GENERAL ARTICLES

 

Decolonisation of health sciences curricula as a vehicle for transformation in higher education: a scoping review

 

 

R. Koch^I; J. Pool^II; J. Heymans^III

^ICentre for Health Professions Education (CHPE), Faculty of Health Sciences. North-West University, Potchefstroom, South Africa https://orcid.org/0000-0003-2398-9475
^IICentre for Health Professions Education (CHPE), Faculty of Health Sciences. North-West University, Potchefstroom, South Africa https://orcid.org/0000-0002-6839-4419
^IIICentre for Health Professions Education (CHPE), Faculty of Health Sciences. North-West University, Potchefstroom, South Africa https://orcid.org/0000-0003-4459-2266

 

 

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ABSTRACT

Inclusive curriculum transformation is crucial in Higher Education (HE). Decolonisation is considered a necessary intervention that offers opportunities to reimagine curricula, broaden access, and foster inclusivity. However, the full potential of decolonisation remains untapped due to contradictory perceptions and the absence of substantive decolonial theory. This scoping review explored how the decolonisation of Health Sciences curricula can be used as a vehicle for transformation in HE. A systematic search of online academic databases was conducted and included 31 relevant articles. Deductive and inductive coding was used to analyse the data, through which 14 decolonial actions were identified and presented as an action framework. By identifying and organising the main concepts used in the literature and proposing an action framework to decolonise curricula within the field of Health Sciences, this study contributes to the ongoing discourse of how decolonisation can be used to bring about transformation in HE.
CONTRIBUTION: Findings contribute to the development of decolonial theory and highlight the benefits of decolonising Health Sciences curricula. This scoping review sets the stage for further research to build on this action framework, develop practical guidelines to guide curriculum change and evaluate and measure decolonisation efforts

Keywords: Higher education, Decolonisation, Health Sciences, Scoping review, Transformation

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INTRODUCTION

Higher education needs transformation to adapt to the rapidly changing global landscape and address society's evolving needs and challenges (Osman and Maringe 2019, Shay 2016). Traditional models may no longer adequately prepare students for the challenges they will face as health professions graduates (Hansen et al. 2023). By embracing transformation and moving towards a critical approach that embraces multiple perspectives and prioritises social justice, HE can enhance accessibility, equity, and inclusivity. HE and, in particular, educators are responsible to future generations to seek ways in which education can contribute to transformation (Sathorar and Blignaut 2021).

According to Behari-Leak (2020), it is essential to disrupt colonial forms of curriculum and pedagogy to transform. The term decolonisation gained prominence in the transformation agenda due to recent student protests, such as #RhodesMustFall and #Feesmustfall in South Africa in 2015 and 2016, and the "Why is My Curriculum White?" campaigns in the UK (Jansen 2019, Pimblott 2020; Quinn and Vorster 2019). Le Grange (2019) suggests that the process of decolonisation presents opportunities for reimagining HE to address the above-mentioned transformation agenda. This stance is echoed by Osman and Maringe (2019) and Quinn & Vorster (2019), who state that decolonisation can transform curricula to ensure inclusivity and broaden access for disadvantaged groups.

However, according to Le Grange et al. (2020), the feasibility of decolonising HE depends on how Higher Education institutions (HEi) utilise this opportunity. Osman and Maringe (2019) and Timmis et al. (2019) report that many HEi have not fully embraced decolonisation opportunities, despite the growing awareness of the importance of decolonisation as a vehicle for transformation in HE.

For health professions educators to use decolonisation to work towards a responsive and culturally relevant curriculum, certain barriers need to be addressed. According to Osman and Maringe (2019) and Lawrence and Hirsch (2020), one of the significant barriers to decolonisation in South Africa includes the existence of many contradictory views of the concept of decolonisation. Another significant barrier the above authors mention is the shortcomings of the decolonisation agendas that focus on removing obstacles, like the removal of the statue of Cecil John Rhodes from the campus of the University of Cape Town, instead of giving guidance on how to decolonise curricula. This resonates with the findings of Subasri Narasimhan and P. Paul Chandanabhumma (2021), which suggest that there are no explicit norms on how the definitions and processes of decolonisation are conceptualised in their reviewed literature. This lack of clarity leads to the perception that the act of decolonising curricula is too ill-defined or daunting for it to be achievable (Lawrence and Hirsch 2020). Osman and Maringe (2019) emphasise that without a coherent understanding and framework, the process of decolonisation will not be able to contribute to the transformation of HE in South Africa.

To address the lack of a clearly defined definition and a mutual agreement of decolonisation in HE requires substantive decolonial theory and regulatory frameworks to guide curriculum change as well as the facilitation of these transformative changes (Behari-Leak 2021, Hoadley and Galant 2019, Jansen 2019). Furthermore, sustainable progress toward decolonisation requires a proactive and future-orientated approach focusing on opportunities for reimagining curricula (Le Grange 2019; Osman and Maringe 2019).

In response to the call for theory and frameworks for decolonising Health Sciences curricula, the authors conducted a scoping literature review to explore the body of knowledge on how decolonisation can be used to transform HE. By systematically exploring and synthesising the available evidence, this scoping review aims to provide insights into the existing literature on decolonisation in health sciences and add to the theory of innovative and transformative practices.

