Global Health Education Research Articles

Market traders’ knowledge, attitude, and practices of solid waste disposal in Calabar Municipality, Nigeria: New implications for global health education

Poor environmental sanitation practices in markets are a serious public health concern, as solid waste poses municipal level and global health risks. Solid wastes also add to the growing issue of global climate change. This study sought to determine the sociodemographic correlates of solid waste disposal knowledge, attitude, and practices among market traders in Calabar Municipality, Nigeria. This was a cross-sectional study of 480 traders across six markets in Calabar Municipality. Data were collected using semi-structured questionnaire and analyzed using descriptive and inferential statistics. Overall, 54% of respondents had good knowledge, 45% had an acceptable attitude, and a significantly low number of respondents (16%) practiced good solid waste disposal. Sociodemographic characteristics that were statistically significant in the bivariate analyses were modeled for the outcomes. The multivariable analyses found that age, primary education, being married, being separated/divorced, being Muslim, and being a traditionalist were statistically significantly associated with knowledge, attitude, and practices of solid waste disposal among market traders. Solid waste disposal practices were poor. Market sensitizations on environmental sanitation need to be carried out. There is also a need to enforce laws stating disciplinary measures for offenders who dump wastes indiscriminately.

Measures to address the stalled development of health law education in Chinese universities

Health law education, an important part of global health education, is beneficial for both medical and law schools. This field can help lawyers and policy makers to develop their careers and equip traditional health professionals, such as doctors and nurses, with a basic knowledge of health law. However, unlike in western universities, health law education in China is still at its infant stage and, as such, lacks a systematic pedagogical approach among institutions of higher education in China. Considering the advancements in the field of health law education, this study systematically reviews the status of health law education in institutions of higher learning in China and suggests ways to make the pedagogical approach more consistent. This systematic review revealed that, between 2012 and 2021, major law schools and medical schools that have developed the subject of health law education in China lack consensus on the aim, scope, mode, and methods of health law education. The first problem is that Chinese universities are unable to agree on how to classify the subject of health law. Another set of problems relate to institutions themselves. Not only do universities lack qualified health law faculty, but they also rely on relatively uninspiring teaching materials. This leads to ineffective, generic pedagogical approaches in both medical and law schools. These problems leave future lawyers, future doctors and nurses unclear about their choices for health law study at the graduate level and their ultimate career development. We therefore propose four preliminary solutions to continue to develop this new interdisciplinary subject—health law education—in Chinese universities: clearly classify the subject of health law, equip the health law field with more professional textbooks, enact joint degree programs between medical schools and law schools, and establish a health law research center in either law schools or medical schools.

Determination of Admission Criteria for Global Public Health Master at the University of Georgia

Abstract Background Recent events in the world, wars, pandemics, have once again raised the issue of the need for competent human resources in global public health (GPH). In Georgia, there are master’s degree programs in public health where global health is mostly offered as an elective or core course of the curriculum. University of Georgia (UG) is involved in the ERASMUS + project in GPH (BACE). UG initiated to create new GPH Master Program, which will be response towards local, regional and international challenges and demand. Objective Main objective of developing GPH program was to address and meet national and international global health education needs and challenges. The aim of the study was to identify evidence-based prerequisites for the MPH in GPH (UG). We conducting document review based on the GPH competency model (GPHCM) and evaluated: 1) GPH & MPH programs of the top 20 world university ranking (THE/2022); 2) CUGH associated programs; 3) Georgian MPH programs; 4) Georgian education documents (such as Georgian National Qualifications Framework (GNQF)); 5) Main directions of career development in global health. In addition, interviews with national experts were conducted (in education, employment, program leaders) using the Delph method. Results Study found that depending on the scope and content of the program, prerequisites for obtaining MPH in GPH varies. In addition to English competence and a high GPA, working or research experience or interviews or additional exams or other are required. In Georgia, there is no adopted GPHCM, but GNQF allows the establishment of MPH in GPH. UG new Master program (120 ECTS) will include 99 ECTS core (including research practicum & thesis) and 21 ECTS elective courses based on 6 domains of GPHCM. The program will mostly focus on population health management at a global level. Conclusions Study findings suggest any undergraduates with appropriate conditions could be eligible for admission to the UG (MPH in GPH). Key messages • UG admission prerequisites for Health Science undergraduates: National entrance exam, English proficiency B2, working experience and motivation letter. • UG additionally admission prerequisites for Health Science undergraduates: basic knowledge epidemiology and medical terminology (if credits available or test).

