Reflective Insights into Undergraduate Public Health Education: Comparing Student and Stakeholder Perceptions

Abstract

Reflective practice is vital for bridging theory and professional application in undergraduate public health education, yet its use in non-Western contexts is underexamined. This mixed-methods study evaluated the Minor in Public Health at the Saw Swee Hock School of Public Health, National University of Singapore, using a convergent parallel design. Using a longitudinal student survey (baseline upon entry: n = 289; graduation upon completion: n = 78) and cross-sectional stakeholder survey (n = 17), quantitative analysis included chi-square tests for competency changes and Wilcoxon rank-sum tests for group comparisons. Thematic analysis of open-ended responses highlighted strengths in systems thinking, analytical skills, and interdisciplinary integration, but also gaps in practical experience, specialised knowledge, and professional communication. Students reported significant improvements in 10 of 13 competencies from baseline to graduation and rated their attainment higher than stakeholders across all competencies. Those who achieved all competencies also gave significantly more positive ratings of the programme in the domains of teaching and learning, and in engagement, assessment, and feedback. These findings underscore the role of reflective practice in aligning education with workforce needs and offer a scalable approach for curriculum development. The study provides actionable insights for educators to design responsive and reflective curricula that support the preparation of competent public health professionals in diverse global contexts.

1. Introduction

The field of public health has expanded significantly in recent decades, driven by global challenges such as pandemics, climate change, and socioeconomic disparities (Armstrong-Mensah et al., 2022). This growth has prompted increased investment in educational programmes to equip students with the competencies needed to address complex public health issues. Whilst postgraduate public health education has been extensively studied, undergraduate programmes, particularly in the Asia-Pacific region, remain underexamined (Lim et al., 2020; Resnick et al., 2018). This gap is noteworthy, as undergraduate education plays a critical role in developing foundational competencies and shaping early career trajectories in public health (Evashwick et al., 2014).

Recent global analyses highlight the need for practical, competency-based undergraduate curricula that integrate interdisciplinary skills, such as systems thinking and cultural safety, to prepare graduates for evolving challenges like climate–health integration and health equity in diverse regions (Coombe et al., 2020; MacKay et al., 2023). In the Asia-Pacific context, where public health threats including infectious and non-communicable diseases are pronounced, updated frameworks emphasise adaptive curriculum design. Examples from Singapore and China demonstrate integrative approaches to needs assessment and the inclusion of general education electives for non-medical undergraduates (Lim et al., 2020; Li et al., 2025). Similarly, recent World Health Organisation (2023) frameworks on essential public health functions and scoping reviews on competency development (MacKay et al., 2023) stress the importance of adaptable curricula, with Asia-Pacific examples including climate–health integration initiatives (Cecilia et al., 2024).

Existing literature on undergraduate public health education has primarily focused on curriculum design, pedagogical strategies, and student outcomes (Crowell & Calamidas, 2016; Nelson-Hurwitz & Buchthal, 2019). Scoping reviews synthesise best practices in developing competency frameworks, emphasising iterative stakeholder involvement and alignment with workforce needs (MacKay et al., 2023). Post-Coronavirus Disease 2019 (COVID-19) reflections further underscore the urgency of strengthening competency-based education to build capacity for essential public health functions, such as digital health literacy and interprofessional collaboration, particularly in resource-constrained Asia-Pacific settings (Ghaffar et al., 2021; Hunter et al., 2023). Studies from Thailand illustrate the difficulties related to curriculum development, highlighting the need for interdisciplinary learning, tailored subjects such as epidemiology and health promotion, and better alignment with regional demands (Leethongdissakul et al., 2024). Other studies in the region assessing the integration of public health into medical curricula have revealed persistent gaps in core competencies, reinforcing calls for enhanced curriculum design (Hunter et al., 2023).

High-impact educational practices, such as e-portfolios and deliberative pedagogy, have also been shown to foster critical thinking and workforce readiness (Armstrong-Mensah et al., 2022; Lim et al., 2024). However, relatively few studies have evaluated the extent to which curricula align with established competency frameworks, such as those developed by the Council on Education for Public Health (CEPH), a globally recognised accrediting body. The CEPH framework outlines essential domains, including epidemiology, biostatistics, and health policy, alongside cross-cutting competencies, such as communication, cultural competence, leadership, and systems thinking—skills indispensable for effective practice (Council on Education for Public Health, 2021). Recent reviews highlight the importance of integrated practical training in undergraduate programmes to ensure graduates are prepared for global workforce needs (Kedia et al., 2024).

Reflective practice is increasingly acknowledged as a valuable pedagogical tool to support competency development, yet its integration into undergraduate curricula remains limited (Kiviniemi & Przybyla, 2019; Mann et al., 2009). It can help students bridge the gap between theoretical knowledge and practical application, thereby supporting their readiness for real-world public health challenges. Engaging both students and employers in the evaluation process offers an opportunity to identify areas of alignment and divergence in perceived competency attainment. These insights are vital for informing curriculum development and ensuring that undergraduate public health education remains relevant, evidence-based, and responsive to the needs of the profession (Evashwick et al., 2014; Resnick et al., 2017).

Despite these developments, three critical gaps persist in the evaluation of undergraduate public health education. First, employer perspectives are rarely incorporated into assessments of whether graduates possess the expected competencies upon entering the workforce (Brînzac et al., 2025; Kedia et al., 2024). Few studies have systematically compared student self-assessments with employer evaluations of competency attainment, limiting insight into how well academic programmes are preparing students for real-world demands. Graduates may perceive themselves as well-prepared, while employers may identify gaps in areas such as the practical application of knowledge (Brînzac et al., 2025; Kedia et al., 2024).

