pendrey et al. ²⁰²³; Shaw et al. ²⁰²¹; Europe Region World Physiotherapy ²⁰²²). In addition, Australia's 2009 National Action Plan advocated for the inclusion of sustainability in university education to equip all Australians with the awareness, knowledge, skills, values, and motivation to live sustainably so that future generations can meet their needs (Scott 2009). Those practices inspired the authors to investigate whether Australian physiotherapy programs had included a similar content in their curricula.

Since 2020, the Environmental Physiotherapy Association, led by Maric et al. (2020), has encouraged physiotherapy institutions worldwide to embed environmental and sustainability perspectives into their curricula, with over 26 physiotherapy institutions worldwide responding to the call (Maric et al. 2021). However, this process faces challenges, such as curriculum creep and lack of knowledge in teaching planetary health content (Brennan and Madden 2023; Diallo et al. ²⁰²³; Hampshire et al. ²⁰²²; Maric et al. ²⁰²⁰; Moro et al. ²⁰²³; Stanhope et al. ²⁰²³). As Environmental Physiotherapy continues to gain momentum, it is crucial to investigate whether such concepts align with contemporary physiotherapy education. To date, research has yet to explore this within the context of Australia and New Zealand. To address this research gap, the current study aimed to explore the views about, and suitability of, embedding environmental curriculum within entry‐level physiotherapy programs in Australia and New Zealand.

2. Methods

2.1. Study Design

A mixed method design was used in this study. This approach was deliberately chosen to measure the views of (quantitative), and explore in‐depth perspectives from (qualitative), representatives of entry‐level physiotherapy programs in Australia and New Zealand about embedding environmental curriculum. By doing so, a comprehensive understanding of issues underpinning embedding environmental curriculum could be achieved. For the quantitative phase, a survey questionnaire was adapted from the studies of Lal et al. (2022) and Gomez et al. (2021), chosen for their close alignment with this study's aim, although they focused on different population groups (medical students). For the qualitative phase, the semi‐structured interview (SSI) questions were developed based on Bearman's (2019) framework in the context of health professional education.

This study was approved by the University of South Australia's (UniSA) Human Research Ethics Committee (HREC) (Ethics Protocol Reference No. 205637) (Supporting Information S1: Appendix 1). Data management (confidentiality and secure storage) met HREC requirements (National Health and Medical Research Council ²⁰²³). The final manuscript was structured using the checklist of Mixed Methods Reporting in Rehabilitation and Health Sciences (MMR‐RHS) as a means of following best practice standards in reporting of mixed methods studies (Tovin and Wormley 2023).

2.2. Rigour in Quantitative Phase

The survey was conducted in two distinct, sequential phases. Phase one consisted of survey development, pilot testing and modification; phases two was the final survey distribution to eligible participants and data collection. Pilot testing ensured face and content validity (Cobern and Adams 2020; Story and Tait ²⁰¹⁹). Additionally, the research team adopted the Total Population Sampling strategy and follow‐up reminders to mitigate non‐response bias (Etikan et al. 2016; Story and Tait ²⁰¹⁹).

2.3. Survey Phase One

The survey development and modification were guided by the research team, which comprised three Australian registered physiotherapists with knowledge of using survey instruments in research. The final online survey instrument, comprising 25 questions (Supporting Information S1: Appendix 2), was designed to gather closed and open‐ended responses. For pilot testing, a purposive sample of seven allied health professionals was recruited via the authors' professional networks (Etikan et al. 2016). These participants were staff at UniSA with academic experience in physiotherapy, exercise physiology, occupational therapy, podiatry, and dietetics. These participants were selected as they had experience in undertaking surveys through their own research as well as in supervising student research. Their input enhanced the readability and clarity of the survey.

