Abstract
Background: Professionals with a sense of Social Justice (SJ) are more likely to advocate for and work towards health equity. Educators have enormous potential to empower graduates to promote health equity. However, evidence suggests that this potential is not being utilised effectively. While previous research has been conducted in developing countries regarding this concept, this is the first research to be conducted in a Small Island Developing State (SIDS) country such as the Maldives - a country composed of hundreds of small islands, which imposes challenges in providing equitable health care services across the islands.
Aim: I aimed to explore the development of SJ constructs and social responsibility towards health equity in undergraduate health professional students at the Maldives National University (MNU).
Methods: This study employed multi-methods through three studies: (i) a cross-sectional survey examined the SJ constructs of health professional students at the MNU, (ii) a qualitative study explored perceptions of students and their educators regarding the role of future graduates in promoting health equity in the country, and (iii) a curricular analysis explored identified subjects for inclusion of knowledge and skills related to health equity, SJ, and social responsibility.
Results: Respondents showed a positive attitude towards SJ with high scores for the total scale (mean = 5.82, SD = 0.75) and subscales: attitudes (mean = 6.51, SD = 0.80), intentions (mean = 5.78, SD = 1.15), perceived behavioural control (mean = 5.09, SD =1.08), and subjective norms (mean = 4.57, SD = 1.31). While 90% of participants agreed that it is important to act for SJ, only 47% agreed that they were confident to talk about social injustices and how social conditions impact health and wellbeing. More than half of the respondents (56%) were confident that they can have a positive impact on others. The qualitative interviews revealed factors that inhibited the confidence of students, in addition to enabling factors that would empower students to promote health equity. Curricula analysis revealed implicit rather than explicit statement of social justice and health equity. Communication, critical thinking, and teamwork skills were explicitly stated across different subjects in the three disciplines of nursing, physiotherapy, and medical laboratory sciences.
Discussion: The capabilities approach was used to explain and understand the process of the development of capabilities to promote health equity in graduates, including enabling the graduates to use those capabilities to promote health equity. Important capabilities that were identified include inter-professional teamwork, political and bureaucratic nous, sense of service, and self-efficacy. Inclusion of adequate knowledge, educators’ enabling role, and teaching strategies influenced the development of capabilities in students, while immersive learning enabled students to work in the regional areas. Clear scope of practice, a supportive work environment, and professional development were factors that helped graduates to realise their capabilities to influence health equity. Identification of such factors will enable education providers, policy makers, and system administrators to ensure that health professionals could be better empowered to influence health equity. This will improve service provision as well as health outcomes of the country.