“TO FIND THE LEVEL OF EMPATHY IN FINAL YEAR OCCUPATIONAL

THERAPY STUDENTS”

Dissertation Submitted to the Tamil Nadu Dr .M.G.R. University, Chennai in Partial

Fulfillment of the Requirement for the Degree Of

BACHELOR OF OCCUPATIONAL THERAPY

2013-2017

Project Work by

GOKUL .S

Guided by

Mr. S.G.PRAVEEN MOT

Vice Principal

Department Of Occupational Therapy,

KMCH College of Occupational Therapy

KMCH COLLEGE OF OCCUPATIONAL THERAPY

AFFILIATED TO THE TAMIL NADU Dr.MGR MEDICAL UNIVERSITY

CHENNAI
 CERTIFICATE

This is to certify that Mr. Gokul .S bearing the Register No :781316016 has satisfactory
completed his project work On “To find the level of Empathy in final year Occupational
therapy students” which is partial fulfillment of Bachelor’s Degree in Occupational Therapy
2013-2017, at KMCH College of Occupational Therapy, affiliated to The Tamil Nadu Dr
.M.G.R. Medical University ,Chennai.

Project Guide Principal

Mr. S.G. Praveen MOT Mrs.Sujata Missal M.sc(OT),PGDR(OT)

Date of Submission :

Internal Examiner External Examiner

 ACKNOWLEDGEMENT

The completion of this thesis would not have been possible without the support and help
of many people, not all of whom can be acknowledged here but to whom I will, nonetheless, be
forever grateful.

First and foremost, I thank my beloved parents, Mr.Srinivasan.K and Mrs.Latha.S for
their unconditional love, sincere prayers, unstinted support and care without which I would not
have accomplished anything.

I thank my God for always watching upon me with grace to fulfill this endeavor.

I express my heartful thanks to our principal, Mrs.Sujata Missal, Msc.(OT), PGDR

(OT), KMCH College of Occupational Therapy, for providing me with all the facilities to make
my project successful.

I express my deep sense of gratitude to my project guide& I am indebted to our Vice

Principal Mr.S.G.Praveen, MOT for being very kind and supportive throughout this project.

I also extend my gratitude to Mrs. Sugi MOT for her timely suggestion and for helping
me in statistical analysis unmindful of her schedule.

With due respect, I thank my Class in-Charge Mrs. Lynda George, BOT for being
supportive throughout the project.

I also extend my thankfulness to other faculty members Mr. Siva Subramaniam,

MOT, KMCH College of Occupational Therapy and Mr.VenuGopal, KMCH College of
Physiotherapy for their guidance through my endeavor.

I express my heartfelt thanks to my batch mates (2013-2017) YNOTZZZ for their

cooperation and giving me the permission to conduct the study.
S. NO CONTENTS PAGE NO:

1 ABSTRACT

2 INTRODUCTION

3 AIM AND OBJECTIVES

4 RELATED LITERATURE

5 REVIEW OF LITERATURE

6 METHODOLOGY

7 DATE ANALYSIS

8 DISCUSSION

9 CONCLUSION

10 LIMITATIONS AND RECOMMENDATIONS

10 REFERENCES

11 APPENDIX
 ABSTRACT

Aim:

To find the level of Empathy in final year Occupational Therapy Students.

Methods:

 Research design: Survey study.

 Population: Occupational Therapy Students.
 Sample size: 50.
 Sampling: Convenient sampling.
 Place of the study: KMCH College of Occupational Therapy.
 Both Gender.
 JSE-HPS Version.

Results:

All the participants have had high level empathy. Comparing male and female, females
were having high level empathy than males.

Conclusion:

The study conclude that final year occupational therapy students have a good level of
empathy.
INTRODUCTION:

Empathy is the ability to listen, understand another’s needs and circumstances and
express that understanding. (WHO)

The cognitive domain of empathy involves the ability to understand another person’s
inner experiences and feelings and a capability to view the outside world from the other
person’s perspective. Such a cognitive component is also amenable to training and, thus,
medical intuitions can play a positive role in the development of student’s understanding about
empathy. The emotional domain involves the capacity to enter into or join the experiences and
feelings of another person. The emotional relationships that elicit emotional response are
conceptually more relevant to sympathy than to empathy.
Empathy has been described as a multi-dimensional construct, comprising two main
domains: an affective capacity to be sensitive to and concerned for another person and a
cognitive capacity to understand and appreciate the other person’s perspective. In a clinical
context, it has been suggested that the cognitive component also includes the ability to
communicate that understanding. Empathy is considered to be normally distributed amongst the
general population, whilst studies both of the general population and of medical students
suggest that females are more empathetic than males. Difficulties in measurement may be
partly responsible for this mixed picture. Systematic reviews of research on empathy in
medicine have highlighted problems relating to the variety and number of measures used the
failure to present evidence supporting their reliability and validity and the failure to indicate
whether the affective or cognitive aspects of empathy are being addressed.

Sympathy, if excessive, could interfere with objectivity in diagnosis and treatment.

“Compassionate detachment” has been used to describe the physician’s empathetic concern for
the patient while keeping sympathy at a reasonable distance to maintain an emotional balance.
Hence an “emotional distance” would be desirable to avoid bursts of emotions that might
interfere with clinical neutrality and personal durability.
Empathy is important to patient care. It enhances patients’ satisfaction, comfort, self-
efficacy, and trust which in turn may facilitate better diagnosis, shared decision making, and
therapy adherence. Assessment of medical students’ empathy has tended to rely on observation
by faculty, rating by standardized or simulated patients (SPs), and self-report measures.
 Empirical research on Empathy in despite the importance of empathy in patient care,
there is a disturbing decline in empathy as health-profession student’s progress through
training. These findings have generated concern among health-professions educators not only
to prevent the decline but also to enhance empathy among students. This concern can be
empirically investigated only when the concept of empathy has been operationally defined and
quantitatively measured patient care is facilitated by the availability of a validated instrument
that is specific to empathic engagement in the context of patient care.
Viewed from the contrasting perspective, a lack of empathy can have negative effects
on Clinical outcomes. Empathy is the ability to consider a situation from someone else’s point
of view, to understand the feelings of others, and to communicate this understanding to them.1
Factors that may affect empathy include age, family background, culture, intelligence,
education, personality, and, specialty interests. More empathy-based education and more
empathetic educators positively affect student’s levels of empathy. Previous study was intended
to assess whether empathy increases with medical training and identify the socio-demographic
background of medical students influencing their empathy level.
Need For the Study:

