Number of Citations: 0

Submitted: 6 December 2024
Accepted: 14 May 2025
Published online: 6 January, TAPS 2026, 11(1), 44-54
https://doi.org/10.29060/TAPS.2026-11-1/OA3596

Anke van der Merwe & Corlia Janse van Vuuren

School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of the Free State, South Africa

Abstract

Introduction: Although effective healthcare communication is widely acknowledged as essential, a significant gap remains in practical communication training for healthcare students. The Theory of Planned Behaviour (TPB) provides a framework for designing communication activities that positively influence healthcare students’ attitudes towards and perceived control over their communication skills. TPB also incorporates societal expectations around healthcare communication, encouraging students to apply their learned skills effectively. This study aimed to explore students’ experiences of interprofessional healthcare communication activities structured around the TPB within an interprofessional healthcare curriculum.

Methods: A qualitative descriptive study design was used to assess communication skill development among first- to third-year healthcare students participating in an interprofessional curriculum. Data were collected via an annual institutional module evaluation and anecdotal feedback and analysed thematically under the TPB’s key constructs: attitudes, subjective norms, and perceived behavioural control.

Results: Students reported positive experiences with communication-based activities, particularly those that involved real-world applications. Feedback indicated that interprofessional group activities and community engagement significantly improved students’ perceived communication efficacy, although some challenges in managing group dynamics were noted.

Conclusion: Intentionally integrating communication skills training within an interprofessional curriculum to create behavioral intention positively impacts students’ attitudes, motivation, and ability to communicate effectively in diverse healthcare settings. The TPB framework supports the purposeful design of communication-based activities, fostering a more patient-centered approach among future healthcare professionals. Further research should investigate the long-term effects of this curricular approach on professional communication practice.

Keywords:           Healthcare Communication, Interprofessional Education, Theory of Planned Behaviour, Curriculum Development

Practice Highlights

• Real-world communication activities enhance students’ confidence and skills through application.
• Interprofessional group work fosters communication skills related to teamwork and adaptability.
• TPB-guided communication activities increase students’ motivation for patient-centred communication.
• Continuous feedback supports the sustainable development of communication skills.

I. INTRODUCTION

Despite the recognised importance of effective healthcare communication, a substantial gap persists in the practical training of communication skills among healthcare students and professionals. Approximately half of the participants in a recent study reported limited exposure to health communication training, highlighting deficits in both skills and awareness of barriers affecting interpersonal health communication (Zota et al., 2023). Current curricula emphasise theoretical knowledge but often neglect practical applications, limiting healthcare providers’ ability to navigate diverse linguistic and cultural patient needs, especially in multilingual societies where language barriers can lead to miscommunication, misdiagnoses, and treatment errors (Mangal & Farmer, 2023; Organi et al., 2024). Compounded by limited access to interpreter services in resource-constrained settings, these barriers increase healthcare costs, delay treatments, and compromise patient safety (Organi et al., 2024).

While healthcare providers play a vital role in promoting informed decision-making through the informed consent process for assessment and treatment interventions, they often struggle to simplify complex medical language to accommodate varying patient health literacy levels- sometimes their own (Guo et al., 2020; Mirza & Tabani, 2018). Effective communication is essential for ensuring that patients fully understand their healthcare situation, which is crucial not only for fostering a strong patient-provider relationship but also for enabling truly informed decision-making (Mirza & Tabani, 2018). Literature thus highlights the critical role of communication skill development in healthcare training (Gilligan et al., 2021; Hagiwara et al., 2019; Medendorp et al., 2021; Stamer et al., 2023). Simulation-based learning is particularly emphasised as an effective method to address gaps in communication skills, especially in areas such as obtaining informed consent (Baby et al., 2018; Medendorp et al., 2021). The rise of digital platforms, however, introduces a need for additional training in digital health communication, considering ethical and legal risks (Etheredge & Fabian, 2022). In response, the practical development of a variety of communication skills is critical for future healthcare professionals (Del Riccio et al., 2023; Fliorent et al., 2023; Neuhauser & Kreps, 2003; Pang et al., 2023).