2.4. Survey Phase Two

2.4.1. Sample and Recruitment

Participants for phase two were Program Directors (PD), or Heads of Discipline (HoD), of entry‐level physiotherapy programs (bachelor's degrees) in Australia and New Zealand. Participants were purposively recruited from organisations accredited by the Australian Physiotherapy Council (APC) and the Physiotherapy Board of New Zealand (PBNZ). There were two main reasons for including bachelor's degrees and excluding postgraduate degrees. First, bachelor programs provide fundamental and foundational knowledge across a range of topics. Second, as these programs are typically 4 years long, they may have the scope to include environmental content during the program compared to the condensed 2 years of master's degrees. Inclusion and exclusion criteria for the participants are outlined (Table 1). Similar to phase one, participant recruitment was conducted through the authors' professional networks and the Council of Physiotherapy Deans Australia and New Zealand (CPDANZ) network (Supporting Information S1: Appendix 3). Potential and eligible participants were emailed with details of this study, the Participant Information Sheet, the Consent Form, and the link to the online survey.

TABLE 1.

Inclusion and exclusion criteria.

Inclusion criteria	Exclusion criteria
Programs offering bachelor's degrees in physiotherapy (Australia and New Zealand).	Programs offering graduate certificates, diplomas, or master's degrees in physiotherapy.
APC and PBNZ accredit the physiotherapy programs.	Programs offering exercise physiology, massage, rehabilitation and others that APC and PBNZ do not accredit.

2.4.2. Data Collection

The survey was published on Qualtrics, and the data were stored on its Australian cloud‐based servers. When participants opened the survey link, a brief description of the study was displayed. They were then asked to provide consent before being able to access the online questionnaire. If they chose not to provide consent, they were thanked for their time, and no further questions were asked. Data were collected between November 2023 and March 2024.

2.4.3. Data Analysis and Interpretation

Survey responses were downloaded from Qualtrics for analysis. Quantitative data were analysed descriptively using Microsoft Excel (Microsoft Corporation, Version 16.0) and the Statistical Package for Social Sciences (IBM SPSS Statistics for Windows, Version 29.0.1.0). Open‐ended responses were combined with the qualitative data from SSI for the thematic analysis.

2.5. Semi‐Structured Interview

2.5.1. Data Collection

At the end of the survey, all participants were invited to participate in the next phase of the research, SSI. Those who expressed interest were then recruited via email and were sent a Participant Information Sheet and Consent Form. The SSI was conducted using Zoom or Microsoft Teams by the primary author and typically lasted between 20 and 30 min (Supporting Information S1: Appendix 4).

2.5.2. Data Analysis

All interviews were transcribed verbatim by the primary author. Transcripts were then subjected to a thematic analysis in six steps (Lister et al. 2022; Maguire and Delahunt ²⁰¹⁷). Themes were organised in a coding tree and mind map; this process involved a detailed examination of similarities and differences in perspectives among participants, as well as a thorough search for patterns and diverse cases of emerging themes within the data. Additionally, all authors participated in discussing and refining the final themes and their relation to this study's aim. Member checking was offered but not taken up by any participant. Data were analysed thematically using Microsoft Excel (Microsoft Corporation, Version 16.0), Microsoft Word (Microsoft Corporation, Version 16.0) and NVivo for Windows (Version 14). This was led by the primary author with regular review and feedback from an experienced qualitative researcher.

2.5.3. Rigour in Qualitative Phase

Strategies to address rigour and trustworthiness in the SSI phase included regular consultation, peer review and debriefing within the research team (confirmability), adhering to established research processes, such as the use of SSI guides (dependability), transparency in the role of the research team (reflexivity) and the use of direct quotes to support findings (transferability) (Dodgson 2017; Zaw et al. ²⁰²³).

3. Results

Thirteen participants completed the survey, and four participated in SSI. As the total population for this study was 20, the response rate was 65% for the survey and 20% for the SSI.

3.1. Demographic Characteristics

Among the 13 participants, 11 were from Australia and two were from New Zealand. The majority (84.6%, n = 11) had more than 5 years of experience working as an academic in the physiotherapy program, while the others (n = 2) had 2 to 5 years of experience (Table 2).

TABLE 2.

Participant characteristics (n = 13).