Second, student perceptions of their own competency attainment at the point of graduation remain underexplored. Although some research has examined general satisfaction or perceived preparedness, there is a lack of focused evaluation on how students assess their attainment of specific, workforce-relevant competencies (Brondani et al., 2014). Without such evidence, it is difficult to determine whether educational programmes are effectively supporting students’ transition into professional roles.

Third, the broader issue of how students perceive the overall effectiveness of undergraduate public health programmes—especially in preparing them for future roles—has received limited attention in structured, competency-based evaluations (Li et al., 2025). Understanding how students reflect on their learning experiences and the impact of the curriculum on their development offers critical insights into whether educational objectives are being met. Capturing student voices is essential for identifying misalignments between intended outcomes and actual experiences, and for supporting ongoing curriculum improvement that remains responsive to learner needs (Lim et al., 2024).

Fourth, while competency attainment and programme perceptions are often studied separately, few investigations explore their interplay, such as whether full mastery of competencies leads to more positive views of programme effectiveness. This linkage is theoretically grounded in Bandura’s (2001) social cognitive theory, which suggests that individuals’ confidence in their abilities (e.g., competency mastery) positively influences their evaluations of the supportive environments (e.g., educational programmes) that enable such success (Honicke et al., 2023; Schunk & DiBenedetto, 2020). Empirical support comes from studies in health professions education, where higher self-assessed competency attainment correlates with more favourable perceptions of programme effectiveness, as it reflects perceived alignment between curricular goals and personal achievement (Lewis et al., 2014; Saud & Chen, 2018; Zheng et al., 2024). Addressing this is significant, as it elucidates how competency outcomes shape holistic programme evaluations in underexplored undergraduate public health contexts, contributing novel insights to literature on curriculum responsiveness and student satisfaction in the Asia-Pacific region.

To address these gaps in the literature, this study evaluates the Minor in Public Health programme at the Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore (NUS), Singapore’s only national school of public health, established in 2011. At NUS, students pursue a first major—their primary field of study, selected upon admission or shortly thereafter—which forms the core of their academic training. The SSHSPH has offered the Minor in Public Health programme since 2013, complementing a first major in other disciplines, as public health is not available as a standalone first major. Students enrolled in the Minor programme must complete a combination of core and elective courses covering various topics to foster development in 13 competencies adapted from the CEPH framework (Lim et al., 2020).

Using a mixed-methods approach, this study investigates students’ perceptions of the programme’s effectiveness and their self-assessed competency attainment upon graduation, compared with perspectives from public health industry stakeholders to inform curriculum improvements. The research questions (RQs) are as follows: RQ1 (quantitative): How do students’ self-assessed competencies change from baseline to graduation? RQ2 (quantitative): How do graduating students who attained all competencies differ in their perceptions of programme effectiveness compared to those who did not? RQ3 (quantitative): How do graduating students’ and stakeholders’ perceptions of competency attainment compare? RQ4 (qualitative): What are the perceived strengths and gaps in the programme according to graduating students and stakeholders?

For the quantitative phase, the working hypotheses are as follows: For RQ1, students will demonstrate significant improvements in self-assessed competency attainment from baseline to graduation across most competencies. For RQ2, graduating students who attained all competencies will have more positive perceptions of programme effectiveness compared to those who did not. For RQ3, there will be a significant difference in competency ratings between graduating students and stakeholders, with stakeholders expected to give lower ratings than graduating students.

2. Materials and Methods

2.1. Study Design, Setting, and Ethics Approval

We employed a mixed-methods approach with a convergent parallel design to evaluate the Minor in Public Health programme. The convergent parallel design involved simultaneous collection and analysis of quantitative and qualitative data, with results integrated to provide a comprehensive understanding of programme effectiveness and competency acquisition. The entire study was conducted at SSHSPH, NUS, and approved by the NUS SSHSPH Departmental Ethics Review Committee (approval reference code SSHSPH-045). Informed consent was obtained from all participants.

2.2. Quantitative Phase

The quantitative phase involved a longitudinal survey of students enrolled in the Minor programme and a cross-sectional survey of public health industry stakeholders.

Student surveys were administered at two time points: baseline (upon entry to the programme, 2021–2023) and graduation (upon completion, 2022–2023). For the baseline survey, participants were recruited via an open online invitation, including a mass email sent to all undergraduates enrolled in the Minor in Public Health programme at SSHSPH, NUS. Eligible students were those enrolled in the programme during the study period. For the graduation survey, an email invitation was sent to students who had fulfilled all programme requirements. Eligible participants were graduating students of the programme during the study period.

The stakeholder survey, conducted from 2022 to 2023, targeted prospective employers to assess perceptions of graduating students’ competencies. Stakeholders were recruited through an open online invitation, including a mass email sent to adjunct faculty members teaching in the Minor in Public Health programme and to internship supervisors for the Public Health Practice course at SSHSPH. Eligible stakeholders were either adjunct faculty involved in teaching these programmes or supervisors of the internship course who were also employers of the graduating students.

For both groups, the email included a participant information sheet. Eligible participants confirmed they had read and understood the study’s purpose and provided consent before completing the questionnaire.

2.3. Quantitative Part of the Survey Questionnaire

The questionnaire was designed to be anonymous and was administered online. The baseline student survey comprised two sections: demographic characteristics and a self-assessment of 13 public health competencies adapted from the CEPH framework. Competency items were rated on a 5-point Likert scale (Strongly Disagree to Strongly Agree). Competency attainment was defined as a response of “Agree” or “Strongly Agree” for each item—all other responses were considered as not attained.