• Empathy is an important attribute for occupational therapists in establishing rapport and

in better understanding their clients.
• However, empathy can be compromised by high workloads, personal stressors and
pressures to demonstrate efficacy.
• Occupational therapists also work with patients from a variety of diagnostic groups.
• During the academic students have to study about empathy, then only they can fulfil
their required skills to became a good occupational therapist.
• Also occupational therapists were deal with different kind of patient from psychiatry,
paediatrics, neurology, orthopaedics etc.
• There need of good understanding between patient – therapist relationship.
• Also in occupational therapy, we used client centred practice, in client centred practice
empathy plays vital role at all the process of treatment planning and other rehabilitation
process.
• But the need of choosing final year was, after completion of their studies they were
directly deals with patient. So there is a need of empathy is high.
• This study also helps to know the importance of empathy in occupational therapy
education programme and if finding shows low level of empathy suggest the health
educator to promote empathy oriented studies in occupational therapy course.
 AIM AND OBJECTIVES

• AIM:
To find the Level of Empathy in Final Year Occupational Therapy Students.

• OBJECTIVES:
To evaluate the level of empathy using Jefferson scale of Empathy-HPS version
(Health professional students version) in final year Occupational Therapy Students.
 RELATED LITERATURE

Conceptualization and definition of empathy:

Empathy, a multi-dimensional concept, has been described as elusive, difficult to

define, and hard to measure (Pike, 1990). Aring (1958) defined empathy as the appreciation for
another person’s feelings, without joining them, as opposed to sympathy that is considered the
act or feelings of joining with another person. Through the years, researchers have attempted
to be more specific in their definitions. Alligood (1992) described two types of empathy, basic
or innate, and trained. Other studies have described cognitive and emotional or affective
empathy (Dziobek et al. 2008).

Through functional MRI studies Derntl et al. (2010) identified gender differences
within three components of empathy (emotion recognition, perspective taking, and affective
responsiveness). In the context of patient care, Olson (1995) defined empathy as ‘the skill of
understanding what a patient is saying and feeling, and communicating this understanding
verbally to a patient’s. Expanding upon Olson’s conceptualization, we adapted the definition of
empathy as a predominantly cognitive attribute that involves an understanding of patients’
experiences combined with a capacity to communicate this understanding and an intention to
provide help to the patient (Fields et al., 2004; Hojat et al., 2001, 2002).

Development of empathy in healthcare providers:

A number of authors (e.g., Alligood 1992; Hojat 2009; Nerdrum 1997) have
suggested that empathy in healthcare providers can be developed through basic and
graduate professional education and/or supported through continuing education efforts for
practitioners. Accordingly, many educators incorporated the development of empathic skills
as the basis of therapeutic communication into health professional curricula to help students
and practitioners progress towards a higher degree of empathy (e.g., Davis, 1983; Harlak et
al., 2008; Svensen & Bergland, 2007).

Recent systematic reviews of the literature regarding conceptualization and

measurement of empathy in nursing by Yu and Kirk (2010); in social work by Gerdes, Segal,
and Lietz (2010); and in medicine by Hemmerdinger, Stoddart, and Lilford (2007), continue
to point out inadequacies in many of the assessment tools and limitations in studies.
 The majority of the studies focus on one specific health profession. Only a few
comparisons of levels of empathy among different professions have been found in the literature.
For example, levels of empathy were examined in nurses and physicians (Fields et al., 2004), and
in nurse practitioners and physicians (Hojat, Fields, & Gonnella, 2003).

We had difficulty in finding studies of empathy extending across several professional

groups. A study by Boyle et al. (2010) of 459 Australian undergraduate students from
emergency health/paramedic, nursing, midwifery, occupational therapy, physiotherapy, and
health science found that there was not a significant difference in the level of empathy (p =
0.862) across the six programs. They also found female students to be more empathetic than
the male students (M = 109.79, SD = 14.73).

There have been studies of practitioners and students across the professions for
other elements related to professionalism (Veloski & Hojat, 2006). For example,
attitudes toward interprofessional collaboration among physicians and nurses as well
as other members of the healthcare team have been studied extensively worldwide
(Fields et al., 2004; Hojat et al., 2003b; Hojat & Gonnella,2011; Hong, Wright, Gagliardi,
Brown, & Dobrow, 2009; Linqvist, Duncan, Shepstone, Watts & Pearce, 2005).
Comparisons across cultures have also been conducted (Hojat et al., 2003b). Although
teamwork is vital to safety and effectiveness, assessment of interprofessional teamwork in
most healthcare settings, especially the critical care areas such as the operating room,
emergency room, and intensive care units in the hospital, has been extremely difficult to
accomplish due to the complex nature of patient care and personal characteristics of each
participating profession (Healey, Undre, Sevdalis, Koutantji & Vincent, 2006).

Assessing attitudes toward ethical issues in healthcare among interprofessional

students and/or practitioners has been another challenging area for researchers
(Buelow, Mahan, & Garrity, 2010). In a study by Ward et al. (2009), a significant correlation
(r = 0.32, p=0.01) was reported between nursing students’ scores on empathy and attitudes
toward interprofessional collaboration.There is evidence internationally that many health
profession students continue to demonstrate limited ability to communicate empathy in
practice (Reynolds & Scott, 2000).
 The educational experience itself has been implicated in the reduction of caring
behaviors of medical and nursing students in the US and abroad, especially during the
indepth clinical learning experience (Hojat et al., 2009; Ward, et al., 2009). Various
experiential factors may be influential, including, social, political, economic, and
generational factors (Harlak et al., 2008; Reynolds & Scott, 2000).