The article begins by describing the research methodology, detailing data collection and analyses. The results are then presented in a table providing an overview of the themes and subthemes that emerged during data analysis. The subsequent section delves into a discussion of the findings. To conclude, the article summarises main actions for decolonising Health Sciences Curricula, highlighting the study's contributions, acknowledging limitations, and suggesting avenues for future research.

 

METHOD

A scoping review is a useful methodological approach when researching questions that are complex and when working with a diverse heterogeneous literature (Pham et al. 2014). Given the complex and multifaceted nature of decolonisation as a vehicle for transformation, a scoping review may be particularly valuable in identifying the range and extent of available literature on this topic and summarising the existing evidence (Munn et al.2018, Peters et al. 2020; Pollock et al. 2021)

This scoping review follows the Joanna Briggs Institute guidelines (Peters et al. 2020) and uses the five-stage method developed by Arksey and O'Malley (2005):

• Stage 1: identifying the research question

• Stage 2: identifying relevant studies

• Stage 3: study selection

• Stage 4: charting the data

• Stage 5: collating, summarising, and reporting the results.

Stage 1: Identifying the research question

This scoping review aims to systematically explore and map current research on how decolonisation of Health Sciences curricula can be used to transform HE.

The study addresses the following research questions:

• How can the decolonisation of Health Sciences curricula be used as a vehicle for transformation in HE?

Stage 2: Identifying relevant studies

The concept of interest and context approach was used to explore the objectives for the eligibility criteria for study selection (Peters et al. 2020). The concept examined in this study is how decolonisation is being used to transform curricula. The context for this review is studies done in Health Sciences. The context is expanded to include curriculum design, redesign, and revision in HE and within this scope, it will focus on teaching and learning in HE.

As recommended by (Peters et al. 2020), a three-step search strategy was used. In the first step, a preliminary search of two relevant databases was carried out in collaboration with a research librarian following the guidance of Pollock et al. (2021: 3). Based on the objectives of the study, keywords were identified and used to generate a set of search terms that included scientific and common terminology, as well as British and American spellings, synonyms, and plurals. The initial search was performed on the Scopus database. The text words from the titles and abstracts of the retrieved papers and index terms were then analysed to develop a comprehensive search strategy. In the second step, all identified keywords and index terms (refer to Appendix A) were used to perform a second search. The final search strategy is described in Appendix B. Subsequently, the third step involved searching the reference lists of the identified reports and articles for additional relevant sources.

Given that the concept of decolonisation gained prominence in higher education after student movements and calls for decolonising HE (Jansen 2019b: 51), only publications from 2015 onwards were considered for inclusion. Only publications written in English that consist of literature reviews, book chapters, and peer-reviewed scholarly articles were considered for inclusion.

The search was conducted on the following databases from 2015 to July 2022: EbscoHost, ERIC, Proquest, Pubmed, Scopus, and Web of Science. Database searches yielded 540 results that were imported into EndNote (a commercial reference management software package). Duplicate sources were combined and removed, resulting in 396 remaining sources. These sources were then imported into Covidence, an online screening and data extraction tool, where another 88 duplicates were removed, leaving 308 studies for further analysis.

Stage 3: Study selection

The 308 studies were screened based on the prespecified inclusion criteria summarised in 0. The researchers independently selected the sources and to ensure reliability, ten articles were randomly selected, and the researchers independently screened the titles and abstracts. Any discrepancies were discussed to ensure consistency in applying the inclusion and exclusion criteria. Disagreements were resolved through discussion, and the screening process began once an agreement was reached. Full-text retrieval was done for potentially relevant sources, which were then independently reviewed by the researchers. The reason for the exclusion was recorded and reported for sources that did not meet the inclusion criteria during the full-text screening.

 

Table 1

 

Of the 308 studies, 209 were marked irrelevant after title and abstract screening as they did not meet the inclusion criteria. The 99 remaining studies underwent full-text review, where the articles were retrieved, and eligibility was assessed. Of these sources, 63 studies were excluded based on the exclusion criteria, as shown in 0. The 31 remaining studies were considered eligible for this review.

 

Figure 1

 

Stage 4: Charting the data

At this stage, the researchers mapped and summarised the data based on the research question and the aim of the study. To ensure that relevant information was extracted accurately, a calibration exercise was conducted to familiarise the researchers with the results and test the data extraction form's appropriateness and usability, as Peters et al. (2020) suggested. The form (Appendix C) was refined and updated to provide a descriptive summary of the results aligning with the objectives of this study.

General data on article characteristics were abstracted such as title, lead author, country of origin, and year of publication. The study's purpose, methodology, and findings were also briefly noted, as well as the academic discipline or subject on which the research is based. To the purpose of the study aim (to establish how decolonisation can be used as a vehicle for transformation in Higher Education), information was abstracted on how decolonisation is applied, what strategies are being used to decolonise, and how educators are implementing these strategies.