“The light made us uncomfortable at the beginning, but we don’t want it to turn off again”: On decolonization and global health teaching

“The light made us uncomfortable at the beginning, but we don’t want it to turn off again”: On decolonization and global health teaching

Putting global health high on the agenda of medical schools.

In this opinion paper, we reflect on global health and global health education as well as challenges that the coming generation are likely to face. As the field is rapidly changing, it is vital to critically reflect categories of “global south” and “global north” as geographical boundaries, and rather think in terms of inequalities that are present in all countries. Global perspectives on health are useful to analyze structural challenges faced in all health care systems and help understand the diversity of cultures and patients’ concepts of disease. We first discuss burning questions and important challenges in the field and how those challenges are tackled. Rather than going into detail on topical issues, we reflect on approaches and attitudes that we think are important in global health education and present opportunities and challenges for young scholars who are interested in working in this field.

Scholarly Products for the Global Health Trainee: a Guide for Educators.

There is consistent interest from medical trainees in high-income countries in academic global health education (GHE) programs. Academic scholarship in global health has traditionally been linked to longer-term programs. However, most programs for medical trainees offer short-term experiences in global health (STEGH). These experiences are typically brief and clinical, and present logistical and ethical challenges for producing scholarship. Given challenges inherent in global health medical education, educators should cultivate ethically sound scholarship prioritizing power, privilege, and decision-making within local communities. Utilizing the framework of community-engaged scholarship, GHE ethics guidelines and examples we present suggestions to guide scholarship in GHE.

Establishing a Virtual Global Health Education Partnership: The Cleveland-Cusco Connection.

IntroductionThe Cleveland-Cusco Connection (CCC) elective was created during the COVID-19 pandemic to continue global health (GH) education for Case Western Reserve University (CWRU) and Universidad Nacional de San Antonio Abad del Cusco (UNSAAC) medical students. The CCC elective was held over Zoom and aimed to promote international collaboration, knowledge about health systems, and perspectives in GH with synchronous and asynchronous learning.MethodsPeruvian and US medical students participated in six monthly sessions consisting of student presentations and large and small group discussions. The elective was led collaboratively by CWRU and UNSAAC students. We evaluated students’ experience using pre- and post-course surveys.ResultsNineteen students (76%) completed the post-course survey. The median rating for meeting each course objective was “somewhat effective” on a 5-point scale ranging from “very ineffective” to “very effective.” All respondents would recommend the course to a friend. Common barriers included language challenges, fatigue from other coursework, and technology issues. Seven students’ pre- and post-course surveys could be linked. The number of students who agreed with the statements assessing course objectives increased for all questions between the pre- and post-test, with only the number agreeing that they understood the Peruvian healthcare system increasing significantly (p < 0.05).DiscussionThe CCC elective provides a valuable GH educational opportunity via a virtual platform. Students reported that learning from their peers was effective and enjoyable.ConclusionVirtual GH electives like the CCC may offer benefits in terms of cost, equity, and flexibility and merit further investigation.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40670-022-01626-6.

Virtual global health in graduate medical education: a systematic review.

To synthesize recent virtual global health education activities for graduate medical trainees, document gaps in the literature, suggest future study, and inform best practice recommendations for global health educators. We systematically reviewed articles published on virtual global health education activities from 2012-2021 by searching MEDLINE, EMBASE, Cochrane Library, ERIC, Scopus, Web of Science, and ProQuest Dissertations & Theses A&I. We performed bibliography review and search of conference and organization websites. We included articles about primarily virtual activities targeting for health professional trainees. We collected and qualitatively analyzed descriptive data about activity type, evaluation, audience, and drivers or barriers. Heterogeneity of included articles did not lend to formal quality evaluation. Forty articles describing 69 virtual activities met inclusion criteria. 55% of countries hosting activities were high-income countries. Most activities targeted students (57%), with the majority (53%) targeting trainees in both low- to middle- and high-income settings. Common activity drivers were course content, organization, peer interactions, and online flexibility. Common challenges included student engagement, technology, the internet, time zones, and scheduling. Articles reported unanticipated benefits of activities, including wide reach; real-world impact; improved partnerships; and identification of global health practice gaps. This is the first review to synthesize virtual global health education activities for graduate medical trainees. Our review identified important drivers and challenges to these activities, the need for future study on activity preferences, and considerations for learners and educators in low- to middle-income countries. These findings may guide global health educators in their planning and implementation of virtual activities.