In addition to these two sections, the graduating student survey included a third section assessing perceptions of programme effectiveness. This was evaluated across three domains: teaching and learning, engagement, assessment, and feedback, and overall usefulness and satisfaction. A positive perception was defined as a response of “Agree” or “Strongly Agree” for each item—all other responses were categorised as negative.

The industry stakeholder survey mirrored the student competency questions to evaluate agreement on graduating students’ competency attainment, also using a 5-point Likert scale.

To minimise social desirability biases, several measures were implemented: (i) the questionnaire was self-administered online, (ii) we emphasised the importance of providing honest responses for programme improvement, and (iii) the questionnaire was worded in a non-judgemental manner (e.g., use of neutral wording).

2.4. Statistical Analysis

Demographic characteristics and competency responses were summarised using frequencies and percentages for categorical variables and means with standard deviations for continuous variables. Differences in competency attainment between baseline and graduation were assessed using chi-square tests, with p < 0.05 indicating statistical significance. Programme effectiveness was evaluated across teaching/learning, engagement/assessment/feedback, and usefulness/satisfaction domains, comparing those who attained all 13 competencies to those who did not. This subgroup analysis, conducted as part of RQ2 and its associated hypothesis, offered an additional lens for evaluating programme accountability and the alignment of intended outcomes with learner experiences in competency-based education (Osiecki et al., 2022; Przybyla et al., 2022). A Wilcoxon rank-sum test (Mann–Whitney U test) was conducted for each of the 13 public health competencies to compare the median ratings on a 5-point Likert scale between graduating students and industry stakeholders. Statistical significance was determined at p < 0.05. All statistical analyses were conducted using STATA version 15.0 (Stata Corp, College Station, TX, USA).

2.5. Qualitative Phase

The qualitative phase involved thematic analysis of open-ended survey questions to explore graduating students’ and industry stakeholders’ perceptions of the programme’s strengths and gaps. Open-ended responses were collected concurrently with quantitative data from the same graduating student and industry stakeholder surveys. This phase aimed to provide deeper insights into the quantitative findings, particularly regarding programme effectiveness and competency application.

2.6. Qualitative Part of the Survey Questionnaire

The graduating student survey included open-ended questions, such as “What are the key strengths of the Minor programme?” and “What gaps or improvements would you suggest for the programme?” Stakeholders were asked parallel questions, including, “What strengths do graduates from the Minor programme demonstrate in the workplace?” and “What areas of training need improvement for these graduates?” These questions were designed to elicit detailed narratives on programme impact and areas for enhancement.

2.7. Qualitative Data Analysis

Qualitative responses were analysed using thematic analysis, following Braun and Clarke’s (2022) six-step framework: familiarisation with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report. The third and fourth authors independently imported all qualitative responses into NVivo 11.0 and coded them line-by-line in parallel, generating initial codes based on recurring concepts. Codes were then grouped into themes and subthemes through iterative discussion. Discrepancies were resolved by consensus among all authors. The subthemes and themes were validated by cross-checking with quantitative findings to ensure coherence. Illustrative quotes were selected to represent each subtheme and/or theme.

3. Results

3.1. Quantitative Results

3.1.1. Demographic Characteristics of Participants

Table 1. (a) Demographic characteristics of student participants. (b) Demographic characteristics of industry stakeholder participants.

(a)
Demographic Characteristic	Baseline (n = 289) n (%)	Graduation (n = 78) n (%)
Sex
Male	92 (31.8)	20 (25.6)
Female	197 (68.2)	58 (74.4)
First Major
Science	179 (61.9)	48 (61.5)
Non-Science	110 (38.1%)	30 (38.5)
Mean age in years (standard deviation)	21.7 (1.6)	23.2 (1.1)
(b)
Demographic Characteristic		Total (n = 17) n (%)
Organisation
Government agencies/Ministries/Statutory boards		2 (11.8)
Hospitals/Polyclinics/Healthcare		8 (47.1)
Non-governmental/Non-profit organisations		4 (23.5)
Private organisations		3 (17.6)
Title Designation
Chief Executive Officer		1 (5.9)
Deputy Director		2 (11.8)
Director		5 (29.4)
Research Fellow		2 (11.8)
Manager		4 (23.5)
Assistant Manager		2 (11.8)
Executive		1 (5.9)

(a) outlines the demographic characteristics of students, comparing baseline (n = 289) and graduation (n = 78) participants. At baseline, 68.2% were female and 31.8% male, while at graduation, 74.4% were female and 25.6% male. The mean age was 21.7 years at baseline and 23.2 years at graduation.

Table 1(b) outlines the demographics of 17 industry stakeholder participants. Most were from hospitals/healthcare (47.1%), followed by non-governmental/non-profit (23.5%), private organisations (17.6%), and government agencies (11.8%). The primary designations were Deputy Director/Director (41.2%) and Assistant Manager/Manager (35.3%).

3.1.2. Attainment of Public Health Competencies at Baseline and Graduation by Students

Figure 1 illustrates the attainment of public health competencies at baseline (n = 289) and graduation (n = 78) by students, with p-values indicating the significance of changes between time points.

Table A1. Description of the public health competencies.

