A review of critical pedagogies in health and social care: findings from a 'best fit' framework synthesis

Although recent research has highlighted the importance of understanding the structural social processes through which stigma is produced and maintained, educational approaches to stigma-reduction have not yet engaged with this concept. Recognising that critical pedagogies have been used in other contexts to help learners better understand and challenge structural social processes of marginalisation, we conducted a review of educational interventions that were informed by critical pedagogies and delivered within settings of health and social care. A systematic search was performed on academic and grey literature databases between January 1970 and 17 May 2017 to identify all literature reporting on the learning outcomes of educational interventions informed by frameworks of critical consciousness development. Articles were selected following a two-stage screening process and an assessment of methodological quality. Of the 9,674 articles identified from the systematic search, 33 were found to satisfy the inclusion criteria and were of sufficient quality to be considered within this review. Two major findings emerged from the analysis of interventional studies. Firstly, it was found that learners consistently articulated a sociostructural understanding of oppressive social relations and their position within it, based upon an understanding of their own group identity. Secondly, and despite the sociostructural content of reflection, individual actions tended to focus on the modification of interpersonal interactions. Although educational interventions informed by a critical pedagogy appear to support a structural analysis of social marginalisation or disadvantage, there is limited evidence to suggest how these structural processes might be challenged following this analysis.