Global child health in higher education in Germany: a mixed-methods study

ABSTRACT Background Germany has an ambitious global health strategy, yet its universities provide few opportunities for global child health researchers. Improved understanding of the reasons and the academic role of global child health is needed. Objective The objective of this study is to offer insights into Germany’s academic global child health landscape by describing the actors and their priorities in research and education and by analysing perceived barriers and opportunities. Methods We used a sequential exploratory mixed-method design. Participants were selected purposively to represent German global child health academics. Information was gathered first from a 33-item online survey and from interviews conducted four to six months post-survey. Surveys were analysed descriptively. A joint thematic approach using content analysis was used to analyse interview transcripts. Results Four categories emerged: training and professional orientation; professional realities; representation and advocacy, and barriers. Of the 20 survey participants (median [IQR] age 55 years [17], five female), seven agreed to be interviewed. Research experiences abroad shaped individuals’ career choices in global child health. They engaged in global child health education, primary health care and access to health services, frequently in clinical and humanitarian settings, but spent little time on global child health-related activities. Participants were active and valued in international networks and keen to extend their activities. Yet they felt under-represented academically and reported multiple structural and individual barriers in Germany. They perceived a lack of leadership positions, career paths, funding opportunities, and institutional and project support which limits academic advancement. Conclusions Germany’s global child health experts are motivated to engage with global child health-related topics but face difficulties in advancing academically. Academic actors may need to intensify research and training efforts in order to expand global child health’s scientific base in Germany.

Adapting teaching and learning in times of COVID-19: a comparative assessment among higher education institutions in a global health network in 2020

BackgroundThis research examines the ways in which higher education institutions (HEIs) across the tropEd Network for Education in International Health (tropEd) began to adapt their teaching and learning approaches in response to the COVID-19 pandemic in 2020. Already during this early phase of the pandemic HEIs’ responses demonstrate global health approaches emphasising cooperation and communication, rather than national health driven strategies that emphasise quarantine and control. Key lessons learnt for multiple dimensions of teaching and learning in global health are thus identified, and challenges and opportunities discussed.MethodsData collection includes a cross-sectional online survey among tropEd member institutions (n = 19) in mid-2020, and a complementary set of open-ended questions generating free-text responses (n = 9). Quantitative data were analysed using descriptive statistics, textual data were analysed using a Framework Analysis approach.ResultsWhile early on in the pandemic the focus was on a quick emergency switch to online teaching formats to ensure short-term continuity, and developing the administrative and didactic competence and confidence in digital teaching, there is already recognition among HEIs of the necessity for more fundamental quality and longer-term reforms in higher education in global health. Alongside practical concerns about the limitations of digital teaching, and declines in student numbers, there is a growing awareness of opportunities in terms of inclusivity, the necessity of cross-border cooperation, and a global health approach. The extent to which the lack of physical mobility impacts HEI programmes in global health is debated.ConclusionThe COVID-19 pandemic has brought about preventive measures that have had a considerable impact on various dimensions of academic teaching in global health. Going forward, international HEIs’ experiences and response strategies can help generate important lessons for academic institutions across different settings worldwide.

Defining and utilizing individualized learning objectives to achieve learning priorities for global health leaders.

IntroductionLearning objectives (LOs) are a common tool used to define learning goals and guide curricula. As the field of global health has expanded, more rigorous and tailored approaches to effectively teach the next generation of the workforce are needed. The STAR project developed and utilized individualized LOs as the basis for on-the-job learning plans for senior global health leaders from low- and middle-income countries and from the US.MethodsWe analyzed basic demographic information and LOs from 36 STAR fellows. Descriptive statistics provided an overview of the STAR fellows, competency areas and planned outputs of their LOs. We utilized qualitative thematic analysis to further explore the LOs themselves.ResultsSTAR fellows were based in the US and in low- and middle-income countries (LMICs). The majority had over 10 years of experience and at least one advanced degree. Fellows commonly worked on LOs related to capacity strengthening, communications, and development practice. Capacity strengthening LOs focused on mentorship, decision-making, and technical skills such as data analysis. Communications LOs focused on language skills, dissemination of information, and writing. Development practice LOs included gaining understanding of key stakeholders in global health and building effective partnerships and teams.DiscussionOur experience developing tailored LOs provided deeper understanding of diverse learning needs of global health leaders. While not representative of all global health learners, we captured priorities of senior US- and LMIC-based leaders and identified common themes for learning. Despite the labor required to tailor curricula in this way, more global health education programs can benefit by integrating similar processes.