Competency	Description
PHC1	Understand the role of public health in society
PHC2	Understand the role and function of health delivery systems
PHC3	Understand the processes of health policy formulation and implementation
PHC4	Use data from various sources to characterise the health of a population or subpopulation
PHC5	Identify political, cultural, behavioural, and socioeconomic factors related to common public health issues
PHC6	Apply basic preventive approaches to disease prevention and health promotion for the individuals and community
PHC7	Design and conduct a basic epidemiological study (define aims, select appropriate study designs, collect, analyse, and interpret data, identify limitations, summarise and discuss findings)
PHC8	Interpret basic statistical results
PHC9	Interpret basic qualitative results
PHC10	Locate, use, and evaluate public health information
PHC11	Communicate public health information in both verbal and written forms
PHC12	Work effectively as a member of a public health team
PHC13	Adopt a systems thinking approach in tackling public health issues

presents the descriptions of the public health competencies (PHC). At baseline, attainment ranged from 60.9% (PHC7: designing and conducting epidemiological studies) to 94.8% (PHC1: understanding public health’s role in society). At graduation, attainment increased across all competencies, ranging from 83.3% (PHC4: using data to characterise population health and PHC13: adopting a systems thinking approach) to 100% (PHC1). Substantial improvements were observed for all competencies except PHC8 (interpreting basic statistical results, p = 0.64), with the most significant changes (p < 0.001) in competencies PHC3, PHC7, PHC10, PHC11, and PHC12, related to health policy, epidemiological study design, information evaluation, communication, and teamwork, respectively.

3.1.3. Perceptions of Programme Effectiveness by Attainment of Competencies in Graduating Students

Figure 2a,b illustrate perceptions of programme effectiveness among students who attained all 13 competencies (n = 44) and those who did not (n = 34), with p-values indicating the significance of differences for each item. Perceptions were assessed across three domains: teaching and learning (TL), engagement/assessment/feedback (EAF), and usefulness and satisfaction (US).

Table A2. Perception statements of programme effectiveness by domain.

Domain	Perception Statement
Engagement, assessment, and feedback (EAF)	I am encouraged to ask questions or make contributions in class. (EAF1)
	The Minor in Public Health has created sufficient opportunities to discuss my work with other students. (EAF2)
	The workload in the Minor in Public Health is manageable. (EAF3)
	I have appropriate opportunities to give feedback on my experience. (EAF4)
	The criteria used in marking is made clear in advance. (EAF5)
	Assessment arrangements and marking are fair. (EAF6)
	Feedback on my work is prompt. (EAF7)
	Feedback on my work (written or verbal) is useful. (EFA8)
Teaching and learning (TL)	Faculty are good at explaining things. (TL1)
	Faculty are enthusiastic about what they are teaching. (TL2)
	The courses are academically stimulating. (TL3)
	There is sufficient contact time (face-to-face and/or virtual/online) between faculty and students to support effective learning. (TL4)
	I am happy with the support I receive from faculty for my learning. (TL5)
Usefulness and satisfaction of programme (US)	Content knowledge acquired through the Minor. (US1)
	Skill sets acquired through the Minor. (US2)
	Interactions with faculty. (US3)
	Interactions with fellow course-mates taking the Minor. (US4)
	Overall, I am satisfied with the quality of the Minor. (US5)

presents the perception statements of programme effectiveness by domain.

As shown in Figure 2a, within the domain of EAF, students who attained all competencies rated the following aspects higher compared to those who did not: opportunities to give feedback (97.7% vs. 76.5%, p = 0.01), clear marking assessment rubric (88.6% vs. 64.7%, p = 0.01), prompt feedback on work (88.6% vs. 64.7%, p = 0.01), and useful feedback on work (95.4% vs. 67.7%, p = 0.002) showed significant differences, while assessment fairness (93.2% vs. 79.4%, p = 0.09), encouragement to ask questions (95.4% vs. 82.3%, p = 0.07), opportunities to discuss with peers (95.4% vs. 82.3%, p = 0.07), and manageable workload (97.7% vs. 85.3%, p = 0.08) exhibited non-significant but consistent trends favouring those attaining all competencies.

As shown in Figure 2b, in the TL domain, students who attained all competencies rated the following aspects higher compared to those who did not: faculty were effective at explaining (100% vs. 88.2%, p = 0.03), courses were academically stimulating (95.4% vs. 79.4%, p = 0.04), and support from faculty was rated highly by 97.7% versus 82.3% (p = 0.04); other items, like faculty enthusiasm (100% vs. 94.1%, p = 0.19) and sufficient contact time (88.6% vs. 76.5%, p = 0.22), showed non-significant trends toward higher ratings among those attaining all competencies. In the US domain, perceptions were generally similar or slightly higher among those attaining all competencies, though differences were not significant: content knowledge gained (97.7% vs. 100%, p = 1.00), skills gained (97.7% vs. 88.2%, p = 0.16), faculty interactions (77.3% vs. 67.6%, p = 0.34), peer interactions (65.9% vs. 52.9%, p = 0.25), and overall satisfaction (97.7% vs. 91.2%, p = 0.31).

Post-graduation plans differed by competency attainment (not reflected in the figure), with 51.7% (15/29) of those attaining all competencies pursuing or securing public-health-related employment or graduating student study, compared to 26.9% (7/26) of those who did not. Non-public health paths were pursued by 41.4% (12/29) versus 61.5% (16/26), and 6.9% (2/29) versus 11.5% (3/26) had yet to decide or indicated other plans, though the overall difference was not significant (p = 0.17).

3.1.4. Comparative Analysis of Public Health Competencies Between Graduating Students and Industry Stakeholders

Figure 3 illustrates a comparative analysis of public health competency ratings by graduating students (n = 78) and industry stakeholders (n = 17). Box plots display the median values and interquartile ranges (IQRs) for each competency within each group. Across all 13 competencies, graduating students consistently reported significantly higher median ratings of competency attainment compared to stakeholders (all p-values < 0.001). The largest discrepancies were observed in PHC1 (understanding the role of public health in society) and PHC2 (the role and function of health delivery systems), attributable to stakeholders reporting a median rating of 3 for both, compared to 5 by graduating students.

