The purpose of this study was to determine the level of health literacy in pelvic health in physical therapy students and how that affects their comfort level in discussing these topics with their patients. Patients' lack of pelvic floor knowledge can increase psychological distress and overall quality of life (Johnson et al., 2021). Any healthcare worker working with the public on pelvic floor disorders must have health literacy surrounding this topic to explain it to their patients adequately and ensure they are comprehensively treating their patients. 

A lack of health literacy in any physical therapy specialty leads to a lack of knowledge and providers to help patients (McDowell & Gobert, 2020). Decreased understanding of pelvic floor disorders can cause patients to become dissatisfied with their treatment options and providers (Kiyosaki et al., 2012). There is a general agreement among providers that students should have exposure to pelvic floor topics in school. Still, there are no consistent standards about how much education should be provided.

People of all ages have decreased health literacy, but this is especially evident in the university student population (Falvey et al., 2021). This is the primary age of the survey respondents in this study, but this survey will include people of all genders, unlike previous studies. There has not been a study that has specifically looked at physical therapy students and their knowledge surrounding this topic, so this study will aim to close that gap in the literature for this population. 

Several hypotheses were addressed in this study. The first was that physical therapy students would show low levels of health literacy surrounding pelvic health. The second was that health literacy among physical therapy students will be positively correlated with their comfort level in talking about pelvic health topics with their patients.

This study's author adopted a cross-sectional, quantitative design for this research project. The sample consisted of physical therapy students enrolled in any accredited graduate program in the United States. Recruitment was completed through email to program directors of every physical therapy graduate program in the United States. Email addresses for each of the directors of accredited programs were collected from the Commission on Accreditation of Physical Therapy Education. All physical therapy student involvement was voluntary, and students could withdraw at any time from the study. . The students completed the survey on a computer, which was returned to this researcher once submitted. These results were then entered into the central spreadsheet. The instrument used to collect the data was the Health Literacy Questionnaire (HLQ), which included several demographic questions. The survey also included a "yes/no" question about the student's ability to ask their patients about pelvic health topics and their comfort level in referring to a pelvic health physical therapy provider. Once the survey data were collected, analysis was completed using linear correlational statistics. Demographic data were analyzed with univariate statistics.

The first research question pertained to the general level of health literacy of physical therapy students around pelvic health topics. The survey results showed that the students had average to high health literacy about pelvic health topics and diagnoses. The students scored the highest in managing their health and social support. The implications will be discussed in the next chapter, including what this may mean for physical therapy education. These results indicate that students may need further education to become well-rounded practitioners and that there may need to be further education to help improve their ability to manage their healthcare and critical thinking about their pelvic health in the future.
	The second research question addressed the relationship between health literacy and the ability of students to talk to and refer their patients to an expert in pelvic health. The model was shown not to be statistically significant. Therefore, the null hypothesis cannot be rejected. The researcher cannot say that the level of health literacy influences a physical therapy student's comfort level in both talking about pelvic health issues and referring a patient to a pelvic health provider.

While there was no statistically significant correlation between health literacy and the ability to refer their patients to a specialist, this study did find a shockingly low level of health literacy in allied health students when it comes to seeking information about their own GU, GI and pelvic health symptoms. The study suggests that perhaps allied health programs are not creating appropriate education surrounding these symptoms, leading to an inability to appropriately identify red flag symptoms or screen for disability and disease in any of the pelvic health areas. This impacts not only the allied health professions but also urology and gynecology because it may lead to poor referrals to appropriate physician specialists by these allied health practitioners. This study also pointed to several further studies that should be conducted to how best improve health literacy of all allied health students about pelvic health issues and treatment options.

Few studies exist examining how health literacy affects practitioners' comfort levels in screening patients for pelvic health disorders. Even fewer look at allied health professionals' levels of health literacy about their pelvic health. This study was an introduction to both of these topics that will hopefully spur further research on how best to make educators aware of health literacy and include pelvic health topics in all allied health education.

Falvey, L., Salameh, F., O'Sullivan, O., O'Reilly, B. (2021). What does your pelvic floor do for  you? Knowledge of the pelvic floor in female university students: A cross-sectional study. Female Pelvic Medicine and Reconstructive Surgery, 27(2), e457-e464. https://doi.org/10.1097/SPV.0000000000000962
McDowell, D. & Gobert, D. (2020). Access to pelvic floor dysfunction in physical therapy:  	Challenging trends in adequate patient care. Medical Research Archives, 8(4). 	https://doi.org/10.1016/j.apmr.2020.10.064
Kiosayki, K., Ackerman, A.L., Histead, S., Sevilla, C., Eilber, K., Miliski, S., Anger, J. (2012).  Patient understanding of pelvic floor disorders: What patients want to know. Female Pelvic Floor Reconstructive Surgery, 18(3), 137-142. https://doi.org/10.1097/SPV.0b013e318254f09c