The Decolonizing Global Health Working Group (2021) at the University of Washington’s International Clinical Research Center has developed a Decolonizing Global Health Toolkit that begins with this definition of Decolonizing Global Health: reversing the legacy of colonialism in health equity work. The Working Group further proposes four primary aims for decolonizing global health practices meant to guide global health practitioners in a variety of fields, including global health education and promotion. As such, they have relevance for this paper and include: (1) achieve equitable collaborations, (2) center projects around local priorities, (3) diversify leadership, and (4) promote respectful, collaborative interactions and language/tone in all communications (Decolonizing Global Health Working Group, 2021).

While pursuing these aims, it is helpful to consider barriers to decolonization that must be managed. For example, Kulesa and Brantuo (2021) identify several barriers to decolonizing global health educational partnerships including: the challenges of bringing all relevant stakeholders to the table; managing anxieties among indigenous or vulnerable peoples related to a growing sense of inequity and loss of belonging; and balancing a variety of ethical dilemmas in global health work (Kulesa and Brantuo, 2021). Resolution of these barriers requires targeted strategies, deep community immersion, and in-depth, open discussions with local partners about appropriate moral frameworks that can guide understandings and mutually acceptable resolutions to moral dilemmas.

As with all public health endeavors, taking a systems thinking approach that fully engages relevant stakeholders is an important process for designing programs and interventions that can minimize the risk of unintended consequences (De Savigny and Adam, 2009). For example, Hellowell and Schwerdtle (2022) have cautioned against three specific harms that should be avoided as the decolonization agenda moves forward, including the potential for: undermining confidence in scientific knowledge; accentuating inter-group and international antagonisms; and curtailing the opportunities for redistributive change in the future (Hellowell and Schwerdtle, 2022). Some authors even argue that if the most radical changes promoted by decolonization are realized, global health as we know and understand it may cease to exist, leaving us with the need to come up with a new name for the discipline (Abimbola and Pai, 2020).

Philosophically, this paper is in alignment with the Freirean school of thought that education can be an empowering force for positive change, especially for the oppressed and most vulnerable. As it applies to the decolonization of global health, education can be instrumental in allowing individuals and communities to move beyond colonial legacies while gaining local control over the social determinants of health (Giroux, 2010; Freire, 2018). Adopting best practices for study abroad programs is an essential part of this process.

This paper, including our findings outlined below, are presented with the intent of avoiding the negative consequences outlined by Hellowell and Schwerdtle (2022), while at the same time identifying best practices for short-term experiential learning in global settings that are theory and evidence-based, and that align most closely with the highest aims of the decolonization movement (Eichbaum et al., 2021).

A federated search was conducted using EBSCOhost on select databases (i.e., Academic Search Ultimate, Medline, CINAHL, and ERIC). Using key search terms: ‘global health’ and ‘decolon* and (‘pedagog* or study abroad or learn* or educat* or experien*’) [where the asterisk catches variations of suffixes], 190 articles were identified. Our initial search shows that a majority of results came from Medline (n = 84) followed by Academic Search Ultimate (n = 80), CINAHL Complete (n = 20), and ERIC (n = 6). Once duplicates were removed, the remaining 131 articles were screened by all three authors for relevance to the goals of this article.

Using inclusion criteria: articles dealing with theory, models, frameworks, assessments, and best practices for conducing short-term experiential education abroad within the context of decolonizing global health, 25 articles underwent full text assessment. At the same time, 106 articles were excluded for lack of relevancy. Exclusion criteria included: subject was insufficiently relevant to global health promotion and experiential learning, research was insufficiently related to the inclusion goals outlined above, and articles were off-topic (e.g., decolonizing bacterial infections) (see Figure 1).

After careful full text review and collective analysis, a total of 13 articles were identified as relevant to curricular innovations, theories, and designs involving experiential education and learning in global settings that are consistent with the aims of decolonizing global health. The subsequent manuscript review revealed several common themes that inform planning, execution, and evaluation of global experiential education programs.

