Cultural safety and anti-racism training in Master of Public Health curricula in "British Columbia": Determinants of uptake and implementation

Racism and colonialism, among other intersecting forms of oppression, operate as social determinants of health and contribute to inequities among Indigenous, racialized, and equity-deserving groups. To counteract these injustices, over the last three decades, there have been a series of nation-wide and world-wide calls to action that put forward clear recommendations for cultural safety and anti-racism praxis (and related concepts) across all sectors, but in particular within healthcare. Across all sectors and disciplines, higher education plays a crucial role in establishing teaching and learning standards, recruiting a representative workforce, and shaping professional culture. Embedding cultural safety and anti-racism training into the learning pathways of the future public health workforce will help advance health equity for the entire population. This research examines the barriers and facilitators shaping the uptake and implementation of these training interventions in Master of Public Health (MPH) programs. As a qualitative research study, a case study design was applied to MPH programs across three universities within a common provincial context. Conceptual frameworks offered by implementation science were coupled with a theoretical lens grounded in anti-colonialism and intersectionality. Data was collected through key informant interviews and focus groups among departmental leadership, faculty, staff, and students; and triangulated with document analysis of academic/ strategic plans, syllabi, and public communications. Framework analysis categorized determinants of uptake and implementation across five core domains: intervention characteristics; characteristics of individuals involved; inner setting; outer setting; and process. Results highlight similarities and variations in cultural safety and anti-racism training across MPH programs, as well as how their respective approaches have evolved and continue to evolve within unique contexts. Recommendations offer a starting point for discussions around revising core competencies for cultural safety and anti-racism practice, as well as promoting standardized interventions and best practices that can be spread, scaled, and adapted to other settings. The significance and impact of this research lies in the potential to inform pedagogy, practice standards, and organizational policies within higher education, health systems, as well as professional accreditation, certification, or regulatory bodies.