A recent meta-analysis of studies conducted over 30 years in the US by researchers

at the University of Michigan, found that undergraduate college students generally have
much less empathy than students in past generations (Konrath, O’Brien & Ksing, 2011).
As these students enter the health professions faculty will need to assess their caring
behaviors and develop strategies to increase the students’ ability to provide empathetic care.

Benefits of empathy in health-care professionals and patients:

Studies by health professionals suggest that empathic engagement in patient care can
lead to better patient compliance (DiMatteo et al., 1993); More accurate prognosis (Dubnicki,
1977), and increased patient satisfaction (Zachariae et al., 2003). In a clinical outcome study, it
was found that nurses’ empathic engagement in patient care was predictive of reduced anxiety,
depression, and hostility in cancer patients (LaMonica, Wolf, Madea & Oberst1987).

Consistent with these findings, Sullivan (1990) reported that empathic nurse–patient
communication resulted in decreased levels of stress among patients and also served as a
buffer against potential psychological and health-related problems among nurses. Recently, a
significant link was found between physician empathy and optimal physiologic outcomes in
diabetic patients (Hojat et al., 2011).

There is extensive research documenting benefits of empathy to both patients and their
health care professionals (Wilson, Prescott & Becket, 2012). In patients, cognitive benefits such
as reduction in depression, anxiety and stress levels have been observed (Fields et al. 2011), as
well as improved adherence to treatment regimens and better patient satisfaction (Wilson et al.
2012).Amongst healthcare professionals, higher levels of empathy have been reported to be
closely related to improved clinical competence ratings, accurate diagnosis, better performance
on history taking and higher ratings of job satisfaction (Farrelly, 2012; Tavakol, Dennick &
Tavakol, 2012; Tel, Mollaoglu, Polatkan & Gunaltay, 2011).
 Importantly, high empathy levels have also been associated with a decrease in likelihood
of litigation against health professionals (Fjortoft, Van Winkle & Hojat 2011). In recent years,
technological advancement has introduced equipment that can be operated without interaction
between the practitioner and patient. Therefore, an empathetic relationship is important in
bridging the gap between patients and practitioners (Wilson et al. 2012, Gonullu & Oztuna
2012).

Research has shown that empathy an acquired skill, rather than purely an innate ability -
can be facilitated through teaching; therefore it is not surprising that empathy forms part of the
patient- centered approach that is taught in the undergraduate curricula of many healthcare
professions (Spiro 1992; Williams et al 2014).

Research on empathy in allied health-care professional students:

Globally, much research on empathy has focused on medical and nursing students
(Nunes, Williams, Sa & Stevenson, 2011). Empathy is an important aspect in non-medical
health professions and recommendations have been made to include training of the skill in
allied health sciences curricula (Hojat et al. 2009). However, little empirical research has
focused on empathy levels in allied health students (Hojat et al. 2009). Research development
has been slow because of confusions in defining and conceptualizing empathy; as well as a
lack of agreement on an instrument that is both reliable and valid to measure empathy (Hojat
et al. 2009). These same challenges have been observed within the African and South African
context (Vallabh 2011; Dehning et al. 2012).

Scant research on empathy has been done within the South African context, with only
one study having been conducted in undergraduate medical students in South Africa, which
used the Jefferson Scale of Physician Empathy (Vallabh 2011). This lack of empathy research
in South Africa suggests the need for further research to be conducted amongst allied Health
Sciences students. Differences in cultures, ethnicity, gender and sex stereotyping, choice of
profession, religious beliefs and norms all contribute to how empathic engagement unfolds in
different settings (Vallabh 2008; Gonullu & Oztuna 2012). Therefore, it is important to study
levels of empathy in a South African context because of its own unique social strata that
influence how one shows empathy towards others. The current study attempts to start
bridging the gap in current literature by focusing specifically on researching empathy levels
in audiology and speech therapy students at a South African university (Boyle et al. 2010).
Factors which influence levels of Empathy:

It is possible that cultural traditions and norms may impact empathy levels. For
example, high levels of empathy were observed in Japanese medical students; and this was
attributed to Japan’s collectivist society influence, science orientation and the inclusion of
humanities courses in their medical curriculum (Wilson et al. 2012).

African countries subscribe to the principle of Ubuntu, which Chaplin (2006)

describes as the potential of being a good human, by striving to help people and putting the
needs of the community and others above one’s own. With the concept of Ubuntu we argue
that we could expect similar results as South Africa is mostly considered a collectivist society
(Gibson, Swartz & Sandenbergh 2002). Hence, the current study’s exploration of empathy
levels in the South African health sciences student population, particularly Speech Therapy
and Audiology, will add to the available literature on empathy together with a contextual
factor, which will in turn help to explain the observed results.

Existing research shows mixed results as to whether there is a gender difference in

empathy (Rueckert 2011). Studies using self-report measures to assess empathy have provided
the most convincing evidence for gender differences in empathy (Rueckert 2011), with
women scoring significantly higher than men, suggesting that women are empathic (Baron-
Cohen & Wheelwright 2004; Davis, 1980). In particular, it has been suggested that female
occupational therapy, pharmacy and other healthcare students have higher empathy scores than
their male counterparts (Fjortoft et al. 2011).

Currently there is little research comparing empathy levels amongst health

professionals in developed versus developing countries. Recently, two studies were conducted
using variations of the Jefferson Scale of Physician Empathy (JSPE), with one study being
conducted in an emerging country and another in an industrialized country. The JSPE-Health
Professions Student version and the JSPE-Student version have a score range of 20-140, with a
higher score indicating a higher self-rated level of empathy (Chen, Lew, Hirschman &
Orlander, 2007; Williams et al. 2014). In a 2008 study conducted amongst 176 third year
medical students at the Thomas Jefferson University in Philadelphia, in which the JSPE was
used, the mean score for female students, which was higher than that of males, was 110.4
(Berg, Majdan, Berg, Veloski & Hojat 2011).
 In a 2008 study amongst 158 final year medical students at the University of
Witwatersrand in South Africa, in which the JSPE-S was used, the mean score female students
was 109 and was also higher than that of the male students (Vallabh 2011). This comparison
indicates no significant difference in empathy levels according to the JSPE when comparing
students in developed and developing countries. From the early days of research in
investigating the presence of empathy in students, studies have tracked the levels of empathy
as the years of clinical training progress (Reynolds & Scott, 2000; Sherman & Cramer, 2005).
Many reasons have been given as to why the general trend is that of a decrease in empathy
amongst health sciences students (Hojat et al. 2009).

