Making context curricular in global health education: a ten-cohort content analysis of learner-defined health priorities and responses

Background Global health curricula may underuse the contextual expertise international students bring from their home countries. We examined health priorities and feasible responses selected after shared foundational teaching and cross-country comparison, and considered how learner-generated contextual knowledge can function as curricular content. Methods We retrospectively analysed 302 reflective reports from ten annual cohorts (2013–2022) in a compulsory first-year International Health course in Taiwan. Before the reflective task, students received foundational teaching in population health, disease burden, social determinants and equity, health systems and financing, major disease domains, environmental health, and evidence-informed priority setting, followed by country presentations and peer comparison. Each report identified one home-country priority and feasible response. Two coders independent of course delivery coded all reports using an iteratively developed codebook. Pre-consensus Cohen's kappa was 0.86 for specific topics, 0.91 for priority categories and 0.85 for intervention orientations. Consensus codes were summarised; regional comparisons used chi-square tests and Cramer's V with restricted-cohort sensitivity analyses. Results Students often selected diabetes, cancer, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), ischaemic heart disease and health-workforce shortage. Leading categories were metabolic/endocrine (n = 76, 25.2%), infectious (n = 68, 22.5%), cardiovascular (n = 36, 11.9%), malignancy (n = 35, 11.6%) and mental health (n = 17, 5.6%). Proposed responses emphasised public education/awareness (n = 136, 45.0%), medical/service measures (n = 62, 20.5%), policy/legislation (n = 60, 19.9%) and resources/financing (n = 44, 14.6%). Regional patterns differed for priorities (chi-square(10) = 56.87, p < 0.001; V = 0.31) and responses (chi-square(6) = 38.81, p < 0.001; V = 0.25); sensitivity analyses were similar. De-identified excerpts illustrated how learners used context, evidence and feasibility when translating problems into proposed actions. Conclusions A shared foundation in population health and health systems, followed by structured cross-country comparison, can create space for learners' home-country knowledge to become curricular content. The findings support a provisional heuristic of elicitation, juxtaposition and translation for context-sensitive global health education. They represent curricular attention and perceived feasibility, not objective disease burden or causal learning effects.