3.2. Qualitative Results

3.2.1. Strengths in the Training of Graduating Students

Table 2. (a) Strengths in the training of graduating students. (b) Gaps in the training of graduating students.

(a)
Theme	Subtheme	Illustrative Quote from Graduating Students	Illustrative Quote from Industry Stakeholders
Public Health Knowledge and Frameworks	Systems Thinking and Holistic Perspective	“The systems thinking approach taught is applicable even outside of public health and has complemented the thinking approach taught in my major (psychology)—A deeper understanding and appreciation of public health systems, policies, and issues” (Female, first major in psychology)	“They demonstrate a strong grasp of Singapore’s healthcare ecosystem and its interconnected components” (Industry stakeholder from IHH Healthcare)
	Familiarity with Public Health Concepts	“The programme exposed me to key public health concepts and terminology, giving me a solid foundation to discuss health issues” (Female, first major in global studies)	“These hires are familiar with public health terminology and show an interest in health, which helps to lower the probability of attrition” (Industry stakeholder from Agency for Integrated Care)
Analytical and Problem-Solving Skills	Quantitative and Research Skills	“Able to learn different skillsets and knowledge, like interpreting data, presenting information, etc.” (Male, first major in business)	“Hires contribute public health perspectives and skillsets to social programmes, including critical appreciation of risk and protective factors affecting health outcomes, as well as quantitative analysis skills” (Industry stakeholder from TOUCH Community Services)
	Systems-Based Policy Design	“Encourages us to think of creative, yet targeted policies which consider holistic aspects of one’s health, the built and natural environment. Adopting a systems thinking approach is useful in tackling public health issues too” (Female, first major in life sciences)	“They excel at designing policies that address macro health issues using a systems approach” (Adjunct faculty and management from the National Centre for Infectious Diseases)
Interdisciplinary Synergy and Career Enhancement	Cross-Disciplinary Integration	“It compliments [sic] many different majors” (Female, first major in sociology)	“They are able to give a public health perspective in approaching solutions and are competent in basic research design and analysis” (Industry stakeholder from TOUCH Community Services)
	Enhanced Career Opportunities	“It opens up more career opportunities” (Male, first major in biomedical engineering)	“Public health grads could be familiar with the economics of healthcare services; such expertise could bring additional insights to our work” (Industry stakeholder from Diagnostics Development Hub, Agency for Science and Technology Research)
(b)
Theme	Subtheme	Illustrative Quote from Graduating Students	Illustrative Quote from Industry Stakeholders
Enhancement of Experiential Learning Opportunities	Fieldwork and Industry Exposure	“Perhaps there can be more fieldwork-based courses for students to have more real-world experience with industry professionals through feedback and interactions” (Female, first major in life sciences)	“Graduates have theoretical knowledge but require more practical experience to work independently” (Adjunct faculty and management from Yishun Health and Khoo Teck Puat Hospital)
	Practical Application Development	“If it is possible, I feel that students can have more exposure to a real public health setting, to experience what public health workers do” (Female, first major in life sciences)	“Their public health knowledge is basic and requires significant supervision in practical settings” (Industry stakeholder from Agency for Integrated Care)
Deepening Specialised Knowledge Domains	Targeted Topical Expertise	“Having more nutrition-related courses to deepen my understanding of dietary public health” (Female, first major in life sciences)	“Graduates need deeper expertise in specialised public health topics to contribute effectively” (Industry stakeholder from Singapore Red Cross)
	In-Depth Conceptual Understanding	“I would like some courses that address more mental health issues, I took that course and went away gaining a lot of new knowledge, but I can’t help but think that we need to split it up into several courses since one course alone can’t possibly cover all mental health conditions in depth” (Female, first major in biomedical engineering)	“Graduates with a public health minor lack the depth needed for advanced public health roles” (Industry stakeholder from Agency for Integrated Care)
Advancement of Professional Communication and Engagement Skills	Adaptive Communication Strategies	“Public health courses should include more assignments to practise writing and presenting for diverse audiences, rather than relying on exams” (Male, first major in communications and new media)	“Their written communication is often too academic and needs to be more practical for professional settings” (Industry stakeholder from TOUCH Community Service)
	Effective Stakeholder Collaboration	“More opportunities to work with faculty, industry professionals, and peers would prepare us for collaborating in complex public health settings” (Male, first major in chemistry)	“Graduates need skills in facilitating collaboration in complex, systemic, and political environments” (Adjunct faculty and management from Yishun Health and Khoo Teck Puat Hospital)

(a) presents qualitative findings on the strengths of the programme, as perceived by students and industry stakeholders. The thematic analysis distilled participants’ responses into three overarching themes, synthesised from the recurrent and interconnected arguments about the programme’s strengths. These themes represent a higher level of abstraction, grouping related subthemes that emerged consistently across both graduating student and stakeholder groups, their alignment with quantitative improvements in competencies, and their collective contribution to understanding how the programme fosters foundational and transferable skills. Rather than privileging isolated excerpts, the representative quotes were chosen for their clarity in illustrating dominant patterns and for reflecting balanced coverage of both student and stakeholder perspectives across diverse contexts.

