Scaffolding patient education

Scaffolding is a core principle of best-practice patient education that involves providing structured education that builds over time as the patient develops knowledge, confidence, and skills.

This allows us to meet the patient where they’re at without overloading them.

Scaffolding is particularly important when:

• A patient has complex or deeply ingrained beliefs about their condition that may take time to shift.
• There are new or complex skills to learn (for example exercise, pacing, graduated exposure, self-management strategies).
• The patient is navigating a long-term condition where education and skills need to be reinforced or built upon over time.

How to scaffold over multiple consultations

Rather than trying to address everything in one session, we can layer education and skills over time. This ensures that patients are not overwhelmed and can gradually integrate what they learn into their daily lives. Habit formation occurs faster and more effectively with smaller and simpler tasks (Gardner et al., 2012). Furthermore, setting small, structured learning goals can help guide the scaffolding process by giving both the physiotherapist and the patient a clear roadmap for progression.

Setting learning goals can:

• help prioritise key educational points so they are introduced at the right time
• ensure information builds logically rather than being presented in a disorganised way
• provide a sense of progress for the patient, helping with motivation and engagement
• encourage self-directed learning, reinforcing the shift from dependence to independence.

Tip: Learning goals should start broad and reassuring, then become more specific and action-focused over time.

Let’s look at an example of learning goals and scaffolding using Helen’s case 

First consultation

Learning goals: Acknowledge concerns, provide reassurance, and focus on key takeaways.

• Identify the patient’s biggest concern and address it first (for example fear of movement, concerns about wear and tear and doing further damage).
• Provide a simple, evidence-based explanation without overwhelming detail. You can support this by offering evidence-based written resources about Helen’s condition for her to take away to review.
• Offer one or two practical takeaways. For example, a) walking is safe to continue, and b) movement and exercise will help, not harm your knee.
• Set expectations for ongoing education: “We’ll go over more about this in future sessions.”

Follow-up consultations

Learning goals: Build on previous education and reinforce key messages.

• Ask Helen what she remembers and clarify any other misunderstandings.
• Utilise spaced repetition – this is where you can revisit and reinforce concepts over multiple sessions rather than all at once to help reinforce learning.
• Gradually introduce more detailed concepts as Helen needs. For example, explaining load tolerance, graded exposure to movement and the importance of progressing the exercise program.
• Encourage Helen to problem solve by gradually shifting from providing solutions to guiding Helen in identifying and troubleshooting challenges herself. For example, “How did that strategy go? What worked, what didn’t?” Helen may report common challenges such as not having time to do exercises or inability to stick to pacing strategies on busier days. If she encountered difficulties, help her brainstorm possible adjustments: “What do you think might make it easier next time?”
• Support self-efficacy by reinforcing what she has already done well and linking it to the next step in her recovery.
• Gradually scaffold skills such as movements, exercise or other strategies as they are getting easier and she builds confidence.

Longer-term management

Learning goals: Foster independence and reinforce self-management.

• Encourage Helen to integrate strategies into her daily life by discussing real-life applications. For example, “How do you think you can modify your routine to keep progressing?”
• Use reflective questioning to reinforce learning and confidence. For example, “If someone else had this condition, what advice would you give them?”, or “Looking back, what have you learned about managing your knee pain?”
• Shift towards self-monitoring and decision-making by helping Helen recognise patterns and adjust her management plan independently. Ask, “How do you know when it’s time to increase or modify your exercises?”
• Encourage Helen to anticipate challenges such as upcoming events or life changes, and develop strategies in advance: “What would you do if your knee pain flares up during a busy week?” or “How do you plan to pace yourself on vacation?”
• Reinforce the long-term benefits of self-management by celebrating progress and maintaining motivation: “You’ve come a long way—what do you feel most proud of?”

We can also gradually reduce external support as Helen builds confidence in managing her condition. This may involve:

1. Extending the time between follow-up appointments.
2. Encouraging her to track progress and problem-solve independently.
3. Providing resources that she can refer to when needed.

When and how to reduce patient education

Recognising when a patient is ready to manage independently is crucial. Signs that scaffolding can be reduced include:

• The patient demonstrates confidence in explaining concepts.
• They begin problem-solving on their own.
• They apply strategies with less or no external prompting.

At this stage, our role might shift to occasional reinforcement and troubleshooting rather than structured teaching.

Scaffolding skill development

Beyond just information, scaffolding can apply to physical skills such as movement, exercise technique, and pacing strategies.

• Introduce movement gradually: Start with comfortable, low-load activities before progressing.
• Use both verbal and physical cues: Guide movement with hands-on feedback initially, then phase it out. Different cues may be beneficial for different people or at different phases of one patient’s rehabilitation, so it’s always worth trying something new to optimise the movement.
• Encourage problem-solving: Ask “What adjustments could you make if this movement feels uncomfortable?”

Addressing setbacks without losing progress

Patients often experience flare-ups, setbacks, or frustrations in long-term conditions. Effective scaffolding prepares them to self-manage these challenges rather than seeing them as failures. Here are some key strategies to consider:

• Normalise setbacks: “It’s common to have ups and downs in recovery. Let’s look at what might have triggered this.”
• Reframe challenges as learning experiences: “What do you think you will do next time?”
• Reinforce progress made so far: “You’ve already improved your ability to walk without pain which is a massive improvement from where we started—let’s build on that.”

Key takeaways for scaffolding during patient education

  Introduce information and skills gradually. Not everything needs to be covered in one session.
  Start with the patient’s biggest concerns and build from there.
  Check understanding frequently and adjust based on the patient’s needs.
  Use reflection and problem-solving to encourage self-management over time.
  Reduce support gradually, helping the patient become independent in managing their condition.

By scaffolding information and skills over time, we can support lasting changes in patient beliefs and behaviours, leading to better outcomes in long-term condition management.