An Approach to Cultural Competence Education into the Pharmacy Curriculum: Glances from the Cuban Framework

Cultural competence is crucial for improved health outcomes in populations. In addition to knowledge and skills, cultural competence involves a confident attitude that underlines regard across all cultures. The importance of cultural competence training has been considered in several pharmacy education statements as part of the Pharmacists’ Patient Care Process. Nevertheless, there is a significant discrepancy in the implementation of cultural competence in a curriculum. There is no consensus on how this could be implemented from a view of logical and pedagogical coherence. Consequently, a cultural and interdisciplinary approach should be considered in the curriculum design process respecting the laws and pedagogical principles that guide the process of training professionals at the universities and pharmacy schools. The main purpose of the study is to describe a cultural background to implement cultural competence education in the Cuban pharmacy curriculum. The data for this study was collected through an overall literature review. Using terms specific to Cuban health care, culture, and education, combined with terms linked to cultural competence, global health, and pharmacy education. Relevant statements by the Pan American Health (PAHO) and World Health Organizations (WHO) were extracted. Electronic sites for the American Journal of Pharmaceutical Education, Currents in Pharmacy Teaching and Learning, and Pharmacy Education were reviewed. Scopus, Google Scholar, EBSCO Host, International Pharmaceutical Abstracts, and Web of Knowledge databases were examined. The outcomes of this study reveal that Cuba is a culturally rich country with complex and diverse perspectives on health. Cuban culture is the result of extremely broad and tedious transculturation processes; therefore, it is not possible to exhaust the subject in a single inquiry. Health and education in Cuba are politically entwined; statistical data, arguments, and related information are not always available to be studied or compared. This study identifies the need for a sincere effort toward global pharmacy education’s purpose; respect for religious values, traditional beliefs, historic and political factors were also taken into consideration to design a framework for cultural competence with Cuban pharmacy curricula. The repercussions of the current study will be valuable to developing curricular improvement processes aimed at implementing cultural competency in pharmacy education taking into consideration an essentially cultural perspective. Furthermore, this study offers a background to simplify culturally sensitive exchanges among practitioners, undergraduates, stakeholders, and other faculties of pharmacy members from Cuba and other nations when they involve health care and pharmacy practice or education.

Critical Pedagogy for Health Professions and International Learning Experiences

Experiential and community-based learning is common in health sciences education as a transition from conceptual level coursework to application of learning at the practical and practice levels. Programs typically focus on knowledge acquisition and obtaining a conceptual level understanding of the material for the initial curriculum, followed by experiential learning and application of that conceptual knowledge in a clinical setting. To address the nuances of health sciences education in the international, community-based context, this study proposes a pathway to facilitating the adoption of a new critical pedagogy accounting for an increasingly globalized and connected world and the need for mediation of the relationship between learning theory and global health education. Bierema’s (2018) models are commonly utilized in health education during the initial curricular stages and are discussed, while Kolb’s (1984) interpretation of Kurt Lewin’s experiential learning theory is offered as the appropriate conceptualization to support the development of a critical pedagogy for international, community-based health education learning experiences. As part of this pedagogy, relevant, foundational theoretical approach to students` experiential learning should support critical observation and reflection. We recommend that educators provide practice-based education that focuses on improved outcomes of experiential learning so that learners do not just recreate their own lived experiences of order, structure and power, instead to use a critical pedagogical approach which allows learners to examine their own social conditioning and biases so that they are empowered to engage, work and live across cultures.

Preparation, relationship and reflection: Lessons for international medical electives.