It can be argued that students enter training to become health-care professionals

because they are driven by an altruistic motive to help people, as enrolled health professions
students have expressed high enthusiasm to help others and be service-orientated (Hafferty
2002; Hojat 2009). This could suggest high levels of empathy amongst these students and is
indeed supported by the higher scores obtained by these students during their first years
(Hojat 2009; Sherman & Cramer 2005). After enrolment, however, the general observation
in these studies has been that of a decline in empathy levels with each year spent in the clinical
training setting (Reynolds & Scott, 2000; Sherman & Cramer, 2005). For example, junior
dental students were shown to have higher empathy levels than their senior clinical peers who
are in contact with patients (Sherman & Cramer, 2005), with occupational therapy and
psychology students also showing a decline in empathy levels (Reynolds & Scott, 2000).

Thus, although research is limited, there has been a common observation of a decline in
empathy levels with clinical training amongst allied health students, medical and nursing
students. Possible reasons for eroding levels of empathy include patient factors, the
encouragement of detachment and a lack of appropriate modeling of empathic skills from
teaching clinicians (Hojat et al. 2009).

Measurement of empathy:

A complex concept such as empathy cannot be empirically investigated in the absence

of a psychometrically sound measuring instrument. A few instruments for measuring
empathy were developed for administration to the general population. The most frequently
used among them are the Interpersonal Reactivity Index (IRI, Davis, 1983); The Empathy
Scale (Hogan, 1969); and Emotional Empathy (Mehrabian & Epstein, 1972).
 None of these instruments was specifically developed to measure empathy in the context
of patient care. The IRI was developed for use in the general population, but has been utilized
in healthcare research. The IRI includes 28 items incorporating four components of empathy
in the cognitive and emotional domains. The 30- year study of empathy in college students
mentioned earlier utilized the IRI (Konrath et al., 2011). In the Hogan Empathy Scale, high
scorers were more likely than low scorers to be socially acute and sensitive to nuances in
interpersonal relationships and low scorers were more likely to be hostile, cold, and insensitive
to the feelings of others (Hogan, 1969). The Emotional Empathy Scale by Mehrabian and
Epstein used an affective conceptualization of empathy that conflicts with our definition as
primarily a cognitive concept in the context of patient care.

The above measures lack face and content validities for administration to health
profession students (Hojat, 2007). La Monica(1981) developed the Empathy Construct
Rating Scale which measures respondents feelings toward another person, but it cannot
be administered to health professions students as a self-report empathy measure, as it requires
reporting by an observer which is time consuming and costly.
 REVIEW OF LITERATURE

Christina Ouzouni, Konstantinos Nakakis, conducted a study on An exploratory

study of student nurses empathy: this study conducted to explore nursing students level of
empathy as well as related variables influencing empathic ability. This study concluded that
empathy is an important multi-dimensional trait of nurses which could be fostered in the early
stages of nursing student’s undergraduate studies. A thorough investigation of the contributing
factors to forming an empathic ability is essential in order to inform the restructuring of the
nursing curricula.

Nancy Fjortoft, Lon J. Van Winkle, and Mohammadreza Hojat, conducted a study
on “Measuring empathy in pharmacy students”. This study conducted to find out the level
of empathy in pharmacy students using the Jefferson scale of empathy- health profession
student’s version (JSE-HPS). This study concluded that the construct validity and reliability of
the JSE-HPS for measuring empathy in pharmacy students.

Sylvia K. Fields, Pamela Mahan, Paula Tillman, Jefffrey Harris, Kaye Maxwell
and Mohammadreza Hojat conducted a study on Measuring empathy in healthcare
profession students using the Jefferson scale of physician empathy: Health provider-
student version: this study conducted to explore the descriptive and correlation study for
psychometric analyses of the adapted empathy scale. And it was part of a longitudinal
investigation to examine changes in empathy during and at the end of student’s professional
education. This study concluded that the results were supports the measurement properties of
the JSE-HPS version are encouraging.

Daniel Chen, MD, Robert Lew, PhD, Warren Hershman, MD, MPH, and Jay
Orlander, MD, MPH, conducted a study on “A cross-sectional measurement of medical
student empathy”. This study conducted to find out the level of empathy in medical students.
This study concluded that empathy score of student’s preclinical years were higher than in the
clinical years. Efforts are needed to determine whether differences in score among the classes
are cohort effects or represent changes occurring in the course of medical education.
 Hulya Yucel, Gonul Acar conducted a study on levels of empathy among
undergraduate physiotherapy students: A cross-sectional study at two universities in
Istanbul. This study conducted to determine differences of levels of empathy among
undergraduates in each year of their four-year programs of physiotherapy. This study shows
that empathy score in both universities increased to a significant degree after school entrance
and decreased in the final year. Levels of empathy did not change according to gender,
specialty interest, or home-region. This study concluded that the points to the need for
physiotherapy curricula that would enhance empathy and give students practice in exhibiting
valuable attribute.

Brett Williams, Malcolm Boyle, Richard Brightwell, Scott Devenish, et al

conducted a study on paramedic empathy levels: results from seven Australian
Universities. This study conducted to assess the extent of empathy in paramedic students
across seven Australian Universities. This study concluded that a framework for educators to
begin constructing guidelines focusing on the need to incorporate, promote and instill empathy
into paramedic students in order to better prepare them for future out-of-hospital healthcare
practice.