The first theme, Public Health Knowledge and Frameworks, integrates perceptions that the programme provided a strong foundation and holistic understanding of public health. Both students and stakeholders emphasised systems thinking and familiarity with public health terminology as indispensable strengths. These perspectives portray the Minor as equipping students with tools to navigate health ecosystems beyond their primary fields of study. For example, a graduating student shared, “The systems thinking approach taught is applicable even outside of public health and has complemented the thinking approach taught in my major (psychology)” (Female, first major in psychology). Stakeholders echoed this, noting, “They demonstrate a strong grasp of Singapore’s healthcare ecosystem and its interconnected components” (Industry stakeholder from IHH Healthcare).

The second theme, Analytical and Problem-Solving Skills, abstracts recurring narratives about the acquisition of quantitative, research, and policy-design capabilities. Rather than treating comments on data interpretation, information evaluation, and policy formulation separately, this theme synthesises them into a problem-solving orientation grounded in evidence-based decision-making. Students repeatedly highlighted learning to interpret and present data, while stakeholders viewed these skills as directly beneficial to social and health programmes. A graduating student noted, “Able to learn different skillsets and knowledge, like interpreting data, presenting information, etc.” (Male, first major in business), echoed by a stakeholder who stated, “Hires contribute public health perspectives and skillsets to social programmes, including quantitative analysis skills” (Industry stakeholder from TOUCH Community Services).

The third theme, Interdisciplinary Synergy and Career Enhancement, consolidates arguments about the Minor’s integrative role in enhancing students’ primary majors and broadening career opportunities. Students described the programme as a complement to their disciplinary training, while stakeholders valued the cross-disciplinary perspectives graduating students contributed to workplace problem-solving. This theme highlights intellectual versatility and professional adaptability as strengths of the programme. For instance, a graduating student remarked, “It complements many different majors” (Female, first major in sociology), and a stakeholder affirmed, “They are able to give a public health perspective in approaching solutions and are competent in basic research design and analysis” (Industry stakeholder from TOUCH Community Services). Students also emphasised career opportunities, e.g., “It opens up more career opportunities” (Male, first major in biomedical engineering), paralleled by a stakeholder who noted, “Public health grads could be familiar with the economics of healthcare services; such expertise could bring additional insights to our work” (Industry stakeholder from Agency for Science and Technology Research).

3.2.2. Gaps in the Training of Graduating Students

Table 2(b) outlines perceived gaps in the training of graduating students, identified through qualitative feedback from students and industry stakeholders. The qualitative responses were synthesised into three overarching themes based on recurrent critiques and were prioritised because they represent systemic limitations rather than anecdotal suggestions. They also resonate with quantitative disparities, particularly the lower stakeholder ratings for practical and communication-related competencies. Representative excerpts were selected to illustrate the most prominent critiques, ensuring balanced coverage of both student and stakeholder perspectives across diverse contexts.

The first theme, Enhancement of Experiential Learning Opportunities, aggregates frequent calls for more immersive, practice-based training. Students and stakeholders consistently argued that insufficient fieldwork and industry exposure hindered the translation of theoretical knowledge into independent practice, thereby limiting workplace readiness. For example, a student suggested, “Perhaps there can be more fieldwork-based courses for students to have more real-world experience with industry professionals” (Female, first major in life sciences). A stakeholder echoed this, “Graduates have theoretical knowledge but require more practical experience to work independently” (Adjunct faculty and management from Yishun Health and Khoo Teck Puat Hospital). Another student remarked on the need for authentic exposure, “I feel that students can have more exposure to a real public health setting, to experience what public health workers do” (Female, first major in life sciences), with a stakeholder adding, “Their public health knowledge is basic and requires significant supervision in practical settings” (Industry stakeholder from Agency for Integrated Care).

The second theme, Deepening Specialised Knowledge Domains, synthesises repeated concerns that the Minor lacked sufficient depth in certain subject areas. Both students and stakeholders highlighted the need for advanced content in topics such as nutrition and mental health, framing the absence of in-depth treatment as a barrier to preparing graduates for advanced roles in the field. For instance, a student noted, “I would like some courses that address more mental health issues… one course alone can’t possibly cover all mental health conditions in depth” (Female, first major in biomedical engineering), echoed by a stakeholder’s assessment that, “Graduates need deeper expertise in specialised public health topics to contribute effectively” (Industry stakeholder from Singapore Red Cross).

The third theme, Advancement of Professional Communication and Engagement Skills, consolidates critiques of the programme’s limited emphasis on practice-oriented communication and collaboration. Participants indicated that communication training was overly academic and insufficiently geared toward the diverse, real-world audiences encountered in professional public health practice. A student argued, “Public health courses should include more assignments to practise writing and presenting for diverse audiences” (Male, first major in communications and new media), while a stakeholder observed, “Their written communication is often too academic and needs to be more practical for professional settings” (Industry stakeholder from TOUCH Community Services). Another student stressed the importance of collaboration, “More opportunities to work with faculty, industry professionals, and peers would prepare us for collaborating in complex public health settings” (Male, first major in chemistry), echoed by a stakeholder who stated, “Graduates need skills in facilitating collaboration in complex, systemic, and political environments” (Adjunct faculty and management from Yishun Health and Khoo Teck Puat Hospital).

4. Discussion

This study provides reflective insights into the Minor in Public Health programme at SSHSPH, NUS, by integrating student and stakeholder perspectives to evaluate programme effectiveness and competency attainment. By addressing gaps in undergraduate public health education, particularly in the Asia-Pacific context, the findings contribute to the global discourse on aligning curricula with workforce needs.