International medical electives (IMEs) provide opportunities for global health education within undergraduate medical curricula; however, ethical and practical preparations vary. Single-centre, prospective, mixed-methods study, utilising online questionnaires with students and host supervisors, contemporaneous reflective diaries and focus groups, to explore the preparedness and experiences of final-year UK medical students undertaking IMEs. Students experienced communication challenges and felt underprepared prior to IME. Students undervalued cultural preparation, whereas host supervisors primarily desired humility and cultural sensitivity. Visitors to high-income countries underpredicted cultural differences with reflective practice supporting understanding of global health inequalities. Burden on hosts and ethical dilemmas related to acting beyond competence remained significant concerns. International medical electives provide experiential learning, and with authentic reflection facilitate professional development. Enhanced culturally competent preparation and debriefing is however essential for collaborative and responsible student learning. Acting beyond competency persists, requiring concerted reform during the pandemic-mandated hiatus of IMEs.

Digital Health Education: Determining Competences and Piloting Innovative Study Course.

Digital technology for health services plays a critical role in the delivery of health services. In order to move towards universal healthcare, improvement of patient outcomes and better health, one must make use of the advantages of Digital Health tools and recognition of the role of the health ICT worker. Therefore, it is necessary to have a workforce that is competent to use these tools. Uniquely positioned at the intersection of healthcare and information technology, the domain of Digital Health builds on a variety of disciplines termed biomedical and health informatics, and other allied fields. With the increasing need to have a knowledgeable, skilled and competent workforce, it is necessary to concentrate efforts towards the provision of education modules in Digital Health. While continuing medical education, certificate courses and other similar courses attempt to bridge the gap in the delivery of Digital Health education, it is also paramount to establish dedicated and standalone courses. Streamlining approaches to Digital Health Education across disciplinary, cultural and national boundaries, is key to address the challenges of firmly embedding Digital Health courses in the fabric of university education. In the effort to provide the necessary knowledge, skills and competencies (KSCs) to the current health ICT worker, the Deggendorf Institute of Technology, European Campus Rottal-Inn (DIT-ECRI) is in the process of piloting a virtual course in Global Digital Health. With the ability to provide core competencies in Digital heath, this virtual course is a step towards advancing Global Digital Health Education.

Eliminating the White Supremacy Mindset from Global Health Education.

The term “decolonization” has been increasingly used to refer to the elimination of the colonial experience and its legacy. However, the use of this overarching term masks the real root of the problem. European countries, whose populations are majority white, used their assumed supremacy as justification for the colonization of current low- and middle-income countries (LMICs) where the majority of non-white people live. This clear overlap between geographic and skin color differences explains how the white supremacy ideology triggered European colonization. Therefore, calls to decolonize global health education must focus on the roots of colonization and fight for the elimination of white supremacy ideology that is one of the pillars of the current ills of our global health architecture. A step in this process acknowledging the expertise that emerges from LMICs, alongside challenging the traditional high-income country (HIC) hegemony over knowledge and strengthening universities in LMICs to provide quality medical and global health education. Additionally, we also need to reevaluate curricula, research selection, and design as well as partnerships. Students need to be equipped with the skills to question norms and contribute to the creation of equitable, mutually beneficial partnerships. This needs to accompanied by the adoption of transdisciplinary education to address critical societal challenges. By challenging the white supremacy ideology, we can shift the center of gravity in global health to respect the right to equal say in education and research according to the disease burden and the distribution of the world population.

Healthcare professionals’ experiences with education in short term medical missions: an inductive thematic analysis

BackgroundShort-term medical mission (STMM) providers supplement healthcare delivery and education in low- and middle-income countries (LMIC). Despite numerous providers working in this space, the views of volunteers who contribute their time and skills to these programs are rarely sought.MethodA qualitative study of 24 volunteers for Pangea Global Health Education (Pangea) was undertaken using semi-structured interviews to better understand their perspectives on program design and delivery, personal and professional outcomes of their volunteer experiences and the resulting implications for STMM program design. An inductive thematic analysis of their responses was completed. Social constructionist theory was utilised to contextualise themes and implications for program design.ResultsParticipants highlighted the importance of co-creation with local learners and staff, the necessity to understand clinical context and the importance of relating to culture in the advancement of patient care. They reported personal growth, including a better understanding of others, and identifying commonalities between people. Professionally, participants reported learning from their colleagues, including new medical content, as well as refining their teaching practices. They also reported learning from those they taught and respecting the resourcefulness of medical and nursing staff working in LMIC.ConclusionSTMM providers may benefit from co-creation with their learners in the development of health professional education programs. A deep understanding of local context and culture provides for a richer learning environment and enables sustainable long-term program delivery. Utilising a social constructionist framework enables a better understanding of cultural barriers, which inhibit group learning, including the tendency to maintain hierarchical divides; addressing these will allow for optimised patient care.