Characteristics			n (%)
Location of physiotherapy programs	Australia	NSW	4 (30.7)
		VIC	1 (7.7)
		ACT	1 (7.7)
		QLD	2 (15.4)
		SA	2 (15.4)
		WA	1 (7.7)
	New Zealand	North Island	1 (7.7)
		South Island	1 (7.7)
Years of experience working as an academic	Less than 2 years		0 (0)
	2–5 years		2 (15.4)
	More than 5 years		11 (84.6)

3.2. Quantitative Data

Eight participants (61.6%) collectively agreed that physiotherapy students should be educated about the causes and impact of climate change (six participants (46.2%) ‘somewhat agreed’ and two (15.4%) ‘strongly agreed’). When asked whether climate change content was delivered in physiotherapy programs, participants gave varied responses: Eight (62%) responded that ‘it is not part of the physiotherapy curricula’, while five (38%) responded that they ‘integrated it into other subjects’.

3.2.1. Teaching Practice

The five participants who indicated that climate change content was integrated into other subjects were asked further questions to explore their teaching practice. Four reported that physiotherapy academics were involved in developing and teaching climate change content; other contributing staff included environment scientists and exercise physiologists. All five participants reported that the proportion of climate change content embedded in the physiotherapy curricula was less than 5%. When asked during which years the content was delivered, participants reported that it was blended into multiple years; the third year was the most common choice (60%). Two participants felt ‘moderately knowledgeable’ (40%) about teaching the association between climate change and health impacts; another two felt ‘slightly knowledgeable’ (40%); and only one felt ‘very knowledgeable’ (20%). The climate change topics delivered ranged from ‘how environment or climate change impacts human health’ (80%) to ‘the impact of human behaviour on the environment’ (20%).

3.2.2. Attitudes, Enablers and Barriers

Lack of accreditation guidelines (40%) and lack of time (33.3%) were the main barriers identified by the eight participants who reported that climate change was not part of their physiotherapy curricula (Table 3). To address this, actions that participants thought would be helpful included ‘political support/requirement from government and regulation bodies’ (50%), ‘leadership support from the Heads of School and institutional decision‐makers’ (50%), ‘contribution from clinicians and lecturers to promote curriculum change’ (50%) and ‘students' interest and engagement in the climate change topics’ (38%). These suggestions emphasised the need for collaboration among various physiotherapy stakeholders to incorporate climate change and sustainable development content into undergraduate physiotherapy programs.

TABLE 3.

Barriers (n = 8).

Barriers to embed climate change contents into the physiotherapy curricula	n (%) a
Lack of time	5 (33.3%)
Lack of cooperation from the communities such as environmental and social scientists	1 (6.7%)
Lack of formal training opportunities in science of climate change	1 (6.7%)
Lack of accreditation guidelines on climate change curriculum	6 (40.0%)
Lack of relevance	2 (13.3%)
Total	15 (100%)

^a As participants could select multiple barriers, the total number of respondents was 15.

3.3. Qualitative Data

Fifteen free text responses from the survey were extracted and combined with data from the SSI to form a comprehensive overview. The participants in SSI were assigned an individual number as part of qualitative data reporting (Table 4). Furthermore, the qualitative data findings were categorised into three themes and eight sub‐themes (Table 5).

TABLE 4.

Characteristics of participants in SSI (n = 4).

Participant	Sex	Location	Years of academic experience	Whether climate change content was delivered
P01	F	Australia	More than 5 years	Not part of the physiotherapy curricula
P02	M	New Zealand	More than 5 years	Not part of the physiotherapy curricula
P03	F	Australia	More than 5 years	Integrated
P04	M	Australia	More than 5 years	Integrated

TABLE 5.

Themes and sub‐themes.