Lis McKenna, Malcolm Boyle, Ted Brown, Brett Williams, Andrew Molloy,
Belinda Lewis, Liz Molloy (2012) conducted a study on levels of empathy in undergraduate
nursing students. This study conducted to explore empathy levels and regard for specific
medical conditions in undergraduate nursing students. This study concluded that the Nursing
students demonstrated acceptable empathy levels. Attitudes towards patients who abuse
substances highlight an area that needs both further exploration and addressing. Attitudes
towards mental health diagnoses were particularly favorable given that these often attract
stigma and negative attitudes.
 Christine Rogers, Zenzo Chakara Romy Cohen Kelsey Fourie, Danielle
Gounder, Nyasha Makaruse conducted a study on Levels of empathy in speech therapy
and audiology undergraduate students. This study conducted to exploring empathy levels
among Health Sciences students; however, little research has been conducted with students on
the African continent. The current study sought to establish the levels of empathy of all
Audiology and Speech-Language Pathology students enrolled at the University of Cape Town.
The Jefferson Scale of Physician Empathy-Health Profession Student version (JSE-HPS) was
used to assess levels of empathy among students across all years of study. Results were
analyzed in terms of year of study, gender and degree program. Students entered both
Programs with a positive attitude towards empathy, and this was sustained throughout their
training, although gender differences existed with male students expressing less orientation
towards empathy. Implications are discussed in the light of a South African context.
METHODOLOGY:

 Research design : Survey study

 Population : Occupational Therapy Students
 Sample size :50
 Sampling : convenient sampling
 Place of the study: KMCH College of Occupational Therapy.

SELECTION CRITERIA

INCLUSION CRITERIA:

 Students of Occupational Therapy.

 Age : 20-24 years.
 Sex : male & female .
 Able to understand the language.

EXCLUSION CRITERIA:

 Students of other health profession.

 Students who have previous knowledge about scale.
 TOOLS USED

Jefferson Scale of Empathy (HPS-Version) (JSE-HP-S):

The Jefferson scale of Empathy (JSE) to measure empathy in physicians and other
health professionals.

Versions:

 Medical students (S-Version).

 Health professionals (HP-Version).
 Health Professions students (HPS-Version).

The Jefferson Scale of Physician Empathy-Health Profession Student version (JSPE-

HPS) (Hojat et al. 2001), a self-report questionnaire, was used to measure empathy. This
scale has been adapted to suit allied health students (Wilson et al. 2012) and is the most
widely researched tool for assessment of student empathy (Vallabh, 2011). The scale
contains 20 items which are scored on a Likert scale (where 1=strongly disagree and 7=strongly
disagree). Ten positively worded items explore the skill of perspective taking whilst the rest
have negative wording and are thus reverse scored (Fields et al. 2011). Negative wording
controls for acquiescence (Hojat et al. 2009). Of the ten negatively worded items, eight are
linked to compassionate care whilst two are linked to ‘standing in the patient’s shoes’ (Vallabh,
2011). It can be used as an evaluation measure where empathy education is being implemented
(Wilson et al. 2012). It has been proven to be a psychometrically sound tool based on its test-
retest reliability (Hojat, 2007), construct validity, internal validity and good internal
consistency (Babar et al. 2013).These questions were then reversed for analysis. Results range
from a minimum of 20 through to a maximum of 140. The higher the score is, the higher the
participant’s level of empathy.

PROCEDURE:

Participants surpassing all inclusion criteria will be selected for the study.Written
consent has to obtain from the participants. Survey method was adopted for the study. Data’s
are obtained from the subjects using the Jefferson Scale of Empathy (HPS-Version)
(JSE-HP-S). Results will be subjected to statistical analysis.
 DATA ANALYSIS AND RESULTS

Both descriptive and non parametric (inferential) statistics were performed using The
Statistical Package for Social Science Version 20.0(SPSS® Inc., Chicago, IL., USA) was used for
data storage, tabulation and the generation of inferential statistics. Frequencies, percentages,
mean, standard deviations, median were also calculated. The data generated by the JSE-HPS is
ordinal therefore, the non parametric Mann-Whitney U- Test, Krusal- Wallis test were used to
measure the difference between gender and age groups. The results were considered statistically
significant if the p- value is 0.05.

TABLE I:(Comparison of male and female)

NUMBER OF STANDERED
VARIABLES PERCENTAGE MEAN
SAMPLES DEVIATION
TOTAL SCORE
OF 50 100% 106.46 10.86
JSE-HPS
TOTAL SCORE
OF MALES 16 32% 101.63 12.258
JSE-HPS
TOTAL SCORE
OF FEMALES 34 68% 108.74 9.510
JSE-HPS
JSE-HPS (Jefferson Scale of Empathy – Health Profession Students Version)

GRAPH.1

110

108

106

TOTAL
104
MALE
FEMALE
102

100

98
JSEHPS

Comparison of male and female empathy, females have high level empathy than male.
TABLE II:(Comparisons of different age groups of males & females)

NUMBER OF STANDERED
VARIABLES PERCENTAGE MEAN
SAMPLES DEVIATION
MF20 3 6% 118.67 6.658
MF21 24 48% 105.37 11.583
MF22 16 32% 105.38 9.294
MF23 7 14% 107.43 11.674
M – Males; F – Female;

GRAPH.2

120

115

110 MF20
MF21
MF22
105
MF23

100

95
JSEHPS

Comparison of different age groups of males & females, Age group of male and female belong
to the age group of 20 have high level empathy than other age groups.
TABLE III:(Comparison of different age groups of males)

NUMBER OF STANDERED
VARIABLES PERCENTAGE MEAN
SAMPLES DEVIATION
M21 5 31.25% 101.60 15.805
M22 8 50% 101 10.784
M23 3 18.75% 103.33 14.640
M – Males;

GRAPH.3

104

103.5

103

102.5

102 M21
M22
101.5
M23
101

100.5

100

99.5
JSEHPS

Comparison of different age groups of males, Males of the age group of 23 have high level
empathy comparing than other age groups.
TABLE IV: (Comparison of different age groups of females)

NUMBER OF STANDERED
VARIABLES PERCENTAGE MEAN
SAMPLES DEVIATION
F20 3 8.82% 118.67 6.658
F21 19 55.88% 106.37 10.531
F22 8 23.53% 109.75 5.007
F23 4 11.76% 110.50 10.017
F – Females;

GRAPH.4
120

118

116

114

112 F20

110 F21
F22
108
F23
106

104

102

100
JSEHPS

Comparison of different age groups of females, Females of the age group of 20 have high level
empathy than other age groups.
TABLE V:

MANN-WHITNEY U TEST

SCALE GENDER N MEAN RANK SUM OF RANK MANN- ASYMP.

