Critical reflection through dialogue: an alternative to in-service training to shift perceptions of patient worthiness in South Africa.

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.