Answering the call for decolonizing global health education: a qualitative approach to educational needs assessment in a Ghanaian NICU

With the overarching goal to promote sustained improvement in newborn health in Ghana through educational research collaboratives, we conducted a targeted educational needs assessment to understand the clinical learning environment (CLE), learners, and continuing learning needs of practicing healthcare professionals (HCPs) caring for neonates in a quaternary neonatal intensive care unit (NICU) in Ghana. To understand the learning climate, participants, and educational needs of HCPs at the University of Ghana Medical Center (UGMC) NICU, a mixed methods qualitative study was conducted. Data regarding the CLE and learners were gathered through semi-structured interviews with multiple HCPs and stakeholders at the UGMC NICU and participant observations totaling over approximately 100 h. Data were analyzed using iterative, constructivist grounded theory approach. The true learning needs were apparent only after rich exploration of the CLE and the learners themselves. Four nested ‘levels’ of influence shaped the CLE (the national healthcare system, the hospital, the NICU, and the unit’s own educational environment), and each level was affected by variables in two broad frames (sociocultural or structural) that facilitated or hindered learning. The primary learners in the UGMC NICU included both medical officers and nurses. Defining the CLE and the learners resulted in twenty actionable design principles (related to educational context, content, and strategies) to inform the next stage of curricular development. A targeted needs assessment revealed nuanced information regarding the learning environment, the learners, and their educational needs in one quaternary Ghanaian NICU. This needs assessment will inform future curricula in this setting; such an approach may also serve as a model for future global health educational efforts aiming to build equitable and bidirectional partnerships between low- and middle-income countries (LMICs) and high-income countries (HICs).