Stage 5: Collating, summarising, and reporting the results

In the final stage of the process, the researchers analysed the results by identifying, characterising, and summarising the evidence collected during the scoping review. This process is in accordance with the JBI Manual for Evidence Synthesis, which emphasises the importance of identifying and synthesising evidence to generate meaningful insights and conclusions (Peters et al. 2020).

Koch et al. (in press) conducted a scoping review to explore the nature of decolonisation within the field of Health Sciences. The authors identified four main themes that describe the nature of decolonisation in the field of decolonisation in Health Sciences. These four main themes were used in this study as a framework for categorising the data. An inductive coding approach was then used to identify new themes during the data analysis. The combined approach used in this study ensured a comprehensive data exploration and allowed for a structured and systematic analysis. The findings were then descriptively mapped in tabular form (0), visually representing the themes and subthemes.

 

RESULTS

This scoping review identified 31 studies that described how the decolonisation of Health Sciences curricula is being used as a vehicle for transformation within HE.

The sources that met the inclusion criteria were from different countries such as Australia, the United States, the United Kingdom, Canada, South Africa, Gaza, Nigeria, Botswana, and China. The disciplines range from Higher Education in general to transdisciplinary, Education, Health Sciences Education, Medicine, Pharmacy, and Psychology. The individual characteristics of the sources can be found in Appendix D.

The following section will provide a detailed analysis of the results of this scoping review.

Decolonisation as a Vehicle for Transformation

As mentioned in section 2.5, the four themes identified in a scoping review by Koch et al. (in press) served as a basis for coding as a framework for organising and categorising the data. An inductive coding approach was then employed to uncover subthemes describing how decolonisation of Health Sciences curricula is used as a vehicle for transformation in HE. 0 provides a clear overview of the themes and subthemes that emerged during data analysis.

 

Table 2

 

DISCUSSION

The data analysis shows that various actions have been undertaken to decolonise Health Sciences curricula when working towards transformation in HE. These decolonial actions are visually presented in 0.

 

Figure 2

 

Theme 1: Recognise and challenge colonialism

The first theme speaks to the recognition and challenging of colonialism and its impact on HE. Data analysis indicated the following decolonial actions that can be employed to achieve transformation in HE: focus on self-awareness, recognise colonialism, and challenge colonialism.

Subtheme 1: Focus on self-awareness

The literature has emphasised the importance of self-awareness and critical reflexivity in pursuing decoloniality (Bhandal 2018, Castell et al. 2018, Zidani 2021). It is recommended that educators should critically reflect on themselves to understand their worldview and practices and educational systems (Castell et al. 2018, Goodman et al.2015, Narasimhan and Chandanabhumma 2021). Through this critical reflection process, colonisation's impact can be assessed, and the self can be decentred to explore alternative ways of being and doing (Galvaan et al. 2022, Narasimhan and Chandanabhumma 2021).

Furthermore, the literature recommends that educators position themselves to promote transparency and self-accountability, because a neutral position may unintentionally endorse existing power structures (Goodman et al. 2015, Rodney 2016). From their established position, educators are encouraged to assume responsibility for any implicit or explicit biases to create a space for the learning and development of diverse students (Barkaskas and Gladwin 2021; Galvaan et al. 2022).

Students should also be encouraged to reflect on their own identities. These reflective practices can assist students in identifying any misalignment between their perceived and actual actions. Educators can design activities that promote self-reflection among students to raise awareness of cultural differences and encourage students to view differences as opportunities for learning (Andrews et al. 2020, Harvey and Russell-Mundine 2019).

Subtheme 2: Recognise colonialism

When using decolonisation of curricula as a vehicle for transformation, it is important to recognise and understand colonisation's historical and multigenerational impact. Recognising colonialism involves interrogating a discipline's history and acknowledging the policies and practices that resulted in resource depletion within the specific discipline (Chandanabhumma and Narasimhan 2020; Mbaki et al. 2021).

Critical awareness of the continuing influence of colonialism is encouraged. A critical reflection of what constitutes as the learning environment is needed to unmask the forces of colonialism. This includes the culture and values of educators, the nature of the curriculum, the delivery, and the resources used. Introducing contrasting perspectives can help to unmask these forces (Chandanabhumma and Narasimhan 2020; Mbaki et al. 2021; Narasimhan and Chandanabhumma 2021).

Subtheme 3: Challenge colonialism

Educators and institutions must reflect on how to move beyond dominant hegemonic perspectives to recognise and address harmful patterns left by the colonial legacy and rethink the issue of graduate mobility, especially in situations where some people may have more opportunities or advantages than others (Bhandal 2018).

Traditional approaches to education must be challenged and critically evaluated to advance transformation in HE (Aldawood and Gómez 2018; Cassim 2020). This can be achieved by examining historical, cultural, and epistemological manifestations of the influence of the colonial legacy on practice and perspectives (Chandanabhumma and Narasimhan 2020).

Therefore, it is essential to challenge assumptions by examining what is learned through interactions with others (Barkaskas and Gladwin 2021; Wong et al.,2021). Since many traditional teaching strategies contradict the aims and goals of multicultural social justice training, according to Goodman et al. (2015), decolonisation requires a paradigm shift from traditional teaching methodologies to creative techniques.