WHITNEY U SIG.(2-tailed)
JSEHPS MALE 16 20.50 328.00 192.00 0.095
FEMALE 34 27.85 947.00

GRAPH V:

There is no significant difference (p =0.095) in the empathy level of males and females.
TABLE VI:
Comparing between different age groups of males and females
DESCRIPTIVE STATISTICS
VARIABLES N MEAN STD. MINIMUM MAXIMUM
DEVIATION
MFJSEHPS 50 106.4600 10.86881 75.00 123.00
MFAGEGROUP 50 21.6000 .80812 20.00 23.00
MJSEHPS 16 101.6250 12.25765 75.00 119.00
MAGEGROUP 16 21.8750 .71880 21.00 23.00
FJSEHPS 34 108.7353 9.51015 86.00 123.00
FAGEGROUP 34 21.3824 .81704 20.00 23.00

TABLE VII:

Kruskal-Wallis Test

VARIABLES AGEGROUP N MEAN RANK CHI-SQUARE ASYMP. SIG.

20.00 3 42.67
21.00 21 23.50
MFJSEHPS 4.652 .199
22.00 19 24.76
23.00 7 26.14
21.00 5 8.70
MJSEHPS 22.00 8 8.06 .170 .919
23.00 3 9.33
20.00 3 28.50
21.00 19 15.58
FJSEHPS 4.431 .219
22.00 8 17.56
23.00 4 18.25

There is no significant difference between age groups and their empathy score.
GRAPH VI:

Y-Values
130

120

110

100

90

80

70

60 Y-Values

50

40

30

20

10

0
0 10 20 30 40 50 60

X- N; Y-JSEHP Score.

Graph VI shows all the participants have had the score above 70, so all the participants are
having high level empathy.
TABLE VIII:

JSEHPS-FREQUENCY TABLE
Cumulative
VALUE Frequency Percent Valid Percent
Percent
75 1 2.0 2.0 2.0
85 1 2.0 2.0 4.0
86 2 4.0 4.0 8.0
90 1 2.0 2.0 10.0
93 3 6.0 6.0 16.0
95 1 2.0 2.0 18.0
97 1 2.0 2.0 20.0
99 2 4.0 4.0 24.0
101 2 4.0 4.0 28.0
103 3 6.0 6.0 34.0
104 1 2.0 2.0 36.0
105 1 2.0 2.0 38.0
107 3 6.0 6.0 44.0
108 4 8.0 8.0 52.0
110 1 2.0 2.0 54.0
111 9 18.0 18.0 72.0
112 2 4.0 4.0 76.0
114 3 6.0 6.0 82.0
116 1 2.0 2.0 84.0
118 1 2.0 2.0 86.0
119 1 2.0 2.0 88.0
120 2 4.0 4.0 92.0
122 1 2.0 2.0 94.0
123 3 6.0 6.0 100.0
Total 50 100.0 100.0
Table VIII and Graph VII shows that 123 is the highest score of this study carried by
3(6%) individuals and lowest score of 75 carried by only one(2%) individual majority of
individuals{9(18%)} scored 111. Only one individual get’s 50-55% of JSEHPS Score, 4
individuals gets 61-65% of JSEHPS Score, 5 individual’s gets 66-70% of JSEHPS Score, 9
individuals gets 71-75% of JSEHPS Score, 19 individuals gets 76-80% of JSEHPS
Score, 6 individuals gets 81-85% of JSEHPS Score and 6 individuals gets 86-90% of
JSEHPS Score.
 DISCUSSION

The purpose of this study is to find the level of Empathy in final year occupational
therapy students.

This study is the first to assess the level of empathy among undergraduate occupational
therapy students in India.

The survey was conducted on final year occupational therapy student, both genders
were included for this study and this study was done in KMCH collage of occupational therapy.
A total number of 50 samples were selected according to the inclusion criteria. The Jefferson
Scale of Empathy Health Professional Students -Version (JSE-HP-S) was used to measure the
level of empathy on final year undergraduate occupational therapy students.

JSEHPS consist of 20 items as self reported questionnaires Participants rate their level
of agreement with each statement on a 7-point Likert scale (Strongly disagree = 1, strongly
agree = 7). Ten of the 20 questions are negatively worded in order. This aims to decrease the
confounding effect of acquiescence responding. These questions were then reversed for
analysis. Results range from a minimum of 20 through to a maximum of 140. The higher the
score is, the higher the participant’s level of empathy.

First explain the purpose of the study to all the participants describing the definition and
as well as the procedure. The self reported paper based questionnaires were administered to
them for mark their response to measure the level of Empathy. The response caries with score
of 7 (strongly disagree to strongly agree).

A total of 50 undergraduate Occupational therapy students from the final year students
participated in this study (100% response rate). The majority of students was females (68%)
and was under the age of 21 years (55.88%). Total numbers of males were 16(32%) with the
age groups of 21-23 years {Age group of 21 years =5(31.25%), age group of 22 years = 8(50%)
and age group of 23 years =3(16.75%)}. Total numbers of females were 34(68%) and were
under the age group of 20-23 years {Age group of 20 years =3(8.82%), age group of 21
years=19(55.88%), age group of 22 years =8(23.53%) and age group of 23 years =4(11.76%)}.

Our finding results show that the overall participants in this study reported a good level
of empathy (Mean=106.46, SD= 10.86). However, this score is somewhat lower than other
studies involving with other healthcare professions. For instance, Fields et al.(2004) reported a
mean empathy of 117.2 among nurses and Hojat et al.(2003) reported a mean empathy of 124.0
among pediatricians.