Research further indicates that fit-for-purpose communication positively impacts patient satisfaction, trust, and treatment adherence (Bennet & Lyons, 2011; Houbby et al., 2020). Structured communication training has been associated with improved patient interactions and better management of challenging interactions (Baby et al., 2018; Bachmann et al., 2022; Hagiwara et al., 2019). Effective communication is also instrumental in advancing health literacy, essential for meeting the United Nations Sustainable Development Goals (UN, 2024). Nevertheless, barriers to healthcare access persist, further complicated by an aging population that challenges global efforts to alleviate healthcare professional shortages (Pang et al., 2023). These complexities, in addition to the reported decline in communication skills, as healthcare professionals progress in their studies (Ha & Longnecker, 2010), highlight the need for the early and longitudinal integration of communication skills development into health curricula to empower students to engage effectively with diverse patient populations (Gilligan et al., 2021).

Despite the growing emphasis on communication in healthcare education, practical application is still limited, particularly in pre-clinical years (Madhavanprabhakaran et al., 2015; Nicolaides et al., 2018). To address this gap, the School of Health and Rehabilitation Sciences (SoHRS) at the University of the Free State (UFS) in South Africa embarked on an interprofessional curriculum initiative, comprising one module a year, that spans the four undergraduate years (van der Merwe & Janse van Vuuren, 2024). Students from the following departments participate in the interprofessional curriculum: Biokinetics, Dietetics, Occupational therapy, Optometry, and Physiotherapy. The first- to third-year modules specifically explore various aspects related to being a healthcare professional including but not limited to a structured progression of communication skills training. Students enrolled in this interprofessional curriculum are from the departments of biokinetics, dietetics, occupational therapy, optometry, and physiotherapy allowing varied perspectives within the curriculum. The detailed process of curriculum development has been described previously (van der Merwe & Janse van Vuuren, 2024) whereas this article will focus only on the intentionally scaffolded and implemented communication-based content from the first- to third-year of study through the lens of the Theory of planned behaviour (TPB).

A. Theoretical Framework: Theory of Planned Behaviour

This literature review explores the significance of healthcare communication skills, and their intentional curricular integration grounded in the Theory of Planned Behaviour (TPB). The TPB posits that an individual’s behavioural intention is influenced by their attitude towards the behaviour, the expectation and attitude of the significant other or group of people toward the behaviour known as the subjective norms, and the individual’s perceived behavioural control namely how difficult or easy they view the performance of the behaviour (Ajzen, 1991; Asare, 2015). The TPB has been previously applied in healthcare research to understand and predict behaviours, such as diagnostic radiographers’ adherence to radiation protection best practices (Lewis et al., 2021) as well as predicting nurses’ intentions and actual use of oxygen therapy in COVID-19 (Dehsorkhi et al., 2023). The TPB highlights the importance of attitudes, subjective norms, and perceived behavioural control in potentially fostering effective training transfer to clinical practice. Within the context of healthcare communication, TPB may help understand and predict how students’ attitudes, the influence of their peers and lecturers, and their confidence in their communication abilities may affect their communication practices.

1) Subjective Norm:

In South Africa, as in many other countries, healthcare professionals are held to high standards by society and regulatory bodies (Hompashe et al., 2021; HPCSA, 2025). The Health Professions Council of South Africa (HPCSA) sets minimum training standards for institutions offering healthcare programmes and requires that all registered professionals adhere to a strict code of conduct. Central to these standards is the expectation of effective patient communication (Hompashe et al., 2021; HPCSA, 2025). Higher education institutions such as the one where the study was performed also emphasise the importance of developing communication skills in their graduates. Coupled with the societal expectation of a healthcare professional who can professionally, but also effectively and clearly communicate with a diverse patient population (Amirthalingam et al., 2022; Hagiwara et al., 2019; Hompashe et al., 2021), the importance of and expectations regarding healthcare communication is clear. Aligned with the TPB, these professional and societal expectations would act as a strong motivator for healthcare students to adjust their communication behaviour through intentional skill development to ensure they satisfy societal and regulatory body expectations.

2) Perceived Behavioural Control:

The authors viewed the student’s perceived control over their communication abilities, as well as their perceived difficulty in demonstrating effective communication to be directly impacted by their educational environment. The impact of the educator is therefore situated within the intentional design of transformational learning spaces where students are guided and supported to develop the required communication skills (Mahdy et al., 2020; Pillay et al., 2019). Within the described interprofessional curriculum (van der Merwe & Janse van Vuuren, 2024), opportunities for gaining theoretical knowledge, the provision of both educator and peer feedback as well as the practical application of learnt skills in various settings were created to allow students to manage and mitigate any perceived barriers, they might experience towards developing their communication skills (Figure 1).