4.1. Summary of Results and Integration of Quantitative and Qualitative Findings

The quantitative data revealed notable advancements in students’ self-assessed competency attainment from baseline to graduation across most competencies within the CEPH framework, with strengths in areas such as health policy, data use, epidemiological study design, communication, and teamwork. While there was an observed increase in perceived attained competency in the interpretation of basic statistical results from baseline to graduation, this difference did not achieve statistical significance, given that most students rated themselves as having already attained this specific competency at baseline, likely because they have prior training in basic statistics from having taken statistics courses offered under their pre-university education and/or primary major’s curriculum. This is consistent with quantitative analytical skills being highlighted as a strength among public health graduating students by both students and industry stakeholders from the qualitative findings. Students who achieved all competencies reported higher satisfaction with teaching, engagement, and feedback mechanisms compared to those who did not, suggesting a strong link between competency fulfilment and positive perceptions of programme effectiveness. A higher proportion of students achieving all competencies planned to pursue public-health-related careers, though this trend was not statistically significant.

In contrast, stakeholders generally reported lower levels of ratings of competency attainment compared to students across all competencies. Qualitative findings complemented these results, highlighting programme strengths in fostering systems thinking, analytical skills, and interdisciplinary synergy, which were valued by both students and stakeholders. However, gaps were identified in experiential learning opportunities, depth of specialised knowledge, and professional communication skills, aligning with the quantitative disparities in stakeholder perceptions. While higher student self-ratings may point to gaps in workplace readiness, alternative explanations should also be considered. These include self-assessment inflation, where students overestimate their abilities due to limited experience (Kruger & Dunning, 1999), and differing frames of reference—students may compare themselves to academic peers, whereas stakeholders benchmark against professionals with higher standards (Brînzac et al., 2025).

The integration of quantitative and qualitative data provides a nuanced, convergent understanding of the programme’s impact, revealing alignments, extensions, and tensions between self-reported metrics and stakeholder perceptions. Students’ confidence in their competency attainment, particularly in systems thinking and interdisciplinary application, highlights the programme’s theoretical and conceptual strengths, as shown by significant quantitative improvements in 10 of 13 competencies from baseline to graduation. However, stakeholders’ consistently lower ratings across competencies suggest potential overestimation in self-assessments, with qualitative themes offering in-depth explanation. While quantitative data demonstrate clear improvements in foundational and analytical competencies, qualitative gaps in experiential learning, professional communication, and specialised knowledge reveal opportunities for enhancement, bridging the divide between academic outcomes and workforce readiness to foster more holistic competency development.

Qualitative themes reinforce quantitative findings in areas of strong alignment. For instance, the theme of Analytical and Problem-Solving Skills supports the significant improvements in data-related competencies (e.g., PHC7: epidemiological study design), with students emphasising gains in study design skills that mirror these statistical trends. Similarly, the theme of Public Health Knowledge and Frameworks reinforces foundational competencies (e.g., PHC1: understanding public health’s role), as narratives highlighting holistic perspectives align with high student attainment rates, validating the programme’s conceptual focus.

Qualitative insights also extend quantitative results by providing context for observed patterns and discrepancies. The theme of Interdisciplinary Synergy and Career Enhancement links competency attainment with programme perceptions, showing that students achieving all competencies report higher satisfaction and interest in public health careers, thereby explaining the motivational impact of interdisciplinary training. Conversely, the theme of Enhancement of Experiential Learning Opportunities explains stakeholder–student rating discrepancies (e.g., PHC6: preventive approaches), indicating that theoretical strengths do not fully translate to practical readiness, which accounts for stakeholders’ lower ratings despite student-reported improvements.

Finally, qualitative themes challenge quantitative self-reports by uncovering limitations and potential overestimations. The theme of Advancement of Professional Communication and Engagement Skills challenges the high attainment in PHC11 (communication), as stakeholders highlight mismatches between academic-style skills and professional demands, suggesting a need for context-specific training. Similarly, the theme of Deepening Specialised Knowledge Domains challenges competencies requiring nuanced understanding (e.g., PHC5: identifying socioeconomic issues), with stakeholders pointing to insufficient depth in specialised topics, aligning with their lower ratings and questioning overall readiness for complex real-world applications.

4.2. Comparison of Results with Existing Literature

The improvement in student competency attainment from baseline to graduation aligns with research highlighting the efficacy of structured undergraduate public health curricula in developing foundational skills (Osiecki et al., 2022; Przybyla et al., 2022). The programme’s strengths in health policy and teamwork corroborate findings from Armstrong-Mensah et al. (2022), who noted that high-impact practices, such as collaborative projects, foster workforce-relevant skills.

The significant discrepancy between student and stakeholder ratings of competency attainment is consistent with prior studies, such as Brînzac et al. (2025), which highlight gaps between academic preparation and employer expectations, particularly in practical application and communication. The qualitative emphasis on systems thinking and interdisciplinary synergy aligns with Lim et al. (2020), who underscore the value of integrative approaches in non-Western contexts like Singapore, where public health education often complements other disciplines. However, the identified gaps in experiential learning and professional communication mirror global concerns. For instance, it was highlighted that public health graduating students often lack skills to communicate effectively with diverse audiences, such as policymakers or community groups, a critical issue in international settings where public health professionals must navigate varied cultural and professional contexts (MacKay et al., 2024; MacKay et al., 2025).

4.3. Implications of Results and Recommendations for Enhancing Undergraduate Public Health Education

The findings from this study offer critical insights into advancing undergraduate public health education, aligning curricula with the diverse needs of an international workforce while addressing gaps identified through student and stakeholder perspectives. The substantial progress in student-reported competencies, such as health policy and teamwork, underscores the programme’s interdisciplinary structure, which effectively cultivates foundational skills applicable across global professional contexts.