Theme 2: Strive for social justice and inclusion

The second theme focuses on combating injustice and striving for a socially just, culturally diverse, and inclusive curriculum. As the identified subthemes explain, to decolonise curricula, educators must strive for social justice, question power dynamics, embrace diversity, be inclusive in their teaching, and promote student agency.

Subtheme 1: Strive for social justice

An overall commitment to social justice and equity is required when the goal is to decolonise curricula (Chandanabhumma and Narasimhan 2020, Goodman et al.2015, Laing 2021). Working toward social justice not only requires a paradigm shift to decentre the frame of reference from the dominant group to the people impacted by the colonial legacy but also requires the re-examination of graduate mobility in an uneven context. This realignment of perspective could broaden understanding, promote social responsibility, and help restore imbalances in knowledge and expertise (Bhandal 2018, Chandanabhumma and Narasimhan 2020, Goodman et al. 2015).

The role of dominant groups in mutual alliances should be re-examined to resist further marginalisation. This can be done by acknowledging past misgivings and honouring and protecting the copyright of indigenous knowledge (Chandanabhumma and Narasimhan 2020, Mheta et al. 2018, . Narasimhan and Chandanabhumma 2021).

Subtheme 2: Question power dynamics

Addressing power relations within decolonisation efforts involves the recognition and examination of power dynamics that have historically shaped knowledge production, curriculum design, disciplinary practices, and professional hierarchies (Aldawood and Gómez 2018; Chandanabhumma and Narasimhan 2020, Rodney 2016).

Balancing power within higher education involves a conscious effort to avoid imposing the voice of colonisers over that of the oppressed. It requires intentionally shifting partnerships and collaborations to address existing power imbalances while also equalising access and opportunities in educational experiences (Diab et al. 2020, Eichbaum et al. 2021).

Subtheme 3: Embrace diversity

Cultural differences should be acknowledged within a HE classroom. Educators and students should be encouraged to reflect on their own dispositions and not push for homogeneity or shy away from conflict (Harvey and Russell-Mundine 2019, Sathorar and Geduld 2019, Zidani 2021). These differences should be viewed as a vital opportunity for learning, and a diversity of knowledge and culture should be accommodated (Harvey and Russell-Mundine 2019, Neden 2021, Zidani 2021). To transform Health Sciences curricula, individual and collective action is needed to train culturally competent healthcare providers who can provide care that is suitable for the culture of a patient (Nazar et al. 2015; Sathorar and Geduld 2019).

Subtheme 4: Be inclusive

To foster a more inclusive classroom environment, archetypal representation must be avoided. This means moving away from simplified or stereotypical portrayals of students, faculty, and staff based on preconceived notions or generalisations. It involves recognising the diversity and individuality of individuals and ensuring that their experiences, identities, and perspectives are accurately and authentically represented. Diverse representation can be promoted in curricula, teaching materials, and classroom examples (Finn et al. 2022, Swidrovich 2020).

It is important to use inclusive delivery methods when approaching education from a decolonial perspective. This includes recognising the presence of a hidden curriculum and acknowledging that curricula can be experienced differently by everyone (Finn et al. 2022, Mbaki et al. 2021, Wong et al. 2021). Using inclusive and appropriate language and terminology accessible to all is important when working toward an inclusive and equitable learning environment (Finn et al. 2022). Professional development opportunities can further enhance inclusivity by increasing educators' knowledge, confidence, and competence in creating an inclusive classroom (Swidrovich 2020).

To create an inclusive learning environment, the course materials must be contextualised. This implies that the course material's cultural and historical context should be described, and assumptions should be explained. Educators must provide a safe environment where open conversations are encouraged and each student feels valued, respected, and empowered to participate (Finn et al. 2022).

Subtheme 5: Promote student agency

To use decolonisation as a vehicle for transformation in HE, a paradigm shift from traditional teaching methodologies to a student-centred approach that empowers students is needed. The focus should be on students' needs, interests, and background. Educators should ideally be supported by academic support staff to become more aware of the epistemological background of students and the relevance and impact that their teaching has on the lives of students (Ajaps and Lejano 2021; Cordeiro-Rodrigues 2017, Goodman et al. 2015). This approach encourages critical thinking and empowers students to take ownership of their learning to become active agents in their educational journey (Ajaps and Lejano 2021, Andrews et al. 2020).

Giving students a voice expands the context beyond the perspectives of the academic team and brings the underlying ideologies of knowledge claims into open discussion. Unequal power relations can also be disabled by learning real-world skills from peers. This partnership between educators and students can empower traditionally marginalised students and involve them in sharing responsibility with educators in developing culturally sustainable teaching methods (Ajaps and Lejano 2021; Andrews et al. 2020, Goodman et al.2015, Iloanya 2017, Joosub 2021, Laing 2021, Reyes et al. 2021).

Theme 3: Embrace cultural heritage

The third theme centres around the reembracing of cultural heritage. As the subthemes below describe, educators should localise curricula, respect local identity, and balance local and global perspectives.

