Cultural considerations in health care capacity building: A qualitative study in Lesotho

ABSTRACT

International non-governmental organisations (NGOs) and academic institutions support health care capacity building to strengthen health systems in low and middle-income countries. We conducted a phenomenological study of foreign and Basotho clinicians who participated in clinical continuing professional development (CPD) in Lesotho. Clinicians included physicians, nurses, and a nutritionist. We sought to understand, through the lens of social cognitive theory, how cultural differences between foreign and Basotho clinicians affected bidirectional clinical education led by NGOs and academic institutions. We also assessed how Basotho clinical educators considered culture when leading NGO-sponsored clinical CPD for Basotho clinicians. After analysing 17 interviews with 24 total participants (four foreign educators, 11 Basotho educators, and nine Basotho learners), using an iterative and inductive approach, we identified 17 themes within the cognitive, environmental, and behavioural domains. Key findings highlighted: (1) cultural tensions between foreign and Basotho culture, including bias against traditional culture; (2) power structures which affected the efficacy of in-service training strategies; (3) perceptions among foreign educators that technical assistance was more effective than direct service delivery at promoting education and sustainability. Educators should map out key relationships and engage local and foreign stakeholders in culturally-focused targeted needs assessments to improve curricular design in capacity building.

KEYWORDS:

• Health care
• capacity building
• Lesotho
• global health
• social cognitive theory

Acknowledgements

The authors would like to thank Dr Terry Kind and Dr Jeremy Kern for their review of the manuscript. Dr Kulesa conceptualised and designed the study, designed the data collection instrument, collected data, carried out the initial analyses, and drafted the manuscript. Dr Chua designed the study, guided data analyses, and supervised drafting of the manuscript. Dr Crawford designed the study, designed the data collection instrument, collected data, and carried out the initial analyses. Dr Thahane designed the study, designed the data collection instrument, and reviewed and revised the manuscript. Dr Sanders coordinated and supervised data collection and reviewed and revised the manuscript. Dr Ottolini reviewed and revised the data collection instrument and critically reviewed the manuscript for important intellectual content. Dr Ferrer designed the study, designed the data collection instrument, coordinated data collection, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

No funding was secured for this study