Publication: Comportamiento sexual inapropiado de pacientes hacia fisioterapeutas: diseño de un instrumento de recogida de datos, estudio de prevalencia, factores asociados y estrategias de afrontamiento desde una perspectiva de géner
Authors
Muñoz Lorente, María
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Escuela Internacional de Doctorado
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Baño Aledo, María Elena del
Publisher
Universidad de Murcia
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DOI
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info:eu-repo/semantics/doctoralThesis
Description
Abstract
Marco teórico
El comportamiento sexual inapropiado de los pacientes hacia fisioterapeutas (CSIP) constituye una forma de violencia laboral que afecta la seguridad clínica, la ética profesional y el bienestar emocional del colectivo. Aunque la literatura internacional reconoce su alta prevalencia en profesiones sanitarias, la fisioterapia ha sido tradicionalmente invisibilizada, especialmente en el contexto español. La práctica fisioterápica implica contacto físico, proximidad y exposición corporal del paciente, condiciones que pueden favorecer malentendidos y conductas inapropiadas, especialmente en un marco sociocultural marcado por desigualdades de género. La falta de formación específica y de protocolos institucionales contribuye a la normalización del problema. El movimiento #MeTooFisio (2018) evidenció públicamente esta realidad y marcó un punto de inflexión en su visibilización.
Hipótesis y objetivos.
Se planteó que existen diferencias de género en la prevalencia, características y afrontamiento del CSIP; que factores personales, laborales y del paciente influyen en su aparición; y que la formación para su manejo es insuficiente. El objetivo general fue diseñar y validar un instrumento para evaluar experiencias de CSIP y estrategias de afrontamiento en fisioterapia, así como analizar su prevalencia, factores asociados y diferencias de género.
Material y métodos
La investigación combinó una fase cualitativa de diseño y validación del cuestionario, basada en instrumentos internacionales adaptados al contexto español, y una fase cuantitativa con un estudio observacional transversal. Participaron 571 fisioterapeutas (380 mujeres y 191 hombres) de distintas comunidades autónomas. Se analizaron variables demográficas, laborales y formativas, así como las experiencias de CSIP, su gravedad y las estrategias de respuesta. El estudio fue aprobado por el Comité de Ética de la Universidad de Murcia.
Resultados
El 93% de las mujeres y el 88% de los hombres habían vivido alguna experiencia de CSIP. Las mujeres presentaron mayores tasas en casi todas las categorías, especialmente en los comportamientos verbales y de insinuación. Los episodios graves, como el contacto físico no consentido, afectaron al 46% de las mujeres y al 35% de los hombres. El perfil más frecuente del agresor fue el de un varón mayor de 40 años sin alteraciones cognitivas. Solo un 4% de los profesionales había recibido formación específica. Predominaron las estrategias evitativas, aunque las confrontativas fueron percibidas como más eficaces.
Discusión y conclusiones
El CSIP es un fenómeno estructural en fisioterapia, condicionado por desigualdades de género y carencias formativas e institucionales. Las mujeres fisioterapeutas son más vulnerables y emplean un repertorio de respuestas más amplio, mientras que los hombres tienden a minimizar el problema. Se recomienda la implementación de protocolos específicos, formación reglada y políticas de prevención y denuncia que garanticen entornos clínicos seguros. La tesis aporta un instrumento validado para su estudio y evidencia la necesidad de incorporar una perspectiva de género en la formación y práctica fisioterapéutica.