Subtheme 1: Localise curricula

Content should not focus primarily on colonised text and theory. Instead, course material from subaltern authors and theorists should be included, local content should be incorporated, and locally authored textbooks should be used where possible (Ajaps and Lejano 2021, Aldawood and Gómez 2018, Sathorar and Geduld 2018). Ensuring a diversity of educators will also lead to greater representation of non-Western knowledge producers in the classroom (Laing 2021).

Course material should incorporate local content and also link content and theory to practice by exposing students to diverse contexts (Sathorar and Geduld 2018). Students must be allowed to reflect on their own heritage and compare it to others (Ajaps and Lejano 2021, Sathorar and Geduld 2018). This can be achieved through field trips where they can experience rather than be taught, or through community involvement where parents, elders, and other community members can form part of students' resources by teaching classes or delivering testimonial evidence (Ajaps and Lejano 2021, Cordeiro-Rodrigues 2017).

Additionally, educators can incorporate local delivery methods. For example, African cultures have a strong oral tradition; therefore, including more oral assessments may be beneficial. Traditional forms of expression, such as storytelling, music, games, or theatre, can be incorporated instead of the Western argumentative (Ajaps and Lejano 2021, Cordeiro-Rodrigues 2017). The literature also suggests the use of locally relatable and nontechnical language. Key concepts can be translated into different languages and students can explain or discuss concepts to and with their peers in local languages (Ajaps and Lejano 2021). Educators can further localise through the artefacts they use in a class (charts, pictures, maps), the places they mention, and by introducing hands-on activities that emphasise the current environment of the students (Ajaps and Lejano 2021, Nibafu et al. 2021). In addition, the examples used in the class can be based on current cultural trends or events related to the students' interests and experiences, or they can be tasked to bring their own examples to the class. This can validate students' knowledge and experience and, in doing so, encourage participation (Zappas et al. 2021).

Subtheme 2: Respect local identity

The curriculum should recognise and generate opportunities for the knowledge and voice of indigenous people to develop local culture-based theories to inform academic content and praxis. The curriculum becomes more culturally relevant and enriched when incorporating indigenous knowledge and perspectives. Curricula should recognise that indigenous people have their own theories and their own ways of understanding the world and that they can contribute to the academic discourse and can inform practical applications in various fields (Chandanabhumma and Narasimhan 2020, Mheta et al. 2018, van der Westhuizen et al. 2017).

This subtheme emphasises the importance of valuing indigenous knowledge. Appropriate actions and measures should be taken to ensure that the knowledge and resources of community experts are protected and used to benefit and empower the community, rather than exploiting it without consent or proper recognition (Chandanabhumma and Narasimhan 2020). To respect and reclaim indigenous heritage, it is important to recentre identities to recognise and celebrate local and challenge and reject colonial superiority. This involves acknowledging the vital role of indigenous cultural knowledge in meeting the needs of local communities (Joosub 2021; van der Westhuizen et al. 2017). Students must be encouraged to think creatively and critically about existing knowledge and view themselves as active agents and contributors(Joosub 2021). The goal is to establish a distinct local educational brand and develop curricula that attract and retain the best minds (Mheta et al., 2018).

Subtheme 3: Balance local and global

The decolonised curriculum should bring a balance between local and global perspectives. It is crucial to incorporate local perspectives alongside Eurocentric viewpoints as part of the knowledge base and practical application. By understanding phenomena from a local point of view, the focus shifts towards the unique contributions that local universities can offer, rather than solely relying on what they can receive from Europe (Mheta et al. 2018, Nibafu et al. 2021, van der Westhuizen et al. 2017).

The literature suggests actively seeking partnerships with relevant organisations and institutions. By collaborating with professional bodies, universities can benefit from their expertise, guidance, and resources and also share local expertise with educators from other countries (Mheta et al. 2018, van der Westhuizen et al. 2017, Witthuhn and le Roux 2017). This interconnectedness has the potential to bridge the gap between Indigenous and non-Indigenous and help build a shared ethics that embraces both Western and Indigenous approaches (Harvey and Russell-Mundine 2019).

Theme 4: Interrogate knowledge and explore alternatives

The fourth theme encompasses the interrogation of knowledge and the pursuit of finding alternative ways of knowing, being, and doing. The subthemes that will be discussed under this theme include thinking about knowledge, employing students as active collaborators in creating knowledge and exploring alternative ways of knowledge creation.

Subtheme 1: Think about knowledge

Knowledge is pluriversal and can be shaped by the context in which it is created and also by the time in which it is taught and learnt (Aldawood and Gómez 2018). Therefore, knowledge must be taught in such a way that it reflects its content and history so that students can understand how it has been shaped (Sathorar and Geduld 2019). This can be done by incorporating non-Eurocentric epistemologies into curricula and by creating spaces where students can learn about and discuss non-Eurocentric ways of knowing and be aware of their own biases and the biases of the people who are teaching them (Aldawood and Gómez 2018, Andrews et al. 2020).