Remote online global health education among U.S. medical students during COVID-19 and beyond

BackgroundDue to the COVID-19 pandemic, the 2021 Harvard Medical School course Clinical Topics in Global Health was offered for the first time as a remote class. We sought to understand student and faculty perceptions of the elective and evaluate the perceived effectiveness of teaching global health using an online education platform.MethodsFollowing the course, students and faculty were invited to complete a combined total of three online surveys, which consisted of closed- and open-response questions assessing the strengths and challenges of online learning. Data analyses included traditional descriptive statistics, Net Promoter Score calculation, and inductive thematic analysis of qualitative data.ResultsThirty-two students and eighteen guest faculty (including four international faculty) participated in the course. Highly-rated course components included guest lecturers, practical skill sessions, polls, and case studies. The Net Promoter Score for the course was excellent at 92, and students reported a greater likelihood of pursuing a career in global health because of the course. While students and faculty highlighted limitations of the remote learning platform (lack of community and interactivity), they also commented on increased accessibility and faculty diversity. Most faculty and students recommended a hybrid model for future versions of the course and suggested strategies to address current limitations.ConclusionsA remote learning platform can effectively deliver global health education, both in the pandemic setting and beyond.

Cultural Considerations for Patient and Community Education in Global Health: A Qualitative Study in Lesotho.

Background: In global health, international nongovernmental organizations (NGOs) frequently hire, train, and partner with host-country clinicians who manage public outreach and patient care. Purpose and Research Design: We conducted a general interpretivist study of Basotho clinicians hired by NGOs and academic affiliates in Lesotho to identify cultural barriers and facilitators to community and patient education. Data Collection and Analysis: We conducted 13 interviews involving 16 participants (one physician, one nutritionist, 14 nurses). Using an inductive and iterative approach, we analyzed interview transcripts through the lens of social cognitive theory and identified 15 themes. Results: Major findings highlighted: 1) patient and community learners may view Basotho clinicians as authority figures; 2) family and community power dynamics affect healthcare access for vulnerable patient groups; and 3) village leaders may refuse community education when excluded from problem-solving and early planning. Conclusions: Although local clinicians and community members may identify with the same cultural group, clinicians can encounter cultural barriers to patient and community education.

The Kenya UK Breast Cancer Awareness Week: curriculum codesign and codelivery with direct and lived experience of breast cancer diagnosis and management.

Global health education holds a paradox: the provision of global health degrees focusing on challenges in low-income and middle-income countries has increased in high-income countries, while those in these low-income and middle-income countries lack access to contribute their expertise, creating an ‘information problem’. Breast cancer is a pressing global health priority, which requires curriculum design, implementation, ownership and leadership by those with direct and lived experience of breast cancer.The Kenya-UK Breast Cancer Awareness Week was conceptualised following the signing of the Memorandum of Understanding between the Kenyan and UK governments launching the Kenya UK Health Alliance. This alliance aims to promote health cooperation to address Kenya’s breast cancer challenge. Here, we present the first of the collaborative’s initiatives: a breast cancer global health education programme designed, implemented, owned and led by Kenyan stakeholders.We present the utilisation of the Virtual Roundtable for Collaborative Education Design for the design and implementation of a nationwide virtual breast cancer awareness week delivered across eleven Kenyan medical schools. By involving partners with lived and/or professional experience of breast cancer in Kenya in all stages of the design and delivery of the awareness week, the project experimented with disrupting power dynamics and fostered ownership of the initiative by colleagues with direct expertise of breast cancer in Kenya.This initiative provides a platform, precedent and playbook to guide professionals from other specialties in the design and implementation of similar global collaborative ventures. We have used this approach to continue to advocate for global health curricula design change, so that those with lived experiences of global health challenges in their contextualised professional and personal environments are given leadership, reward and ownership of their curricula and further to highlight breast cancer as a global heath priority.