3) Attitude Towards Behaviour:

Student’s expectations and evaluation of their applied communication abilities were explored through the intentional application of the learned communication skills within a community setting (Figure 1). Additionally, students explored their changing attitudes toward their communication abilities through interprofessional class engagement, closely simulating the interprofessional nature of their future healthcare environment (Pillay et al., 2019). Healthcare students acknowledge the importance of collaborative teamwork in achieving optimal patient outcomes (Pillay et al., 2019), while their commitment to improving the well-being of individuals under their care serves as a key motivator for their engagement with provided educational content and learning opportunities (Kassab et al., 2022). By directly engaging with both their peers and the community they will serve during their later study years, students are afforded the opportunity of real-life implementation of their learned skills for the betterment of society.

B. Conceptual Framework

Applying the TPB in communication training involves addressing students’ attitudes toward communication, reinforcing positive subjective norms, and enhancing their perceived control over performing communication tasks. In line with the TPB, the authors considered the interplay between the various TPB elements and intentionally selected and designed activities, content, and assessments to better prepare students for real-world communication challenges. The authors mapped communication-based activities throughout the interprofessional modules from the first- to third year of study (Figure 1).

With an initial first step of any behavioural change being that of the participant’s motivation to change (Ajzen, 1991; Asare, 2015), it was deemed essential to ensure students were introduced to the importance and value of effective communication within the healthcare field from their first year of study. Additionally, to minimise potential cognitive overload the content was scaffolded, as illustrated in Figure 1, to gradually expose students to increasingly challenging concepts and activities.

HC: Healthcare
HPCSA: Health Professions Council of South Africa

Figure 1. Conceptual framework of the curricular mapping of communication-based activities

Table 1. Student enrolments 2022 to 2024

Qualitative data were collected from all students enrolled in the respective modules through two processes namely an annual institutional module evaluation (2022 and 2023) as well as voluntarily provided anecdotal feedback (2024). The survey included open-ended questions to gather narrative accounts of student participants’ module experiences and to capture any provided suggestions. Verbal feedback was provided by students to the researcher directly following activity engagement answering the question “How did you experience the communication-based activity?”.

The primary author (AvM) repeatedly reviewed both the typed responses to open-ended survey questions and the verbatim transcriptions of students’ verbal feedback to identify and extract aspects related to students’ experiences of communication-based activities presented in the interprofessional modules. All data were thematically analysed by the AvM through deductive In vivo coding (Saldaña, 2018) under the predetermined themes of the TPB namely subjective norm, attitude towards behaviour, and perceived behavioural control, and subsequently checked by the second author (CvV).

III. RESULTS

Module evaluation response rates, although varied between years and student groups (Table 2), remained low. Additional verbal feedback from students following communication activities supplemented module evaluation data.

Table 2. Response rates on module evaluation survey (2022, 2023)

Figure 2. Thematic analysis of qualitative data

Quotes supporting the identified themes and categories (Figure 2) are presented in Table 3.

Table 3. Supporting quotes per theme

A. Subjective Norm

Students reported that, through practical engagement, they were allowed to develop essential professional skills expected of them in their future work environments (Table 3).

The interprofessional nature of the module and module groups allowed students the opportunity to get to develop teamwork and interprofessional communication skills (Table 3).

B. Attitude Towards Behaviour

The real-world application of communication skills in a community setting was generally described as a positive experience, though it was accompanied by some uncertainty and revealed areas for improvement (Table 3).

C. Perceived Behavioural Control

Activities presented by or including external guests were mentioned to have a positive impact on students through providing a real-world perspective (Table 3).

The allowance for students to, both in class and in assessment activities, practically apply learned communication skills was mentioned repeatedly as a positive aspect in the development of these essential skills (Table 3).

As shown in Table 3 the inclusion of group work activities, although fostering the development of a supportive environment, did challenge some students, most notably in finding a common understanding during class activities.

An essential aspect highlighted in this study was that the communication extended beyond the taught skills, but also to the lecturer-student communication relationship (Table 3).