Educators should consider why certain content, materials and methods are used and how this affects their students (Cordeiro-Rodrigues 2017, Rodney 2016). Educators must be open to new ideas and perspectives and willing to challenge their own assumptions. By being prepared to question and unlearn what has been taught, educators can help students develop critical thinking and problem-solving skills (Harvey and Russell-Mundine 2019, Rodney 2016). These skills are essential for students in the complex world of healthcare, where patient safety can be at risk if care provision is not culturally and linguistically appropriate (Eichbaum et al. 2021). It is also important for educators to question if their institution provides opportunities for engaging in global work that challenges existing knowledge hierarchies (Rodney, 2016).

Health sciences education should be open to different ways of knowing and thinking and should be able to draw from other disciplines (Wong et al. 2021, Zappas et al. 2021). Curricula should not be based on a single authoritative voice and should not shy away from presenting students with complex and challenging ideas. Instead, students should be encouraged to think critically about ideas, question the status quo, and form their own opinions (Aldawood and Gómez 2018; Zappas et al.2021). Protocols, such as including content on how Western and indigenous knowledge can be used to address health problems, can build capacity for integrating knowledge (Harvey and Russell-Mundine 2019, Neden, 2021).

Subtheme 2: Employ students as collaborators in creation of knowledge

The existing knowledge and experience students bring to the classroom should be considered and built upon in the teaching process. Considering the positionality and identity of students provides opportunities to engage with the lived realities of students and demonstrate that they can be comfortable using the language, knowledge, and experience that they already possess (Andrews et al. 2020, Galvaan et al. 2022, Reyes et al. 2021, Sathorar and Geduld 2018, 2019).

In the co-creation of knowledge, it is important for all students to actively participate in the learning process. Sharing between cultures should be allowed by offering a space to collaborate, share experiences, challenge each other's thinking, and learn from one another. Students should feel accepted and heard, and their unique contributions to the learning process should be recognised by ensuring that all students are not just responding, but bringing in new knowledge (Ajaps and Lejano 2021, Chandanabhumma and Narasimhan 2020, Sathorar and Geduld 2019, Zappas et al.2021).

Engaging students as active agents in shaping their own learning can be achieved through a partnership between the educator and the student. Students can be engaged at a meta-pedagogical level where they are invited to think about their own learning and where educators explain choices of content, assignments, and class policies. Educators need to value students as allies and create a community of inquiry in their classroom (Galvaan et al. 2022, Laing 2021, Reyes et al. 2021, Sathorar and Geduld 2019, Zappas et al. 2021). When students are acknowledged as active collaborators and coproducers of knowledge, it positions them as critical thinkers who can analyse and evaluate issues arising from a topic to form their own opinions and theories (Ajaps and Lejano 2021, Andrews et al. 2020; Iloanya 2017; Sathorar and Geduld 2018).

Students also need the opportunity to reflect on how theories are applied in context. Theories can be put into practice by exposing students to real-life situations through inquiry-based questions, problems, or scenarios as well as practical examples or experiments or allowing students the opportunity to practise skills in real-life situations. This can develop students' awareness of their positionality and emphasise the fact that knowledge always arises in a specific context (Ajaps and Lejano 2021; Andrews et al. 2020, Sathorar and Geduld 2018, 2019).

Subtheme 3: Explore alternative ways of knowledge creation

This subtheme reflects on alternative ways to create knowledge. One such approach mentioned is to adopt a research-based approach to curriculum transformation. Educators should consider how inclusive the research environment is for people of all backgrounds and how well the environment meets the needs of all researchers to identify areas for improvement to ultimately create a space where everyone feels welcome and valued (Mashiyi et al. 2020, Mbaki et al. 2021)

Educators must be courageous in exploring creative and innovative teaching methods. By incorporating decolonial activities, they can create a space that allows students to engage in a collaborative and connected learning experience (Barkaskas and Gladwin 2021, Goodman et al. 2015). Real-life skills can be learned from peers in activities like groupwork, discussion, and interaction. These skills include workplace skills such as applying theory, functioning in a group, negotiating others' opinions, learning independently, and analysing information. This can also increase opportunities for students to engage meaningfully within their communities (Cassim 2020, Goodman et al. 2015, Joosub 2021).

Other authors also give examples of decolonial activities. Barkaskas and Gladwin (2021) describe the use of pedagogical talking circles, an activity based on indigenous frameworks. This activity focuses on learning by creating, storytelling, reflecting, observing, and listening. Cassim (2020) encourages playful learning using the pedagogy of play and describes how an educational toolkit design activity was implemented to facilitate a learning opportunity for students not bound to the classroom to disrupt a 'one-size-fits-all' approach. Mheta et al. (2018) contribute to the list of activities by proposing the use of multilingual classroom talk, where students are encouraged to use their first language to discuss and ask questions in small groups and translanguaging, which refers to the ability of multilingual speakers to shuffle between languages. They advocate that using such language activities can maximise learning, balance power relations, enrich the linguistic repertoires of the educator and students, and draw on more nuanced meanings of concepts. Laing (2021) adds that educators can add the use of creative and innovative teaching tools like storybooks, films, arts, and field trips as alternative ways to learn to decentre written texts as the only source of legitimate knowledge.

Diversification of assessment strategies is also an important consideration for teaching and learning when attempting to decolonise curricula (Mbaki et al. 2021). Assessment criteria should reflect the commitment to acknowledge contributions from a greater range of thinkers (Laing 2021).