Themes	Sub‐themes
Relationship between climate change and health	Climate change is happening
	Climate impacts health
	Health industry's impact on environment
Knowledge, attitudes, and beliefs	Knowledge
	Competing teaching priorities
	Reason for teaching climate change
Influencing factors	Barriers
	Enablers

3.3.1. Interconnectedness of Climate and Health

Participants expressed the view that climate change impacted human health as they had seen patients with conditions secondary to climate change. They were also aware that the health industries contributed to GHG emissions and other environmental problems. Despite this, most were unsure how physiotherapists could mitigate the impacts of climate change.

3.3.1.1. Climate Is Changing

Participants stated that they could see that climate change was occurring based on their own experiences.

P02: We are quite clearly starting to see the changes…seeing very expensive beachfront properties being uninsurable now because the seas are getting too close, all these sorts of things.

P04: We live in a warm environment. It is getting hotter. Climate is changing.

3.3.1.2. Climate Impacts Human Health

Participants also highlighted the impact of climate change on health based on their experience of managing patients' health impacted by climate change. They also expressed concerns about food safety impacted by changing climate for the general public.

P03: People coming to us with conditions secondary to climate change…heat stress with older patients…asthma.

However, it was unclear whether the physiotherapy program played a role in teaching the causes of climate change or helping students to practise in an environmentally conscious manner. Participants noted the difference between understanding climate change's impact on health and being able to advocate for and influence climate protection action. Two free text responses from the survey and P01 offered alternate choices, such as environmental scientists, who were viewed as better‐positioned to educate the general population.

3.3.1.3. Health Industry's Impact on Environment

Participants emphasised that the health industry also contributed to GHG emissions and other environmental problems, such as ‘the rubbish and the waste’ and ‘the single‐use masks and gloves’. However, participant P03 noted that without education on environmental health and sustainable development, physiotherapy students may lack the knowledge needed to help the health industry achieve sustainable development goals.

P03: I do not think it is a profession where we are aware enough yet of how to influence systems…I think we are still in early days…we tend to pay lip service to that. We are kind of making sure the patients get home safely rather than what is the system that is making the environment unsafe for that patient.

3.3.2. Knowledge, Attitudes and Beliefs

Most participants expressed the importance of being skilled to teach topics on climate change as part of the physiotherapy curriculum. While the drive for this knowledge could come from a personal interest in public health and sustainability in healthcare, or it could be attained through professional development opportunities provided by physiotherapy associations and other agencies. There were nevertheless polarising attitudes and beliefs about integrating topics on climate change as part of the physiotherapy curricula. While some participants (P03 and P04) had commenced integrating of climate change content into their undergraduate physiotherapy curricula, some participants (P01 and P02) were unsure about their role in educating future physiotherapists about climate change. For example, one free text from the survey stated that teaching climate change content ‘is not relevant’ to physiotherapy programs.

3.3.2.1. Insecure and Lack of Knowledge

Participants reflected on their own education and reported that they generally lacked training in climate change, sustainability, and environmental health. As a result, they did not feel confident in training others on topics for which they themselves did not receive adequate training.

P03: I am very experienced in this space (sustainability, health and education), but no one else in the team is. Physios do not get trained in it.

P01: We probably have formed our own opinions personally and bring that into the way we approach our work, but certainly, I would not be in a position to defend my knowledge on climate change in an academic environment.

3.3.2.2. Competing Teaching Priorities

Participants noted that physiotherapy programs were already jam‐packed with content and were increasingly asked to include other emergent topics (such as cultural safety and reflective practice, etc.). As such, climate change would likely not be viewed as a priority.

P02: I feel climate change would get bumped down the priority list… I am not sure how our staff would take that… I think I would get really big push back (from the staff).

Survey Free Texts: Unless there are clear requirements and justifications for adding this to our programs, it will not be a high‐priority item at this stage.

3.3.2.3. Drivers for Teaching Climate Change

However, some participants identified opportunities for embedding topics related to climate change within physiotherapy curricula. Participants P03 and P04 highlighted several reasons for embedding an environmental curriculum. First, physiotherapy students should be educated about ‘the awareness of their role as a good citizen’. Second, providing students with a broad understanding of health topics is essential in an undergraduate program. Third, physiotherapists could ‘play a huge role’ in climate change because they could ‘…shape the environment’.