From in this study findings were demonstrating females have higher level of empathy
than the males. But there were no statistically significant difference between the variables of
their age groups and their scores. Due to the un even grouping non parametric statistics like
Mann- Whitney U test and Kruskal-Wallis Test were used to assess the difference between
gender and age groups. Results were considered statistically significant if the p- value is less
than 0.05.
 Comparison of mean value of the age groups of both male and females different age
group, male and female belongs to the age group of 20 has the high level empathy.(Mean=
118.67, SD=6.658)

Comparison of mean value of males different age groups, males belongs to age group of
23 has high level empathy. (Mean=103.33, SD=14.640).

Comparison of mean value of females different age groups, females belongs to age
group of 20 has high level empathy. (Mean=118.67, SD=6.658).

But there is no statistically significant difference between their age groups and gender.
 CONCLUSION

The purpose of this study is to find out level of empathy in final year
occupational therapy students. The results of this study conclude that the
occupational therapy students have a good level empathy. Comparison of male
and females, females have high level empathy than male. But there is no
statistically significant difference found between different gender and age group.
These results are important as they shows the undergraduate occupational
therapy course as it currently stands, does not impact on occupational therapy
students’ empathy. Furthermore, if educators are to promote empathy. Further
investigations needed for this area as a longitudinal manner.
 LIMITATIONS AND RECOMMENDATIONS

LIMITATIONS:
 Small sample size.
 Study was done only in one institution.
 Only one scale was used.

RECOMMENDATIONS:
 Large sample size can be used.
 Study can be conducted in more than one institution.
 Study can be conducted to measure how empathy varies each year throughout the four
years of typical occupational therapy program as a longitudinal study.
 Two or more standardized scales can be used.
 REFERENCES

 Nancy Firtoft, Lon J.Van Winkle, and Mohammadreza Hojat. Measuring Empathy in
Pharmacy Students. American Journal of Pharmaceutical Education 2011; 75 (6) Article
109.
 Christine Rogers, Zenzo Chakara, Romy Cohen et al. levels of empathy in speech therapy
and audiology undergraduate students training at the University of Cape Town 2015.
 Lisa McKenna, Malcolm Boyle, Brett Williams et al. Levels of empathy in undergraduate
nursing students. International journal of nursing practice 2012; 18: 246-251.
 Peter Hartley, Michael McCall, Paula McMullen et al. Paramedic Empathy Levels: Results
from Seven Australian Universities. International Journal of Emergency Services, 1(2),
111-121.
 Christina Ouzouni, Konstantinos Nakakis. An Exploratory study of students nurses’
empathy volume 6, issue 3 (July – September 2012).
 Yucel H, Acar G. Levels of empathy among undergraduate physiotherapy students: A cross
sectional study at two universities in Istanbul. Pak J Med Sci. 2016;32(1): 85-90.
 Daniel Chen, Robert Lew, Warren Hershman et al. A cross sectional Measurement of
Medical Student Empathy. Society of general Internal Medicine 22(10);1434-8.
 Sylvia K. Fields, Pamela Mahan, Paula Tillman et al. Measuring empathy in healthcare
profession students using the Jefferson Scale Of Physician Empathy: Health provider –
student version. Journal of interprofessional care, 2011, 25:287-293.
 Hojat M, Mangione S, Nasca TJ, et al. The Jefferson Scale of Empathy: Development and
preliminary psychometric data. Educ Psychol Meas. 2001;61: 349-65.
 Hojat M,Gonnella JS, Nasca TJ, mangione S, Vergare M, Magee M. The Jefferson Scale of
Physician Empathy: further psychometric data and difference by gender and specialty at
item level. Acad Med.2002; 77 (suppl); 58-60.
 Aring, C. D. (1958). "Sympathy and empathy." J Am Med Assoc 167(4): 448-52.
 Boyle, M., B. Williams, et al. (2010). "Levels of empathy in undergraduate health Science
students." Int J Med Educ 1 (1).
 Hojat, M. (2007). Empathy in patient care: Antecedents, development, measurement,
and outcomes. Philadelphia, PA: Springer.
 Hojat, M., Gonnella, J., Nasca, T.J., Mangione, S., Vergare, M., & Magee, M.
(2002) Physician empathy: Definition, components, measurement, and relationship to
gender and specialty. American Journal of Psychiatry, 159, 1563-1569.

e-REFERENCES
1. www.google.com
2. www.bing.com
3. www.sci-hub.ac
4. www.pubmed.com
5. www.googlescholar.com
 APPENDIX-I

CONSENT FORM

I __________________________________________________ voluntarily consent to

participate in the survey study “ TO FIND THE LEVEL OF EMPATHY IN FINAL YEAR
OCCUPATIONAL THERAPY STUDENTS ”.

The researcher has explained me about the procedure to fill empathy scale
and the question related to the research to my satisfaction.

PARTICIPENT’S SIGNATURE:

SIGNATURE OF WITNESS:

SIGNATURE OF RESEARCHER:

DATE:

PLACE:
 APPENDIX-II

Jefferson Scale of Empathy

Health Profession (STUDENT- VERSION)
(JSE-HP-S)

NAME:
AGE:
COLLEGE / DEPT:
Instructions:
Please indicate the extent of your agreement / disagreement with
each of the following statements about patient care below, by marking
the appropriate circle to the right of each statement.
Please use the following 7-point scale (a higher Number on the scale
indicates more agreement):
1 2 3 4 5 6 7

Strongly Strongly

Disagree Agree
 Healthcare providers' understanding of their patients'
1. feelings and the feelings of their patients' families does not 1 2 3 4 5 6 7
influence treatment outcomes