 

CONCLUSION

This scoping review mapped and summarised the available literature on how the decolonisation of Health Science curricula is being used to transform HE to provide insight into innovative and transformative practices in the field of Health Science.

This systematic literature review identified the main decolonial actions used to work towards transformation in HE as shown in 0.

 

Table 3

 

Against the background stated in this study, it is evident that decolonisation as a means of driving transformation holds significant importance for HE. However, the challenge lies in determining how this process should unfold. As Le Grange (2019) highlighted, the focus should extend beyond defining decolonisation itself and shift toward envisioning its potential outcomes and future possibilities. By identifying and organising the main concepts used in the literature and proposing an action framework to decolonise curricula within the field of Health Sciences, this study contributes to the ongoing discourse of how decolonisation can be used to bring about transformation in HE. The aim is to contribute to developing decolonial theory that can guide curriculum change and provide an evidence-based foundation for policy and practice changes related to decolonisation within Health Sciences, ultimately making decolonising curricula less daunting.

Knowing how to decolonise Health Sciences curricula in Africa will benefit healthcare education and contribute to the transformation of HE on the continent. Decolonisation can enable African nations to reclaim their cultural identities and indigenous knowledge systems, ensuring that health education reflects African communities' diverse needs and realities. Furthermore, the theory and frameworks developed in Africa acknowledge the continent's unique historical, social, and political context. This will allow for customised solutions that address the specific challenges faced by African healthcare systems.

The contribution of this study is that further research can now draw from this action framework to develop practical guidelines to guide curriculum change.

 

STRENGTHS AND LIMITATIONS

A Scoping review may have several limitations that may affect its accuracy and usefulness. Scoping reviews are focused, meaning important information that falls outside their scope may be missed. Although providing a broad overview of the literature, scoping reviews may lack detail, making it difficult to fully understand individual studies. There may also be the potential for bias in the study selection and in the interpretation of the findings due to the biases of the researchers. Additionally, scoping reviews can be time-consuming, especially when evaluating a large number of studies, and may be limited by the quality and availability of the relevant literature. Furthermore, scoping reviews can become outdated quickly due to their time constraints, as new research and data may be published after the completion of the review. Therefore, a scoping review should be considered as just one step in a larger evidence-based approach.

 

FUNDING

This research did not receive funding.

 

DECLARATION STATEMENT

The authors declare that they have no conflict of interest.

 

SUPPLEMENTAL MATERIAL

• APPENDIX A: Search terms

• APPENDIX B: Search strategy

• APPENDIX C: Data extraction form

• APPENDIX D: Results of individual sources of evidence

 

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APPENDICES

 

Appendix A - Click to enlarge

 

APPENDIX B: SEARCH STRATEGY

DATABASE 1: Scopus (Results: 89)

( TITLE-ABS-KEY ( decolonise OR decolonize OR decolonisation OR decolonization OR decolonising OR decolonizing OR africanisation OR africanization OR decolonial OR democratization OR democratisation ) AND ALL ( transform OR transformation OR renew OR renewal OR renewing OR change OR revision OR intervention OR mediate OR deconstructing OR revolution OR transition OR diversity OR development OR adjustment OR reversal OR modification OR diversification OR remodelling OR reconstructing OR reconstruction OR change ) AND ALL ( curriculum OR curricula OR pedagogy OR pedagogic OR pedagogical OR pedagogies OR educational AND program OR syllabus OR module OR course OR program AND strategy OR guideline OR guidelines OR framework OR action OR approach OR blueprint OR design OR tactics OR method OR planning AND higher AND education OR college OR university OR post-secondary OR postsecondary OR undergraduate OR graduate OR tertiary AND health AND science OR health AND sciences OR health ) AND TITLE-ABS-KEY ( health AND science OR health AND sciences OR health OR education ) ) AND PUBYEAR > 2014 AND PUBYEAR > 2014

DATABASE 2: EBSCOhost Research Databases (56 Results)

https://nwulib.nwu.ac.za/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=eric&bquery=TI+(+Decolonise+or+decolonize+or+Decolonisation+or+decolonization+or+Decolonising+or+Decolonizing+or+Africanisation+or+Africanization+or+decolonial+or+democratization+or+democratisation+)+AND+(+Transform+or+Transformation+or+renew+or+renewal+or+renewing+or+change+or+revision+or+intervention+or+mediate+or+deconstructing+or+revolution+or+transition+or+diversity+or+development+or+adjustment+or+reversal+or+modification+or+diversification+or+remodelling+or+reconstructing+or+reconstruction+or+change+)+AND+(+Curriculum+or+curricula+or+pedagogy+or+pedagogic+or+pedagogical+or+pedagogies+or+educational+program+or+syllabus+or+module+or+course+or+program+)+AND+(+Strategy+or+guideline+or+guidelines+or+framework+or+action+or+approach+or+blueprint+or+design+or+tactics+or+method+or+planning+or+model+)+AND+(+Higher+education+or+college+or+university+or+post-secondary+or+postsecondary+or+undergraduate+or+graduate+or+tertiary+)+AND+AB+(+Health+Science+or+H ealth+Sciences+or+health+or+education+)&cli0=DT1&clv0=201501-000001&type=1&searchMode=Standard