IV. DISCUSSION

This study aimed to explore the experiences of students participating in purposefully designed communication-based activities hosted within an interprofessional healthcare curriculum. The TPB framework used in this curriculum allowed the authors to purposefully design communication-based teachings and activities to foster behavioural intention on the part of undergraduate healthcare students to best incorporate learned communication skills and appreciate the value thereof within their future practice (Bennett & Lyons, 2011). The findings reveal that by integrating TPB elements – attitudes, subjective norms, and perceived behavioural control—into a healthcare education framework, students reported increased confidence, skill retention, and adaptability in real-world interactions. These results align with prior studies demonstrating the positive effects of structured communication training on healthcare students’ self-efficacy and readiness for patient-centred care (Bachmann et al., 2022; Vogel, Meyer, & Harendza, 2018).

Healthcare professionals are expected to be increasingly adaptable, driven by both the evolving demands of the healthcare environment and societal expectations for effective communication within the profession. Even though the healthcare landscape has changed dramatically over the past few years, the importance of effective and clear healthcare communication within a diverse patient population remains central to optimal patient management (Paget et al., 2011; Skolnik & Butler, 2014). Previous studies have noted challenges related to language and cultural barriers in healthcare often leading to miscommunication, delays in treatment, and poorer health outcomes (Organi et al., 2024; Zota et al., 2023). Not only limited to this study’s context but also from a global perspective, effective intercultural engagement is, therefore, an essential skill expected from healthcare professionals, necessitating the development thereof during the undergraduate study years (Madhavanprabhakaran et al., 2015; Nicolaides et al., 2018; Pillay et al., 2019). This does not imply mastery of all cultural nuances but rather an understanding of the principles necessary for managing diverse patient interactions effectively.

Effective health communication is grounded in a shared decision model, which emphasises the patient’s understanding of proposed management options and aligns with society’s expectation that healthcare communication be collaborative, fostering a partnership between healthcare professionals and patients (Ha and Longnecker, 2010; Paget et al., 2011; Zota et al., 2023). However, healthcare professionals’ reliance on an information-based approach where information on symptoms and treatment options is provided with limited consideration of the patient’s perspective, understanding, or emotional response remains a challenge (Ha & Longnecker, 2010; Zota et al., 2023). Clear, accessible information through, amongst others, employing lay terms in healthcare communication significantly enhances patient understanding by making information clearer, facilitating informed decision-making, reducing anxiety, building trust, and preventing misunderstandings (Guo et al., 2022; Paget et al., 2011; Skolnik & Butler, 2014). However, participants in this study noted struggling to communicate healthcare information in a simplified manner, highlighting the need for additional attention being given to the development of this essential skill.

Considering the collaborative nature of healthcare, this study highlighted the value of interprofessional communication-based engagement in preparing students for the world of work. Participants reported that working alongside peers from diverse health disciplines provided valuable exposure to different perspectives, reinforcing the importance of clear communication, teamwork, and adaptability. Interprofessional learning experiences have been reported to foster a shared understanding of patient needs and enhance collaborative problem-solving, skills that are vital in patient-centred models of care (Madhavanprabhakaran et al., 2015; Nicolaides et al., 2018). Allowing students the opportunity to engage with and learn from one another further ensures exposure to varied personal, professional, and cultural perspectives and managing the received input accordingly. The value of interprofessional engagement has further been highlighted in promoting resilience and adaptability (Gilligan et al., 2021; Pillay et al., 2019), by allowing students to communicate effectively across different professional contexts, aligning with the professional and societal expectations of qualified healthcare professionals. The importance of the early integration of interprofessional activities and community engagement spanning across study years has also been emphasised (Bennett & Lyons, 2011; Thibault, 2020) with this current study’s participants expressing the value of learning how to co-operate and respectfully communicate with others. The authors believe that positive experiences in interprofessional communication will lead healthcare students to engage more confidently and positively in future interprofessional interactions.

The study’s findings indicated that participants’ attitudes towards communication were positively influenced through practical community-based interactions, potentially translating to feelings of perceived behavioural control. Although some students reported uncertainty when engaging in real-world communication activities, most expressed increasing confidence and were able to identify areas for improvements related to their communication abilities. Aligned with previous research, it is suggested that if students perceive positive communication outcomes and consider those positive outcomes to be more likely, they will place more value on working toward achieving those outcomes (Bennett & Lyons, 2011; Dehsorkhi et al., 2023; Lewis et al., 2021). Consequently, it is hypothesised that students will be more inclined to engage in improved communication behaviours, with potentially improved skills transferred to clinical settings.

