BACKGROUND:Socially marginalised people in South Africa are at risk of being deemed unworthy of care in the Primary Health Care facility. Traditional in-service learning strategies to address unequal treatment have failed to shift negative perceptions that result in determinations of (un)worthiness. Despite evidence that learning often occurs tacitly through informal conversations, formal in-service training persists. AIM:This study sought to address a gap in the literature regarding learning strategies to minimise the practice of triaging socially marginalised patients based on perceived worthiness. METHODS:In this critical participatory action research study, a purposeful sample of nurses and cross-border migrants - a socially marginalised population in South Africa - engaged in participant-led dialogue and critical reflection for one year. DISCUSSION:Critical reflection on problematic assumptions and beliefs holds promise as a strategy to deter worthiness determinations that perpetuate inequality. This critical dialogical process provides a template for a learning strategy that may prove more effective than the traditional in-service training approach.
Health inequalities education is increasingly recognised as essential in healthcare training, particularly for generalist and primary care practice, yet undergraduate provision is inconsistent, shallow and often tokenistic. Students report limited opportunities to apply learning meaningfully in clinical settings. This study explores healthcare students' experiences and preferences for pedagogy to inform curriculum development relevant to primary care. An online survey, informed by literature and student collaborators, collected data from 50 students across more than 10 healthcare programmes. Descriptive frequency analysis guided questions for a student-led virtual focus group (n = 5). Focus group data underwent reflective thematic analysis to identify pedagogical preferences transferable to primary care education. Most respondents (78%) agreed health inequalities education is relevant to future practice, and 86% wanted more teaching. Only 34% reported consistent coverage, and 56% felt teaching applied to clinical practice. Students strongly preferred hearing from patients and service users (92%) and favoured interactive formats over lectures. Thematic analysis revealed four insights: teaching often lacks authenticity; case scenarios risk reinforcing stereotypes; reflective practice and patient narratives enhance understanding; and educator preparedness and positionality influence learning. Students highlighted the need for practical skill development, authentic stories and safe, critically reflective learning spaces. Students want education to move beyond theoretical awareness towards application, reflection and authentic engagement. Optimal pedagogy should prioritise co-produced patient narratives, interactive learning, realistic scenarios, educator preparation and aligned assessment. Curriculum reform must focus on better design rather than more content, equipping students to address inequities in primary care.
