The Deployment and Utilization of the Allied Health Professions Support Workforce: A Scoping Review

Figures & data

Table 1 Comparison of AHP Support Workforce Role Titles Across Three Different Countries

	Australia^Citation11	UK^Citation12	USA^Citation13*
Generic Name	Allied Health Assistant (AHA)	Clinical Support Worker	Allied Health Assistant
Entry level	Level 1 AHA	Support Worker	Basic Healthcare Worker
Senior	Level 2 AHA	Senior Support Worker	Allied Health Assistant
Advanced	Level 3 AHA	Assistant Practitioner	Advanced Allied Health Assistant

Note: *USA allied health assistant roles vary between states.

Table 2 PEO Framework

PEO Framework	Search Terms
Population: Allied Health Professions	Allied health, (all UK allied health professions – see Appendix 1 for full search strings)
Exposure: Support workers and Assistant Practitioners	Assistant, support
Outcome: Impact, deployment, role	Professional role

Figure 1 PRISMA flow chart showing screening and selection process for SWAP deployment.

Notes: Adapted from Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Int J Surg. 2021;88:105906.¹⁹

Table 3 Extraction Table for Selected Articles

Citation	Country	Method Description	Profession/Service	Sample Size	Participants	Sector	Setting	QuADS Score / 39
Armstrong et al (2012)^Citation34	USA	Electronic survey	Speech and language therapy	415	Other: Speech-language pathologists (SLPs), Speech-language pathologist assistants (SPLAs)	Schools	Mixed	25
Bennion & Irvine (2011)^Citation35	UK	Qualitative, descriptive and exploratory. Focus group and follow up interviews. Framework analysis for data analysis.	Radiography	10	Radiology managers	Hospital	Not stated	27
Cartwright et al (2021)^Citation22	Australia	Prospective comparison of multiple workforce models, including usual practice, to measure the efficiency of each.	Radiography	6	Support Workers; Administrative assistant; radiographers.	Hospital	Urban	25
Eliassen & Moholt (2023)^Citation36	Norway	Observations and follow up interviews	Physiotherapy	14: 7 PTs, 7 HTs	Other: Physiotherapists (PTs) and Home Trainers (HTs)	Mixed	Not stated	25
Eliassen et al (2020)^Citation37	Norway	Observation and interviews (qualitative)	Physiotherapy	21: 7 users, 7 PTs, 7 HTs	Other: Home trainers (HTs) and Physiotherapists (PTs)	Mixed	Not stated	33
Ellis & Connell (2001)^Citation38	UK	Semi-structured interviews	Physiotherapy	36 (18 assistants and 18 physiotherapists)	Other: Physiotherapy assistants and their supervising physiotherapists	Mixed	Mixed	27
Ford (2004)^Citation39	UK	Questionnaires and follow up focus group	Radiography	16 for surveys, 7 for focus group	Radiology Service Managers	Hospital	Not stated	26
Frowen et al (2021)^Citation40	Australia	Pre and post-test study	Speech and language therapy	61	Other: Head and neck cancer patients undergoing radiotherapy	Hospital	Not stated	31
Huglin et al (2021)^Citation41	Australia	Literature scan, scoping survey of key stakeholders, and individual and focus group semi structured interviews. Thematic analysis was used for interview data.	Multiple AHPs	119	Allied Health Assistants; AHPs; Allied Health Leaders; AHA certificate training program educators and managers; AHA certificate training program students; and consumers of Victorian, health, disability and aged care services.	Mixed	Mixed	34
King et al (2022)^Citation42	Australia	Semi-structured interviews	Multiple AHPs	21	Allied Health Assistants	Hospital	Mixed	29
Kiss et al (2019)^Citation43	Australia	Pre and post-test study	Nutrition/dietetics within a cancer treatment clinic	91	Other: Head and neck cancer patients	Hospital	Not stated	18
Knight et al (2004)^Citation24	UK	Case study approach of 13 rehabilitation assistants using time sheets, observation, the think-aloud technique, and semi-structured interviews	Multiple AHPs	13	Rehabilitation Assistants, and team leaders	Mixed	Not stated	23
Kuipers et al (2015)^Citation44	Australia	Role audit	Multiple AHPs	41	Allied Health Assistants; AHPs; line managers/team leaders; health care team members	Mixed	Mixed	10
Le Cornu et al (2010)^Citation45	UK	Mixed methods - questionnaire and semi-structured telephone interviews	Dietetics	18 DSWs, 62 dietitians for survey, sub-sample of 6 DSWs and 6 dietitians for interviews	Support Workers; Dietitians	Mixed	Not stated	26