P03: The good citizen awareness aligned with the notions of sustainability and most universities' graduate attributes requirement.

P04: All we can do with undergraduate students is to give them a broad understanding of many areas. We have to go in depth into some…and I say, climate change is not core, but it is important.

P04: We need to know what we can do as physios or health professionals to help people either adapt or minimise those changes (from climate).

3.3.3. Curriculum Integration Factors

Participants expressed a range of factors for embedding environmental content in physiotherapy curricula. There were generally varied views on how best to achieve this, with participants reflecting barriers to, and enablers for, this to occur.

3.3.3.1. Barriers

The most frequently mentioned barrier from SSI and survey free texts were the busy physiotherapy curricula. Other barriers included the lack of accreditation requirements, the teaching team's lack of knowledge and experience, and lengthy administrative processes for implementing curriculum changes.

Survey Free Texts: We do not have the room or expertise to teach climate change.

Survey Free Texts: Our programs are already content heavy and unless there are clear requirements and justifications for adding this to our programs, it won't be a high priority item at this stage.

P01: I think possibly more barrier is. If we bring in new content, we need to get rid of something. So…like our curriculum is already quite obese.

3.3.3.2. Enablers

The most frequently mentioned enabler from SSI and survey free texts was the accreditation requirement, followed by access to professional training to address the lack of knowledge related to climate change topics. Participants reflected that training could also provide opportunities to cultivate content champions, who were adequately supported and resourced, within academic institutions to drive change from within. Other enablers included ‘motivation’, ‘funding and money’, ‘pathway for delivery’; and ‘network of researchers’.

P02: If the physio Board was to change the criteria… then whether we like it or not, whether we agree with it or not, we are actually forced to make those changes and then it is up to us to work out how we would do it.

P02: At least initially until you were able to get content champions within the universities, so people for whom…they really want to drive this and they're going to take it to the next level, is giving them some sort of resource that could be incorporated into a curriculum.

4. Discussion

To our knowledge, this is the first study to explore the views about, and suitability of, embedding environmental curriculum within entry‐level physiotherapy programs in Australia and New Zealand. Findings indicate that most entry‐level physiotherapy PD and HoD in Australia and New Zealand believe that climate change, which is part of broader environmental changes, is occurring and affecting human health. However, there were polarising views about incorporating climate change content within physiotherapy curricula. While some participants acknowledged the importance of including content about sustainability and the environment, others flagged a multitude of barriers, such as relevance, curriculum creep, limited resources, and a lack of a clear pathway for content delivery. Additionally, because accreditation agencies for physiotherapy programs do not mandate content on these topics, there was a perceived lack of motivation to include it.

Some of the findings in this study are consistent with similar research investigating the integration of environmental education within health discipline curricula. For instance, the most frequently reported barriers, lack of time and curriculum creep, were also the main barriers for incorporation of climate change content in medicine, nursing, and other health professional disciplines (Brennan and Madden 2023; Diallo et al. ²⁰²³; Hampshire et al. ²⁰²²). Where there were opportunities for integration, these were driven by personal interests in some instances. For example, two participants (P03 and P04) highlighted their interests in public health and sustainability, which influenced their motivation to include topics about sustainability, climate change and environmental education. Not all participants shared this view. Some reflected that their physiotherapy training lacked coverage of climate change topics, leaving them with limited knowledge and feeling inadequately prepared to teach others on the subject. This underscores the need for professional training opportunities to enhance the workforce's skills in environmental education. Organisations such as Australian Physiotherapy Association (APA) and Physiotherapy New Zealand (PNZ) could support physiotherapists with continuing professional development opportunities on these topics. These suggestions were supported by Chi et al. (2024) and Li et al. (2024), who emphasised the importance of the advocacy role of such agencies to facilitate awareness and action.