A scaffolded teaching and learning approach aimed to assist students in gradually developing their communication skills by providing opportunities to continuously build knowledge and allow engagement (Van de Pol et al., 2010). This scaffolded learning approach also aimed to prevent cognitive overload by breaking complex communication tasks and skill acquisition into manageable steps, allowing students to focus on mastering each element gradually (Sweller, 2010; Van Merriënboer & Kirschner, 2018). The intentional transition from theoretical understanding to real-world application also allowed students to engage in hands-on practice optimising their learning and potentially effecting behavioural change (Kurtz, Silverman, Benson, & Draper, 2003). Berkhof et al. (2011) underscore this by showing that repeated exposure to communication training enhances students’ skills in empathy and active listening, while also equipping students to manage emotionally charged patient interactions more effectively.

Through establishing a curricular space that encouraged the exchange of diverse perspectives and incorporated both peer and educator feedback, students were empowered to address and overcome perceived barriers to their communication-based learning, potentially enhancing their behavioural control over time. Additionally, exposure to varied viewpoints—through content presenters, assessors, and feedback providers—aimed to foster the development of critical thinking skills and a deeper understanding of the subject matter (Bedford & Barnes, 2024). Aligned with published recommendations, communication-based activities in this curriculum also emphasised diverse forms of interaction such as simulation and role-play, aiming to further assist students in overcoming communication barriers by providing practical experience in effective person-centred communication (Bennett & Lyons, 2011; De Sousa Mata et al., 2021). This practical approach encourages active student participation, enabling them to practice key skills and fostering behaviour change (De Sousa Mata et al., 2021).

The inclusion of group work activities was mostly experienced as positive in developing a different communication skill set. However, some students expressed frustration with groupwork activities especially when navigating diverse opinions and communication styles. These challenges reflect findings by Vacheishvili (2021) and Wilson et al. (2018) who note that while group work fosters teamwork skills, it can also be difficult to manage if group work activities are not selected with care. Considering the collaborative nature of healthcare practice, developing communication skills within a group setting may contribute to the resilience and flexibility required as students develop the skills to mediate conflicts and balance differing viewpoints, ultimately enhancing their adaptability in future professional settings (Paget et al., 2011; Vacheishvili, 2021; Wilson et al., 2018).

The perceived impact of educator-student communication as a model for professional behaviour and academic support was also highlighted in this study. Positive educator-student communication and feedback were frequently cited by participants as contributing to their confidence and clarity in the learning process, a finding corroborated by Kassab et al. (2022) linking educator engagement with increased student motivation and self-efficacy in healthcare training. Educator feedback provided students with practical guidance, while the supportive learning environment encouraged open dialogue, both of which are key for developing reflective healthcare practitioners (van der Merwe et al., 2024).

V. CONCLUSION

This study highlights the value of, through consideration of the TPB, embedding interprofessional, practical communication-based activities in healthcare education to facilitate behavioural intention towards patient-centred communication. Findings suggest that practical, real-world communication activities helped students develop the expected healthcare communication skills. Additionally, results indicated that the intentional communication-based activities positively influenced students’ attitudes toward patient-centred communication. By incorporating a range of communication-based activities paired with continuous feedback, students were consistently supported across multiple study years, helping them to develop and sustain essential communication skills. This ongoing reinforcement positively impacted participants’ sense of behavioural control, as they gained confidence in their ability to perform these skills effectively in practice. The study underscores that to ensure healthcare graduates can communicate in an adaptable, culturally sensitive, and collaborative way, purposefully integrating communication-based activities to affect potential behavioural change is essential. Future research into the long-term effects of such training on professional performance and patient outcomes is recommended.

Notes on Contributors

AvM coordinates the curricular implementation. All authors contributed equally to the manuscript conceptualisation, data checking, and proofreading of the manuscript. All authors have read and approved the manuscript.

Ethical Approval

Before the commencement of the study approval was granted by the General/Human Research Ethics Committee (UFS-HSD2021/0921/21) at the University of the Free State, ensuring that all guidelines for research including human participants were adhered to. Informed consent was obtained from all individual participants included in the study.

Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Acknowledgement

The authors wish to acknowledge the participating students for their valuable feedback. The authors acknowledge the use of OpenAI’s ChatGPT to provide language and grammar feedback in the discussion section during the preparation of the final manuscript.

Funding

No funding was received for this study.

Declaration of Interest

The authors have no conflict of interest to declare.

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*Anke van der Merwe
205 Nelson Mandela Drive,
Park West, Bloemfontein, 9301
Email: gonzalesa@ufs.ac.za