Leach & Wilton (2009)^Citation25	UK	Semi-structured questionnaires and interviews	Multiple AHPs; Nursing	13	Assistant Practitioners and Managers	Mixed	Not stated	8
Lin et al (2007)^Citation46	Australia	Cross-sectional survey of AHP managers, TAs, TA coordinators and AHPs administered via either telephone interview or email.	Multiple AHPs	14	Allied Health Assistants	Mixed	Rural/remote	21
Mackey & Nancarrow (2005)^Citation26	UK	Focus group semi-structured interviews	Occupational Therapy	17	Assistant Practitioners; Supervisors, Team managers, service users	Community	Not stated	19
Mackey (2004)^Citation47	UK	Focus group interviews	Occupational Therapy	36	Qualified and Unqualified Occupational Therapy Practitioners	Community	Not stated	22
McCartney et al (2005)53	UK	Case studies - questionnaires and interviews	Speech and language therapy	5	Other: Speech and language therapists	Schools	Urban	28
Mickan et al (2018)^Citation48	Australia	Exploratory semi-structured interviews	Multiple AHPs	12	Senior Allied Health clinicians and academics	Mixed	Not stated	25
Nancarrow et al (2015)^Citation49	Australia	Semi structured interviews, focus groups, documentary analysis, workload audit	Speech and language pathology	13	Speech language pathology assistants, Speech and language pathologists, service managers, service users and their carers.	Hospital	Not stated	19
Palmer et al (2018)^Citation27	UK	Electronic surveys	Radiography	108	Assistant Practitioners	Hospital	Not stated	29
Pearce & Pagett (2015)^Citation50	Australia	Literature review, informal telephone and Email consultation, focus groups, online survey, semi structured interviews	Multiple AHPs	36 AHAs, 23 AHA managers	Allied Health Assistants; AHAs; assistants’ managers.	Mixed	Not stated	16
Penner et al (2020)^Citation51	Canada	Quantitative surveys and qualitative focus groups	Physiotherapy; Occupational Therapy	89 for surveys (56 therapists, 37 assistants), 30 for focus groups (17 therapists, 13 assistants)	Other: OTs and Physiotherapists, Occupational therapist assistants and Physiotherapist assistants	Hospital	Urban	28
Pinson et al (2023)^Citation52	Australia	Time motion survey and qualitative interviews	Radiography	4	Medical Imaging Assistants	Hospital	Mixed	30
Price & Le Masurier (2007)^Citation28	UK	Quantitative, structured questionnaire	Radiography	177	Radiology managers	Hospital	Not stated	21
Price et al (2015)^Citation29	UK	Telephone interviews	Radiography	20	Imaging department managers	Hospital	Not stated	18
Rushton et al (2022)^Citation23	Australia	Semi-structured interviews	Dietetics	23	Dietitian assistants; dietitians; management staff; food services staff.	Hospital	Mixed	27
Russell & Kanny (1998)^Citation53	USA	Questionnaire (both quantitative and qualitative questions)	Occupational Therapy	366	Occupational Therapy Assistants and Occupational Therapists	Mixed	Not stated	29
Snaith et al (2018)^Citation30	UK	Electronic surveys	Radiography	193	Assistant Practitioners	Hospital	Mixed	24
Snowdon et al (2022)^Citation54	Australia	Time-motion study	Multiple AHPs	51	Allied Health Assistants	Mixed	Not stated	26
Somerville et al (2015)^Citation55	Australia	Mixed methods - focus groups and quantitative survey	Multiple AHPs	2449	Allied Health Assistants; AHPs.	Mixed	Mixed	16
Somerville et al (2018)^Citation56	Australia	Mixed methods - focus groups and quantitative survey	Multiple AHPs	1247	Allied Health Assistants; AHPs	Mixed	Not stated	18
Stewart-Lord et al (2011)^Citation31	UK	Scoping exercise, survey	Radiography; Radiotherapy	167	Assistant Practitioners	Hospital	Not stated	22
Stewart-Lord et al (2014)^Citation32	UK	Semi-structured interviews	Radiography; Radiotherapy	38	Assistant Practitioners	Hospital	Not stated	27
Stute et al (2014)^Citation57	Australia	Pilot study and role audit	Multiple AHPs	41	Allied Health Assistants	Mixed	Mixed	25
Wilberforce et al (2016)^Citation58	UK	Pilot of time use (diary tool evaluation)	Occupational Therapy	151	Other: Occupational therapists and assistants	Mixed	Urban	31
Wood et al (2011)^Citation59	Australia	Semi structured interviews	Multiple AHPs; Community Rehabilitation	31	ACRAs; health professionals; rehabilitation clients.	Community	Not stated	20
Zelenyanszki et al (2022)^Citation33	UK	Service evaluation	Radiography	8	Assistant Practitioners; Registered mammographers; programme manager; office manager.	Mobile breast screening units	Not stated	25