Background. Inappropriate sexual behaviour by patients toward physiotherapists (IPSB) constitutes a form of occupational violence that undermines clinical safety, professional ethics, and practitioners' emotional well-being. Although international literature acknowledges its high prevalence across healthcare professions, physiotherapy has been comparatively underrepresented, particularly within the Spanish context. Physiotherapy practice inherently involves physical contact, close interpersonal proximity, and patient bodily exposure conditions that may facilitate misunderstandings and inappropriate conduct, especially within sociocultural contexts shaped by gender inequalities. The absence of discipline-specific training and institutional protocols further contributes to the normalization and underreporting of the phenomenon. The #MeTooFisio movement (2018) brought this issue to public attention and marked a significant turning point in its visibility. Hypotheses and Objectives. It was hypothesized that gender differences exist in the prevalence, typology, and management of ISB; that personal, occupational, and patient-related factors influence its occurrence; and that existing training for its management is insufficient. The primary objective of the study was to design and validate an instrument to assess experiences of IPSB and coping strategies among physiotherapists, and to examine its prevalence, associated factors, and gender-related differences. Materials and Methods. The study employed a mixed-methods design, with a qualitative phase to develop and validate the questionnaire, adapted from international instruments to the Spanish context, followed by a cross-sectional observational study. A total of 571 physiotherapists participated. Demographic, professional, and training variables, along with experiences of ISB, perceived severity, and coping responses, were collected. Ethical approval was granted by the Research Ethics Committee of the University of Murcia. Results. A total of 93% of women and 88% of men reported having experienced at least one episode of ISB. Women reported higher rates across nearly all categories, particularly in verbal and suggestive behaviours. Severe incidents, such as non-consensual physical contact, were reported by 46% of women and 35% of men. The most frequent aggressor profile corresponded to a man over 40 years of age without cognitive impairment. Only 4% of participants had received formal training on the issue. Avoidant strategies were most commonly employed, although confrontational strategies were perceived as more effective. Discussion and Conclusions. ISB constitutes a structural issue within the physiotherapy profession, shaped by gender-based inequalities and deficiencies in training and institutional support. Female physiotherapists appear to be more vulnerable and make use of a broader repertoire of coping strategies, whereas male physiotherapists tend to downplay the phenomenon. The findings underscore the need for the implementation of profession-specific protocols, structured training programmes, and comprehensive prevention and reporting policies to ensure safe clinical environments. This thesis provides a validated instrument for the assessment of ISB in physiotherapy and highlights the importance of integrating a gender perspective into professional education and clinical practice.
Background. Inappropriate sexual behaviour by patients toward physiotherapists (IPSB) constitutes a form of occupational violence that undermines clinical safety, professional ethics, and practitioners' emotional well-being. Although international literature acknowledges its high prevalence across healthcare professions, physiotherapy has been comparatively underrepresented, particularly within the Spanish context. Physiotherapy practice inherently involves physical contact, close interpersonal proximity, and patient bodily exposure conditions that may facilitate misunderstandings and inappropriate conduct, especially within sociocultural contexts shaped by gender inequalities. The absence of discipline-specific training and institutional protocols further contributes to the normalization and underreporting of the phenomenon. The #MeTooFisio movement (2018) brought this issue to public attention and marked a significant turning point in its visibility. Hypotheses and Objectives. It was hypothesized that gender differences exist in the prevalence, typology, and management of ISB; that personal, occupational, and patient-related factors influence its occurrence; and that existing training for its management is insufficient. The primary objective of the study was to design and validate an instrument to assess experiences of IPSB and coping strategies among physiotherapists, and to examine its prevalence, associated factors, and gender-related differences. Materials and Methods. The study employed a mixed-methods design, with a qualitative phase to develop and validate the questionnaire, adapted from international instruments to the Spanish context, followed by a cross-sectional observational study. A total of 571 physiotherapists participated. Demographic, professional, and training variables, along with experiences of ISB, perceived severity, and coping responses, were collected. Ethical approval was granted by the Research Ethics Committee of the University of Murcia. Results. A total of 93% of women and 88% of men reported having experienced at least one episode of ISB. Women reported higher rates across nearly all categories, particularly in verbal and suggestive behaviours. Severe incidents, such as non-consensual physical contact, were reported by 46% of women and 35% of men. The most frequent aggressor profile corresponded to a man over 40 years of age without cognitive impairment. Only 4% of participants had received formal training on the issue. Avoidant strategies were most commonly employed, although confrontational strategies were perceived as more effective. Discussion and Conclusions. ISB constitutes a structural issue within the physiotherapy profession, shaped by gender-based inequalities and deficiencies in training and institutional support. Female physiotherapists appear to be more vulnerable and make use of a broader repertoire of coping strategies, whereas male physiotherapists tend to downplay the phenomenon. The findings underscore the need for the implementation of profession-specific protocols, structured training programmes, and comprehensive prevention and reporting policies to ensure safe clinical environments. This thesis provides a validated instrument for the assessment of ISB in physiotherapy and highlights the importance of integrating a gender perspective into professional education and clinical practice.
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