Table 3 Key contextual factors and illustrative quotes

Graduates workload and work foci

In [country]—workload locally is huge (all about reacting to crises)—have no time to strategise and use HSS concepts in day-to-day work

Limited opportunity to apply HSS approaches

Course is designed very well, but staff struggle to make time to find opportunities to apply HSS approaches—need to look for opportunities in real world to apply HSS—the disconnect ‘it is not happening…I have tried to find opportunities for staff to apply HSS—as I am a strong advocate of HSS—but they [staff member] are resistant to data analysis systems, we have EQUIST tool—but they do not used it—they say—not everybody likes data—but it is public health

Limited HSS examples

Overall HSS course very useful—need more examples, need macro pictures to enable staff to think through other lens—a whole health sector lens

Varied supportive workplace environments

When trainees go back to work—management needs to see agenda in the same way—or else will just see HSS as a theoretical concept with no practical applications