Table 4 Factors Influencing Effective Deployment and Barriers to Career Progression by Country

	Factors Influencing Effective Deployment	Career Pathway Barriers
Australia	Role definition Defined scope of practice Effective delegation Effective communication Sufficient training Appropriate clinical governance Effective supervision Challenging workloads Increasing demand Trust in SWAPs’ competence SWAPs having to earn trust of registered practitioners Time and experience Perspectives of registered practitioners (towards delegation) Positive relationships between registered practitioners and SWAPs	Lack of a defined career pathway to qualified roles Limited opportunities to gain experience Lack of a formal training plan Insufficient time for training Limited access to and support for training
USA	Mixed attitudes towards SWAPs
Canada	SWAPs having a multidisciplinary role Tasks delegated from external professions	Limited access to and support for training SWAP part-time status
UK	Time and experience Lack of clarity around role boundaries Ambiguity around SWAP competence Poor understanding of SWAP qualifications Perspectives of registered practitioners (scope creep) Registered practitioners feeling unprepared to supervise SWAPs Loss of job satisfaction for registered practitioners Perspective of SWAPs being a “cheap replacement” SWAPs feeling competent and involved in decision making	Absence of a career framework Limited opportunities for progression Lack of recognized qualifications available for their role
Norway		Limited access to and support for training

Australian Capital Territory Government. Allied health assistant classification: guidelines, work level standards and duty statement templates. Available from: https://www.health.act.gov.au/sites/default/files/2019-02/Allied%20Health%20Assistant%20Classification%20Guidelines.docx. Accessed January 8, 2024.

 Google Scholar

AHP - website content - allied health professions’ support worker competency, education and career development Framework.pdf - all documents. Available from: https://healtheducationengland.sharepoint.com/sites/AHPWC/Shared%20Documents/Forms/AllItems.aspx?id=%2Fsites%2FAHPWC%2FShared%20Documents%2FDeveloping%20the%20role%20of%20AHP%20Support%20Workers%2FAHP%20Support%20Worker%20Competency%2C%20Education%20and%20Career%20Development%20Framework%2FAllied%20Health%20Professions%E2%80%99%20Support%20Worker%20Competency%2C%20Education%20and%20Career%20Development%20Framework%2Epdf&parent=%2Fsites%2FAHPWC%2FShared%20Documents%2FDeveloping%20the%20role%20of%20AHP%20Support%20Workers%2FAHP%20Support%20Worker%20Competency%2C%20Education%20and%20Career%20Development%20Framework&p=true&ga=1. Accessed December 1, 2023.

 Google Scholar

Adult Education Works. Allied Health Assistant | adult & career technical education. Available from: https://www.adulteducationworks.com/allied-health-assistant/. Accessed January 8, 2024.

 Google Scholar

Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg. 2021;88:105906. doi:10.1016/j.ijsu.2021.105906

 PubMed Web of Science ®Google Scholar

Armstrong E, White G, Moorer-Cook L, Gill C. Workload status of school-based speech-language pathologists in texas: perspectives on school-based issues. Perspect Sch Bas Issu. 2012;13(4):136–149. doi:10.1044/sbi13.4.136

 Google Scholar

Bennion CM, Irvine F. Embedding the assistant practitioner role within the clinical department: a qualitative study. Radiography. 2011;17(4):292–296. doi:10.1016/j.radi.2011.02.007

 Google Scholar

Cartwright AK, Pain T, Heslop DJ. Substitution, delegation or addition? Implications of workforce skill mix on efficiency and interruptions in computed tomography. Aust Health Rev. 2021;45(3):382–388. doi:10.1071/AH20118

 PubMed Web of Science ®Google Scholar

Eliassen M, Moholt JM. Boundary work in task-shifting practices – a qualitative study of reablement teams. Physiother Theory Pract. 2023;39(10):2106–2119. doi:10.1080/09593985.2022.2064380

 PubMed Web of Science ®Google Scholar

Eliassen M, Henriksen NO, Moe S. Variations in physiotherapy practices across reablement settings. Physiother Theory Pract. 2020;36(1):108–121. doi:10.1080/09593985.2018.1481162

