Design thinking for fostering 21st-century skills among Thai public health undergraduates: a design-based research approach

Abstract

Background: Design Thinking (DT) has gained increasing recognition in health professions education for its ability to foster key 21st-century skills such as creativity, critical thinking, collaboration, and adaptability. Objective: This study employed a Design-Based Research approach to develop and evaluate a Design Thinking (DT)-driven pedagogical innovation aimed at streamlining curriculum delivery while fostering 21st-century skills among Thai undergraduate public health students. Methods: The intervention was co-constructed with students, faculty, alumni, employers, and community stakeholders (December 2022–May 2023) and assessed using a one-group pretest-posttest design with paired-samples t-tests. A 15-week integrated prototype, implemented among 53 third-year students, restructured conventional lecture-based instruction into a hybrid ecosystem comprising interactive sessions, integrated modules, an autonomous Self-study Café, and field-based projects. Data were collected through self-administered questionnaires and after-action reviews (AARs) with students and instructors. The innovation reduced formal classroom contact hours by 21% without an apparent reduction in learning depth, based on qualitative feedback. Results: Findings revealed significant improvements across all six dimensions of 21st-century skills (p < 0.001, d = 0.91–1.93). Students’ perceptions of teaching-learning management were significantly more positive under the integrated model than the traditional model (p < 0.001), with high overall satisfaction toward the prototype (mean 4.38–4.51). AARs findings indicated that reducing lecture-intensive content facilitated deeper engagement and greater student agency, while also reducing academic anxiety and appearing to strengthen professional identity through authentic problem-solving. Conclusion: Findings align with Cognitive Load Theory, suggesting that reduced extraneous cognitive load facilitated higher-order learning. This DT-driven model constitutes a potentially viable framework for educational reform in health professions education, bridging theoretical knowledge and public health practice. Multi-site, longitudinal research is recommended to examine the model’s scalability and sustained impact.