2. Patients feel better when their healthcare providers 1 2 3 4 5 6 7

understand their feelings

3. It is difficult for a healthcare provider to view things from 1 2 3 4 5 6 7

patients' perspectives

Understanding body language is as important as verbal

4. 1 2 3 4 5 6 7
communication in healthcare provider-patient relationships

5. A healthcare provider's sense of humour contributes to a better 1 2 3 4 5 6 7

clinical outcome

6. Because people are different, it is difficult to see things from 1 2 3 4 5 6 7

patients' perspectives

7. Attention to patients' emotions is not important in patient 1 2 3 4 5 6 7

interview

8. Attentiveness of patients' personal experiences does not 1 2 3 4 5 6 7

influence treatment outcomes
Health care providers should try to stand in their
9. 1 2 3 4 5 6 7
patients' shoes when providing care to them

Patients value a healthcare provider's understanding of their

10. 1 2 3 4 5 6 7
feelings which is therapeutic in its own right
 Patients' illnesses can be cured only by targeted treatment;
therefore, healthcare providers' emotional ties with their
11. 1 2 3 4 5 6 7
patients do not have a significant influence in treatment
outcomes

Asking patients about what is happening in their personal lives

12. 1 2 3 4 5 6 7
is not helpful in understanding their physical complaints

Healthcare providers should try to understand what is going

13. on in their patients' minds by paying attention to their non- 1 2 3 4 5 6 7
verbal cues and body language

I believe that emotion has no place in the treatment of

14. 1 2 3 4 5 6 7
medical illness

Empathy is a therapeutic skill without which a healthcare

15. 1 2 3 4 5 6 7
providers' success is limited

Healthcare providers' understanding of the emotional status

of their patients, as well as that of their families is one
16. 1 2 3 4 5 6 7
important component of the healthcare provider – patient
relationship

Healthcare providers should try to think like their

17. 1 2 3 4 5 6 7
patients in order to render better care

Healthcare providers should not allow themselves to be

18. influenced by strong personal bonds between patients and 1 2 3 4 5 6 7
their family members

19. I do not enjoy reading non-medical literature or the arts 1 2 3 4 5 6 7

I believe that empathy is an important factor in patients'

20. 1 2 3 4 5 6 7
treatment
 APPENDIX-III
MASTER CHART
S.no Name Age Gender JSE-HPS
1. ABEY JOHN 22 M 95
2. ABIRAME SITHAMBARAM 23 F 114
3. AKHIL IDICULA 23 M 90
4. ANITHA CHELLAMONI 21 F 103
5. ANNE KALYAN SAHAN 21 M 112
6. ARAVINDH.V 22 M 93
7. ASHLEY MARIA BABU 21 F 103
8. BALA MURUGAN.K 21 M 111
9. CHINCHU MARIAM THOMAS 22 F 108
10. DIVYA.P 20 F 123
11. DIJITH.K.V 23 M 119
12. DIVYA M JOSE 23 F 104
13. DIVYA. R 20 F 122
14. ELSA MERIN JOY 22 F 107
15. EVANGELIN NISHA.P.H 21 F 123
16. GOPIKA GOVIND 21 F 108
17. HENSIYA SWEETY.H.V 21 F 93
18. JAGADEESH.A 21 M 111
19. JEGAN.A 22 M 85
20. JERALD ROBINSON.E 22 M 97
21. JISNA JOHNSON 22 F 107
22. JIYA ELSA THOMAS 21 F 111
23. JOEL MATHEW ALFERD 22 M 114
24. KAVIYA.P.B 21 F 86
25. KESHEKA KUMARATHEESAN 23 F 123

M-Male; F-Female.
 MASTER CHART
S.NO NAME AGE GENDER JSEHPS
26. KOWSALYA.M 22 F 120
27. KRISHNA.N.S 21 M 75
28. LINDA ANNE JACOB 22 F 103
29. LIYANA AMEEN.K.V 23 F 101
30. MAYURI.R 21 F 86
31. MOHAMMED RISWAN.H 21 M 99
32. NELLAIAPPAN.V 22 M 99
33. PARASAKTHI.A 21 F 108
34. POORNA PRIYA.N 21 F 107
35. POURNAMI.P.V 21 F 111
36. PRAISY.E 21 F 108
37. PREETHI.A 21 F 111
38. RESHMI JENNIFER.R.S 21 F 105
39. SARANYA.S 21 F 118
40. SHERIN SURENDRAN 22 F 112
41. SHILPA ELIZABETH JACOB 22 F 110
42. SOFIYA.R 21 F 111
43. SWEET LINDA.P 21 F 120
44. TAMILARASI.P 21 F 116
45. VIDHYA.N 20 F 111
46. VINEETH TUMMALAPALLI 22 M 114
47. VINITHA.M 21 F 93
48. YAMIJALA VENKATA SAMEER KUMAR 22 M 111
49. PRIYANKA.G 22 F 111
50. GOPALAKRISHNAN.P 23 M 101

M-Male; F-Female.
 APPENDIX-IV

TABLE I:

NUMBER OF STANDERED
VARIABLES PERCENTAGE MEAN
SAMPLES DEVIATION
TOTAL
SCORE OF 50 100% 106.46 10.86
JSE-HPS
TOTAL
SCORE OF
16 32% 101.63 12.258
MALES
JSE-HPS
TOTAL
SCORE OF
34 68% 108.74 9.510
FEMALES
JSE-HPS
JSE-HPS (Jefferson Scale of Empathy – Health Profession Students Version)

TABLE II:

NUMBER OF STANDERED
VARIABLES PERCENTAGE MEAN
SAMPLES DEVIATION
MF20 3 6% 118.67 6.658
MF21 24 48% 105.37 11.583
MF22 16 32% 105.38 9.294
MF23 7 14% 107.43 11.674
M – Males; F – Female;

TABLE III:

NUMBER OF STANDERED
VARIABLES PERCENTAGE MEAN
SAMPLES DEVIATION
M21 5 31.25% 101.60 15.805
M22 8 50% 101 10.784
M23 3 18.75% 103.33 14.640
M – Males;

TABLE IV:

NUMBER OF STANDERED
VARIABLES PERCENTAGE MEAN
SAMPLES DEVIATION
F20 3 8.82% 118.67 6.658
F21 19 55.88% 106.37 10.531
F22 8 23.53% 109.75 5.007
F23 4 11.76% 110.50 10.017
F – Females;