DATABASE 3: Web of science (Results 168)

decolonised or decolonized or Decolonisation or decolonization or Decolonising or Decolonizing or africanisation or africanization or decolonial or democratization or democratisation (Title) and Transform or Transformation or renew or renewal or renewing or change or revision or intervention or mediate or deconstructing or revolution or transition or diversity or development or adjustment or reversal or modification or diversification or remodelling or reconstructing or reconstruction or change (All Fields) and Curriculum or curricula or pedagogy or pedagogic or pedagogical or pedagogies or educational program or syllabus or module or course or program (All Fields) and Strategy or guideline or guidelines or framework or action or approach or blueprint or design or tactics or method or planning or model (All Fields) and Higher education or college or university or post-secondary or postsecondary or undergraduate or graduate or tertiary (All Fields) and Health Science or Health Sciences or health or education (Abstract) | 168 results | Timespan: 2015-01-01 to 2022-07-07 (P

DATABASE 4: Pubmed (Results 48 results)

((((((Decolonise[Title] OR decolonize[Title] OR Decolonisation[Title] OR decolonization[Title] OR Decolonising[Title] OR Decolonizing[Title] OR Africanisation[Title] OR Africanization[Title] OR decolonial[Title] OR democratization[Title] OR democratisation[Title]) AND (Transform or Transformation or renew or renewal or renewing or change or revision or intervention or mediate or deconstructing or revolution or transition or diversity or development or adjustment or reversal or modification or diversification or remodelling or reconstructing or reconstruction or change)) AND (Curriculum or curricula or pedagogy or pedagogic or pedagogical or pedagogies or educational program or syllabus or module or course or program)) AND (Strategy or guideline or guidelines or framework or action or approach or blueprint or design or tactics or method or planning or model)) AND (Higher education or college or university or post-secondary or postsecondary or undergraduate or graduate or tertiary)) AND (Health Science[Title/Abstract] OR Health Sciences[Title/Abstract] OR health[Title/Abstract] OR education[Title/Abstract])) AND (("2015"[Date - Publication] : "3000"[Date -Publication]))

DATABASE 5: Ebsco host

Searching: APA PsycArticles, APA PsycInfo, Applied Science & Technology Source, CINAHL with Full Text, eBook Collection (EBSCOhost), E-Journals, Health Source - Consumer Edition, Health Source: Nursing/Academic Edition, MEDLINE, Newspaper Source, Teacher Reference Center Results 122, Ebsco host removes duplicates before downloading: Results 96 https://nwulib.nwu.ac.za/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=pdh&db=psyh&db=aci&db=c8h&db=nlebk&db=eoah&db=eric&db=hxh&db=hch&db=cmedm&db=nfh&db=trh&bquery=TI+(+Decolonise+or+decolonize+or+Decolonisation+or+decolonization+or+Decolonising+or+Decolonizing+or+Africanisation+or+Africanization+or+decolonial+or+democratization+or+democratisation+)+AND+(+Transform+or+Transformation+or+renew+or+renewal+or+renewing+or+change+or+revision+or+intervention+or+mediate+or+deconstructing+or+revolution+or+transition+or+diversity+or+development+or+adjustment+or+reversal+or+modification+or+diversification+or+remodelling+or+reconstructing+or+reconstruction+or+change+)+AND+(+Curriculum+or+curricula+or+pedagogy+or+pedagogic+or+pedagogical+or+pedagogies+or+educational+program+or+syllabus+or+module+or+course+or+program+)+AND+(+Strategy+or+guideline+or+guidelines+or+framework+or+action+or+approach+or+blueprint+or+design+or+tactics+or+method+or+planning+or+model+)+AND+(+Higher+education+or+college+or+university+or+post-secondary+or+postsecondary+or+undergraduate+or+graduate+or+tertiary+)+AND+AB+(+Health+Science+or+Health+Sciences+or+health+or+education+)&cli0=DT1&clv0=201501-000001&type=1&searchMode=Standard

DATABASE 6 : ProQuest (Results 83)

ti(Decolonise OR decolonize OR Decolonisation OR decolonization OR Decolonising OR Decolonizing OR Africanisation OR Africanization OR decolonial OR democratization OR democratisation) AND (Transform OR Transformation OR renew OR renewal OR renewing OR change OR revision OR intervention OR mediate OR deconstructing OR revolution OR transition OR diversity OR development OR adjustment OR reversal OR modification OR diversification OR remodelling OR reconstructing OR reconstruction OR change) AND (Curriculum OR curricula OR pedagogy OR pedagogic OR pedagogical OR pedagogies OR educational program OR syllabus OR module OR course OR program) AND (Strategy OR guideline OR guidelines OR framework OR action OR approach OR blueprint OR design OR tactics OR method OR planning OR model) AND (Higher education OR college OR university OR post-secondary OR postsecondary OR undergraduate OR graduate OR tertiary) AND ab(Health Science OR Health Sciences OR health OR education)

 

Appendix C - Click to enlarge

 

 

Appendix D - Click to enlarge