In addition to adding to existing knowledge, there are also unique findings from this research. First, the relevance of integrating environmental education into physiotherapy programs was questioned by some participants. In contrast, academics and students from medicine, nursing, and public health recognised the connections between climate change, sustainability, and their professions. This understanding has led to initiatives aimed at integrating environmental education into their curricula (Aasheim et al. 2023; Moro et al. ²⁰²³; Pendrey et al. ²⁰²³; Shaw et al. ²⁰²¹). Second, some participants in this study were unsure how to integrate environmental education into the physiotherapy programs, especially due to the lack of time, packed curricula, and limited resources. Current literature provides some suggestions on how to achieve this; for instance, an intervention study by Moro et al. (2023) explored the effects of incorporating planetary health content into anatomy and physiology courses. In this study, educators added a ‘fact box’ to the bottom of their presentation slides during weekly lectures. This ‘fact box’ highlighted the connections between the planet, human health, and various health determinants, such as global warming, air pollution, and vector‐borne diseases. Students responded positively to this practice, and a post‐intervention survey indicated that they felt motivated to engage in efforts to mitigate the impact of climate change (Moro et al. 2023). As physiotherapy programs have anatomy and physiology courses as part of their foundational studies, educators could draw inspiration from this example of curriculum integration. Similarly, research conducted in Sweden (Swardh et al. 2024) provided valuable suggestions for pedagogical approaches to support sustainable development education within undergraduate physiotherapy programs. There are also dedicated organisations, such as the Environmental Physiotherapy Association (EPA), which brings together a range of physiotherapy stakeholders interested in environmental physiotherapy and provides access to a range of resources for physiotherapy educators. Organised by topics (such as anatomy and physiology, musculoskeletal physiotherapy, pulmonary physiotherapy, etc.), these teaching prompts can help educators integrate environmental and sustainability content within physiotherapy curricula. Some participants in this study, who were members of the EPA, mentioned that regular attendance at EPA meetings helped them develop teaching strategies. What remains unclear is whether such curriculum integration had been trialled and, if so, what impact it may have had on student learning outcomes as well as patient management. Nevertheless, successfully integrating environmental education into physiotherapy curricula will likely require a multifaceted approach that involves collaboration among accreditation agencies, professional associations and societies, educators, and students at the front line of physiotherapy education.

4.1. Strengths

This study has several strengths. It builds on the previous study by Chi et al. (2024) and addresses an important research gap with a focus on physiotherapy educational settings in Australia and New Zealand. Utilising a qualitative phase in addition to the quantitative survey enabled the investigators to gain firsthand, lived experiences of PD and HoD views about integrating environmental curriculum. Finally, the use of MMR‐RHS guidelines ensured this study followed best practice standards in the reporting of mixed methods studies.

4.2. Limitations

As with any research, there are limitations to this study as well. Although the Total Population Sampling strategy was adopted, seven potential participants did not respond to this study. Additionally, self‐selection bias may be present as participants who volunteered to complete the survey may hold either positive or negative views. For the qualitative phase, only four participants agreed to participate and shared polarising views. Given the small number of participants and the inclusion of participants from only Australian and New Zealand educational settings, transferability of these findings to other jurisdictions may be limited and ongoing further research is required to substantiate these findings.

5. Implications on Physiotherapy Practice

Most entry‐level physiotherapy PD and HoD in Australia and New Zealand believe that climate change is happening and impacts human health. However, integrating environmental education into physiotherapy programs faces challenges. A range of barriers were identified, including how physiotherapists could mitigate the impact of climate change, lack of guidance from accreditation agencies, time, curriculum creep, resource limitations, and the need for clarity on how best to deliver the content within the physiotherapy curricula. A multifaceted approach is required to bring together a range of physiotherapy stakeholders to collaborate on how best to achieve this; such approaches could be the focus of future research.

Ethics Statement

The study was approved by the University of South Australia's Human Research Ethics Committee (HREC) before its commencement (Ethics Protocol Reference No. 205637).

Consent

All participants gave informed consent to participate in the research.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Supporting Information S1

Data Availability Statement

The authors confirm that the data supporting the findings of this study are available within the article and its appendices.