Transformative Learning Theory (TLT) is a common thread in all articles that proposed student focused interventions. Some authors directly referred to TLT (Wood and Jobe, 2020; Hawks, 2021), while other frameworks included very similar elements (Myers and Fredrick, 2017; Ratner et al., 2022), particularly disorienting dilemmas, critical reflection, and integration and action based on new perspectives. These steps each help students progress along the path from being unaware of colonial legacies to becoming agents of decolonization. Of note, these same concepts are deeply interwoven in the praxis of Freire and provide an underlying moral foundation for this theoretical and philosophical approach to education (Darder, 2017).

Ratner et al. (2022) recognizes that true decolonial education must start with an initial realization and a grappling with real life struggles caused by colonial power. Myers and Fredrick (2017), Wood and Jobe (2020), and Hawks (2021) each posit that short-term educational experiences in a global setting can be effective settings for creating these disrupting dilemmas. “Numerous authors have conveyed the unsettling experiences felt by participants encountering international settings especially for the first times” (Wood and Jobe, 2020). Hawks (2021) comments on the effectiveness of deep engagement with diverse communities, and Myers and Fredrick (2017) attribute transformative benefits of “desirable difficulties” in learning retention.

According to Hawks (2021), reflection becomes a catalyst for converting experiences into new, and hopefully transformative perspectives. It can also promote critical examination of course concepts (Hawks, 2021). Taking time to reflect allows learners to identify and confront their own biases (Ratner et al., 2022). Additionally, reflection is helpful in assessing an individual’s progress toward transformation (Wood and Jobe, 2020).

Transformative learning culminates as new perspectives inform action moving forward. This would translate into observable behavior that could only be completed after engaging in the project (Wood and Jobe, 2020). A learner who has reached this stage is actively seeking to dismantle colonial practices, ideally at a systemic level (Ratner et al., 2022).

Wood and Jobe (2020) and Ratner et al. (2022) each propose tools for assessing students’ progress as they engage with transformational learning activities. Ratner’s tool moves learners through stages including Pre-contemplative Learner, Contemplative Reflective Learner, Critical Action Learner, and Transformative Action Learner. The first stage is a baseline, while the final stage is aspirational. Ratner notes that regardless of stage, one is never finished with transformation and an ‘end-point’ would be antithetical and possibly harmful to learners’ decolonial journey” (Ratner et al., 2022).

Wood and Jobe (2020) propose an assessment tool that takes three different competencies—Global and Cultural Competency, Leadership, and Service Learning and Civic Engagement—through three stages—Exposure, Integration, and Transformation. Exposure indicates an openness to improving one’s views, integration is using experience to advance a cause, and transformation involves using one’s leadership skills to empower others to embark on the same process. Wood and Jobe (2020) point out that short term study abroad experiences may not be sufficient to move students through all three stages, however they can be an important element in this journey.

Myers and Fredrick (2017) describe a program that seeks to address the shortcomings short-term study abroad programs may have compared to longer courses of study in a global setting by engaging students in a four-year, longitudinal global medical program. This course follows the transformative learning pattern by creating a disturbing dilemma during a first-year, short-term study abroad experience, guiding reflection during years two and three, and culminating in a second trip to the same community during the fourth year that integrates learning into clinical experience.

As program planners design study abroad experiences with an aim toward decolonization, the best practices in the literature fall into themes of (1) challenging knowledge hierarchies, (2) self-awareness and cultural humility, and (3) understanding of the larger systemic, historical, and sociopolitical global health landscape (Pentecost et al., 2018; Kulesa and Brantuo, 2021; Skopec et al., 2021). Wong points out the need to move from biomedical hegemony to epistemic plurality (Wong et al., 2021). Decolonization demands that curricular design question the “structured, standardized, compartmentalized” approach to medical and health education, as well as the assumption that this approach is superior in efficiency and measurability (Naidu, 2021). Additionally, to both meet the aims of decolonization and further the progress of innovation, an appreciation of traditional and indigenous practice and ways of knowing is necessary (Naidu, 2021).