 PubMed Web of Science ®Google Scholar

Ellis B, Connell N. Factors determining the current use of physiotherapy assistants: views on their future role in the South and West UK region. Physiotherapy. 2001;87(2):73–82. doi:10.1016/S0031-9406(05)60444-0

 Google Scholar

Ford P. The role of support workers in the department of diagnostic imaging—service managers perspectives. Radiography. 2004;10(4):259–267. doi:10.1016/j.radi.2004.03.009

 Google Scholar

Frowen J, Hughes R, Kiss N. Introduction of a speech-language pathology assistant role for swallow screening in a head and neck radiotherapy clinic. Int J Speech Lang Pathol. 2021;23(4):441–451. doi:10.1080/17549507.2020.1800818

 PubMed Web of Science ®Google Scholar

Huglin J, Whelan L, McLean S, et al. Exploring utilisation of the allied health assistant workforce in the Victorian health, aged care and disability sectors. BMC Health Serv Res. 2021;21(1):1144. doi:10.1186/s12913-021-07171-z

 PubMed Web of Science ®Google Scholar

King OA, Pinson J, Dennett A, Williams C, Davis A, Snowdon DA. Allied health assistants perspectives of their role in healthcare settings: a qualitative study. Health Social Care Community. 2022;30(6). doi:10.1111/hsc.13874

 Web of Science ®Google Scholar

Kiss N, Gilliland S, Quinn P, Atkins L, Black J, Frowen J. Evaluating the effectiveness of a nutrition assistant role in a head and neck cancer clinic. Nutr Diet. 2019;76(1):21–27. doi:10.1111/1747-0080.12462

 PubMed Web of Science ®Google Scholar

Knight K, Larner S, Waters K. Evaluation of the role of the rehabilitation assistant. Int J Ther Rehabil. 2004;11(7):311–317. doi:10.12968/ijtr.2004.11.7.13359

 Google Scholar

Kuipers P, Hurwood A, McBride LJ. Audit of allied health assistant roles: suggestions for improving quality in rural settings: quality of rural allied health assistant roles. Aust J Rural Health. 2015;23(3):185–188. doi:10.1111/ajr.12161

 PubMed Web of Science ®Google Scholar

Le Cornu KA, Halliday DA, Swift L, Ferris LA, Gatiss GA. The current and future role of the dietetic support worker: role of the dietetic support worker. J Hum Nutr Diet. 2010;23(3):230–237. doi:10.1111/j.1365-277X.2010.01055.x

 PubMed Web of Science ®Google Scholar

Leach C, Wilton E. Evaluation of assistant and associate practitioner roles across NHS South Central. Br J Healthcare Assist. 2009;3(2):97–99. doi:10.12968/bjha.2009.3.2.39397

 Google Scholar

Lin I, Goodale B, Villanueva K, Spitz S. Supporting an emerging workforce: characteristics of rural and remote therapy assistants in Western Australia. Aust J Rural Health. 2007;15(5):334–339. doi:10.1111/j.1440-1584.2007.00917.x

 PubMed Web of Science ®Google Scholar

Mackey H, Nancarrow S. Assistant practitioners: issues of accountability, delegation and competence. Int J Ther Rehabil. 2005;12(8):331–338. doi:10.12968/ijtr.2005.12.8.19535

 Google Scholar

Mackey H. An extended role for support workers: the views of occupational therapists. Int J Ther Rehabil. 2004;11(6):259–266. doi:10.12968/ijtr.2004.11.6.13331

 Google Scholar

Mickan S, Golenko X, Buys N. Educational needs and workplace opportunities of allied health assistants: a qualitative pilot. Focus on Health Professional Educat. 2018;19(3):52. doi:10.11157/fohpe.v19i3.251

 Google Scholar

Nancarrow SA, Moran A, Sullivan R. Mechanisms for the effective implementation of an allied health assistant trainee: a qualitative study of a speech language pathology assistant. Aust Health Rev. 2015;39(1):101. doi:10.1071/AH14053

 PubMed Web of Science ®Google Scholar

Palmer D, Snaith B, Harris MA. Assistant radiographer practitioners: creating capacity or challenging professional boundaries? Radiography. 2018;24(3):247–251. doi:10.1016/j.radi.2018.03.001

 PubMedGoogle Scholar

Pearce C, Pagett L. Advanced allied health assistants: an emerging workforce. Aust Health Rev. 2015;39(3):260. doi:10.1071/AH14253

