Embedding Social Accountability through Transformative Pedagogies: A Case Study from a South African Physiotherapy Curriculum

Background Health profession curricula must produce healthcare professionals who are not only clinically competent but also socially accountable. This requires graduates to understand and respond to the health systems and social contexts within which they practice, and lecturers play an important role in facilitating the attainment of these competencies. Despite growing calls for socially accountable health professional education globally, limited research exists on how these principles are understood and implemented within physiotherapy curricula, particularly in low- and middle-income contexts where health inequities are pronounced. Aim To explore how physiotherapy lecturers understand and integrate the principles of social justice and social accountability into a South African undergraduate curriculum and to examine the pedagogical strategies employed to foster transformative learning. Methods A qualitative descriptive case study with an interpretivist paradigm was conducted at the Division of Physiotherapy, Stellenbosch University. Data were collected via two focus groups (n = 10 participants) and eight individual semi-structured interviews with permanent academic staff involved in curriculum coordination and development. Mezirow's transformative learning theory and established theories of social justice and social accountability guided a hybrid inductive and deductive thematic analysis via AtlasTi® software. Results Two key themes emerged: (1) understanding social accountability and its underpinning elements, including professional accountability, ethics of care, citizenship, health equity, interprofessional engagement, and professional identity formation, and (2) pedagogical strategies for transformative learning, encompassing contextual and experiential learning, structured reflection, interprofessional collaboration, progressive scaffolding, discursive pedagogy, and role modelling. While lecturers demonstrated a sophisticated understanding of social accountability as a multidimensional construct, significant implementation challenges were identified, including inconsistent student exposure, logistical barriers to authentic learning experiences, limited scaffolding for transformative action, and insufficient faculty development support. Conclusion Social accountability is a recognised but complex goal within the physiotherapy curriculum. While transformative pedagogies are employed, critical gaps remain between curricular intent and implementation, particularly in scaffolding students' progression from critical reflection to transformative action. Strengthening pedagogical coherence, enhancing faculty development, and expanding authentic experiential learning opportunities may support the development of socially responsive physiotherapy graduates equipped to address health system challenges and promote health equity. Trial registration: Not applicable