As Ratner points out, even the most advanced and experienced practitioners and educators may be novices when it comes to decoloniality (2022), highlighting the need for critical reflection, self-awareness, and cultural humility (Wong et al., 2021). This includes awareness of the knowledge and value systems in which one is formed and embedded (Pentecost et al., 2018). Authors emphasize the distinction between cultural competence and their chosen phrases such as critical reflection (Wong et al., 2021), critical consciousness (Keikelame and Swartz, 2019), and critical awareness (Naidu, 2021). Because culture changes one cannot be simply competent, but also must possess the humility to be adaptable to changing times and contexts as one continues to learn (Keikelame and Swartz, 2019). Behari-Leak et al. (2021) encourage changing the teacher-student power structure as a tool of decolonization through vulnerability, making the teacher and students co-learners, and drawing on the principles of Transformative Learning Theory, give both parties disrupting dilemmas to spur transformation.

Finally, multiple authors argue that an understanding of the history and legacy of colonialism in global health and medicine is essential to global health education. Additionally, current social and political factors must be acknowledged, taught alongside and integrated into the global health curriculum (Eichbaum, 2017; Pentecost et al., 2018; Behari-Leak et al., 2021; Naidu, 2021; Wong et al., 2021). Pentecost et al. (2018) encourage the integration of the humanities, arts, and social sciences, to promote understanding of history, center inclusion, and seek social justice.

Study abroad experiences inherently involve partnerships with host nations, communities, and organizations. The colonial model inherently produced hierarchical relationships between unequal partners. Themes in the literature regarding partnerships promoting decolonization include: (1) mutual partnerships with bidirectional learning and empowerment of host country, (2) sustainable programs and capacity building, and (3) accountability and safety.

In the interest of mutual partnerships, global health programs can build trust with partners by prioritizing community engagement, and emphasize respect, reciprocity, collaboration, and cooperation (Keikelame and Swartz, 2019). Trust is maintained by listening to the community members including traditional practitioners, leaders, lay people, and those on the receiving end of services (Lawrence and Hirsch, 2020; Prasad et al., 2022). Bidirectional learning can include giving partners opportunities to share their knowledge and perspectives (Prasad et al., 2022), as well as equalizing access to opportunities, educational experiences, and credit (Keikelame and Swartz, 2019; Eichbaum et al., 2021). Host communities can be empowered as they are allowed to define their own needs and the activities that take place among their people (Prasad et al., 2022). Recognition of community assets and indigenous strengths also leads to relationships that Keikelame and Swartz (2019) define as “power with” instead of “power over.”

A concern with short-term study abroad experiences is that they lack the structure to be sustainable in the long run. Myers and Fredrick (2017) note that this is one of the challenges that is addressed by creating a longitudinal study abroad program, however they acknowledge logistical barriers to maintaining these programs. Kulesa and Brantuo (2021) advises integrating into the community, and asks international partners to consider, “If you cannot integrate, is your presence needed?” Lawrence and Hirsch (2020) encourages utilizing local institutions and expertise as well as existing infrastructure for research to avoid the trap of the “fly-in, fly-out, parachute and publish” researcher.

Lastly, authors emphasized the need for study abroad programs to be accountable for actions and protect the safety of their host communities (Eichbaum et al., 2021; Prasad et al., 2022). Research and program interventions should follow ethical principles, use understandable language, and collaborate with community leaders and practitioners (Keikelame and Swartz, 2019). Protecting the vulnerable is an important element of building trust (Keikelame and Swartz, 2019), and partners should pay attention to the experiences that have led to fear-based rumors such as those about “blood-stealing” (Lawrence and Hirsch, 2020). Participants and facilitators should recognize potential power imbalances and the dangers such imbalances may pose to partners in a position of lesser power (Kulesa and Brantuo, 2021). Additionally, participants should recognize power imbalances within culture, with an awareness that culture does not excuse or justify harm (Kulesa and Brantuo, 2021).