 PubMed Web of Science ®Google Scholar

Penner JD, Snively A, Packham TL, Henderson J, Principi E, Malstrom B. Viewpoints of the occupational therapist assistant–physiotherapist assistant role on inter-professional teams: a mixed-methods study. Physiother Can. 2020;72(4):394–405. doi:10.3138/ptc-2019-0011

 PubMed Web of Science ®Google Scholar

Pinson J, King OA, Dennett AM, Davis A, Williams CM, Snowdon DA. Exploring the role of medical imaging assistants in Australian medical imaging departments: a mixed‐methods study. J of Medical Radiation Sci. 2023;70(1):46–55. doi:10.1002/jmrs.623

 PubMed Web of Science ®Google Scholar

Price RC, Le Masurier SB. Longitudinal changes in extended roles in radiography: a new perspective. Radiography. 2007;13(1):18–29. doi:10.1016/j.radi.2005.11.001

 PubMedGoogle Scholar

Price R, Miller L, Hicks B, Higgs A. The introduction, deployment and impact of assistant practitioners in diagnostic radiography in Scotland. Radiography. 2015;21(2):141–145. doi:10.1016/j.radi.2014.08.003

 Google Scholar

Rushton A, Bauer J, Young A, Keller H, Bell J. Barriers and enablers to delegating malnutrition care activities to dietitian assistants. Nutrients. 2022;14(5):1037. doi:10.3390/nu14051037

 PubMed Web of Science ®Google Scholar

Russell KV, Kanny EM. Use of aides in occupational therapy practice. Am J Occup Ther. 1998;52(2):118–124. doi:10.5014/ajot.52.2.118

 PubMed Web of Science ®Google Scholar

Snaith B, Harris MA, Palmer D. A UK survey exploring the assistant practitioner role across diagnostic imaging: current practice, relationships and challenges to progression. Br J Radiol. 2018;91(1091):20180458. doi:10.1259/bjr.20180458

 PubMed Web of Science ®Google Scholar

Snowdon DA, King OA, Dennett A, et al. Delegation of patient related tasks to allied health assistants: a time motion study. BMC Health Serv Res. 2022;22(1):1280. doi:10.1186/s12913-022-08642-7

 PubMed Web of Science ®Google Scholar

Somerville L, Davis A, Elliott AL, Terrill D, Austin N, Philip K. Building allied health workforce capacity: a strategic approach to workforce innovation. Aust Health Rev. 2015;39(3):264. doi:10.1071/AH14211

 PubMed Web of Science ®Google Scholar

Somerville L, Davis A, Milne S, Terrill D, Philip K. Exploration of an allied health workforce redesign model: quantifying the work of allied health assistants in a community workforce. Aust Health Rev. 2018;42(4):469. doi:10.1071/AH16266

 PubMed Web of Science ®Google Scholar

Stewart-Lord A, McLaren SM, Ballinger C. Assistant practitioners (APs) perceptions of their developing role and practice in radiography: results from a national survey. Radiography. 2011;17(3):193–200. doi:10.1016/j.radi.2011.02.006

 Google Scholar

Stewart-Lord A, Ballinger C, McLaren SM. Assistant Practitioners (APs) in radiography: an exploration of perceptions and experiences related to role development. Radiography. 2014;20(2):137–142. doi:10.1016/j.radi.2013.11.001

 Google Scholar

Stute M, Hurwood A, Hulcombe J, Kuipers P. Pilot implementation of allied health assistant roles within publicly funded health services in Queensland, Australia: results of a workplace audit. BMC Health Serv Res. 2014;14(1):258. doi:10.1186/1472-6963-14-258

 PubMed Web of Science ®Google Scholar

Wilberforce M, Hughes J, Bowns I, et al. Occupational therapy roles and responsibilities: evidence from a pilot study of time use in an integrated health and social care trust. Br J Occup Ther. 2016;79(7):409–416. doi:10.1177/0308022616630329

 Web of Science ®Google Scholar

Wood AJ, Schuurs SB, Amsters DI. Evaluating new roles for the support workforce in community rehabilitation settings in Queensland. Aust Health Rev. 2011;35(1):86. doi:10.1071/AH10880

 PubMed Web of Science ®Google Scholar

Zelenyanszki C, Vertenten C, Spencer S, Hudson D, Currie R. Extending the scope of practice for experienced assistant practitioners in breast screening and the impact on service resilience. Radiography. 2022;28(4):973–980. doi:10.1016/j.radi.2022.06.021

 PubMed Web of Science ®Google Scholar