Co-creating palliative care education across contexts: faculty experiences from a Ghana-Canada partnership for primary health care strengthening.

Introduction: Palliative care education developed in high-income settings often requires significant contextual adaptation to address the needs of diverse clinical and cultural environments. Globally, strengthening palliative care is increasingly recognized as critical to achieving the health-related sustainable development goals (SDGs), Universal Health Coverage (UHC), and strong primary health care (PHC)-oriented systems. Despite this, access to palliative care remains limited globally, particularly in low-and middle-income countries. Co-creation provides a collaborative approach to developing relevant and equitable curricula that can support the integration of palliative care into primary care and advance progress toward UHC and the SDGs; however, little is known about how this process unfolds in transnational partnerships, particularly in West Africa. This study aims to describe how Ghanaian and Canadian faculty experienced the co-creation and delivery of a palliative care training programme. Materials and methods: We conducted a qualitative study using semi structured interviews with faculty from Kwame Nkrumah University of Science and Technology (KNUST; Ghana) and the University of Toronto (UofT; Canada) who co-developed and facilitated a palliative care course between 2023 and 2025 under the Africa Health Collaborative (AHC). Purposive sampling included all eligible faculty participants. Interviews were conducted in person, audio-recorded, transcribed, de-identified, and analyzed using inductive thematic analysis. Sampling continued until conceptual depth was reached. Results: Ten faculty described five interconnected themes to characterize their co-creation experience. Navigating culture and context required ongoing adaptation of teaching approaches and clinical content to ensure relevance. The co-creation process evolved from initial uncertainty and vulnerability toward trust, cohesion, and shared ownership. Communication was central, serving both as a pedagogical focus and as a foundation for collaboration. Participants described professional and personal growth, including expanded perspectives and enhanced teaching practices. Co-creation was also viewed as a promising model for future curriculum development, although barriers such as limited preparation time, technological challenges, and initial apprehension were identified. Conclusion: Within this Ghana-Canada partnership, co-creation functioned as a relational and adaptive process that supported contextually grounded curriculum development and collaborative learning. These findings provide insight into the experiential and relational dimensions of co-creation in global health education and may inform similar partnerships, while highlighting the importance of contextual adaptation in resource-diverse settings.