The discrepancy between students’ confidence in their competencies and stakeholders’ concerns about practical application and communication reveals a global challenge in public health education: ensuring theoretical learning translates into workplace-ready skills. The findings indicating limited experiential learning opportunities suggest curricula should prioritise partnerships with public health organisations for internships, fieldwork, or service-learning projects. Concrete curriculum enhancements include mandatory structured internships (e.g., 8–12 weeks with reflective portfolios), service-learning courses partnering with local non-governmental organisations for community health projects, and simulation-based training using virtual scenarios of public health crises, like COVID-19 responses in Singapore. These are feasible through existing university partnerships and align with evidence from recent studies (Baker et al., 2024). These initiatives enable students to apply theoretical knowledge to diverse health challenges, such as infectious diseases in Asia, enhancing their readiness for professional practice (Armstrong-Mensah et al., 2022). Service-learning models collaborating with local and international health organisations can address region-specific priorities, ensuring graduates are prepared for varied public health roles (Leistner et al., 2023).

The emphasis on professional communication deficits signals a need for targeted training to prepare students for international public health settings, where effective engagement with policymakers, communities, and interdisciplinary teams is essential (MacKay et al., 2024; MacKay et al., 2025). Incorporating assignments, such as drafting policy briefs or simulating public health campaigns, can foster adaptable communication skills, enabling graduates to navigate diverse cultural and professional landscapes (AlMubarak, 2023). The programme’s strength in fostering interdisciplinary synergy, valued by both students and stakeholders, highlights the potential of cross-disciplinary projects to prepare students for collaborative roles in global health, aligning with integrative educational approaches in the Asia-Pacific region (Mirbahai et al., 2024).

To address stakeholders’ lower ratings on competency attainment, engaging employers, policymakers, and community leaders in curriculum design will be crucial to align academic training with workforce expectations. For example, establishing advisory boards with diverse stakeholders can ensure curricula reflect professional needs across varied cultural contexts, enhancing graduates’ readiness for international roles (Bertilsson et al., 2023; Chidwick et al., 2024). Incorporating elective courses tailored to region-specific priorities, such as mental health, climate-related health issues, or global health security, will deepen students’ expertise and enhance curriculum relevance across international settings (Versluis et al., 2023). By embedding these strategies, public health programmes can cultivate versatile and skilled graduates who are well-equipped to meet the evolving demands of the field.

4.4. Strengths and Limitations

The study’s strengths include its mixed-methods convergent parallel design, which integrated quantitative metrics with qualitative insights, providing a comprehensive evaluation of programme effectiveness (Creswell & Plano Clark, 2018). The longitudinal student surveys and stakeholder perspectives offer valuable data on competency attainment and workforce alignment. The use of the CEPH framework ensures international relevance, while the non-Western context addresses a literature gap.

The small stakeholder sample, drawn primarily from healthcare organisations, adjunct faculty, and internship supervisors, may introduce selection bias, as these participants could have more academic-oriented views, potentially overlooking perspectives from international public health sectors. This limits generalisability to the broader Asia-Pacific workforce, where diverse roles might highlight different gaps (MacKay et al., 2023). Implications include possible underrepresentation of biases like familiarity with the programme, which could inflate positive perceptions. Larger, more diverse samples in future research would mitigate these issues and enhance applicability. Another limitation is the reliance on self-assessment for student competency attainment, which may capture perceived self-efficacy more accurately than objective performance, as competencies are better demonstrated in professional settings (Brînzac et al., 2025). Self-assessments can also be biased by overconfidence, particularly among less experienced individuals (Kruger & Dunning, 1999). In public health education, this issue is compounded by students’ limited real-world exposure, which may inflate ratings compared to stakeholder evaluations. Future studies should, therefore, incorporate objective measures, such as performance-based assessments or direct observations, to triangulate findings. The qualitative component, relying on open-ended survey questions, may lack the depth of interviews or focus groups, which allow for richer narratives (Braun & Clarke, 2022). However, triangulation with quantitative findings enhanced the rigour of qualitative interpretations (Creswell & Plano Clark, 2018). Social desirability bias, where participants may overreport positive perceptions, cannot be fully excluded, though active steps (e.g., anonymous surveys and neutral wording) were taken to minimise this risk. The study’s focus on a single national institution and a Minor programme may restrict direct comparisons with standalone public health degrees or programmes in other regions. The competency-based subgrouping was not applied to the qualitative component due to the limited number and depth of responses from students who did not report attainment of all competencies. As a result, thematic analysis was conducted across all respondents. Nevertheless, future research could adopt purposive sampling or complementary qualitative approaches to capture subgroup-specific insights, thereby strengthening programme accountability and providing a richer understanding of differential learner experiences.

4.5. Future Directions

Future research could include larger, more diverse stakeholder samples, including international employers, to enhance generalisability. Longitudinal studies tracking graduating students’ workplace performance could assess the long-term impact of competency attainment on professional success, providing insights into the programme’s effectiveness in preparing students for global health roles. Employing other qualitative methods, such as focus groups or in-depth interviews, could yield deeper insights into student and stakeholder perceptions, building on the thematic analysis used in this study. Exploring standardised tools for competency-based evaluations that integrate student and stakeholder perspectives could facilitate cross-programme comparisons, driving improvements in public health education worldwide.

5. Conclusions

This study underscores the strengths and challenges of undergraduate public health education, emphasising strengths in systems thinking and interdisciplinary synergy while identifying gaps in practical experience, specialised knowledge, and communication. The integration of quantitative and qualitative findings offers actionable strategies for enhancing pedagogical practice through experiential learning, tailored content, and stakeholder collaboration, relevant for international educators aiming to align curricula with global workforce needs.