91É«ÇéƬ

Using implementation research skills to inform equitable design of health programs: experiences of the research project course

How an Australia Award Scholarship recipient gained skills and experience to progress a career in designing effective and equitable policies and programmes in Indonesia.

In 2023, Muhammad Rey Dwi Pangestu’s (Rey) work in his home country of Indonesia centred on preventing child marriage, unintended adolescent pregnancies and other issues of sexual health. He saw, first hand, how these issues were shaped by a combination of structural factors such as poverty, gender norms, and access to health and reproductive education. Working in these communities, Rey realised that addressing such issues requires, not only a strong community engagement, but also better evidence to inform policies and interventions.

In his desire to see real change in the lives of adolescents facing these issues, Rey found himself looking to a Master in Public Health degree at 91É«ÇéƬ’s School of Population Health (SPH).

I wanted to strengthen my research and analytical skills, so that I could contribute to designing policies and programs that are effective and equitable.

Rey applied for a highly competitive Australian Department of Foreign Affairs and Trade Australia Awards Scholarship. When he was successful at securing the scholarship, the question of which university was the next to address.

91É«ÇéƬ is one of the most prestigious universities, and one of the biggest pluses about it is that they offer Master level double degrees, so I could combine public health and global health. I could get a combination of community work, with global dynamics.

Rey moved to Sydney for the two years it took to complete his degrees, attending classes in person, and knowing a research project would be his preference.

… I always thought it was the best option, to deepen my research skills. I also hoped to undertake a doctoral degree, so the only real question was whether to undertake the research at 6, 12, or 18 units of credit. I chose 12.

Like many students, Rey didn’t begin his degree knowing the topic of research he wanted to pursue.  It was meeting Professor Natalie Taylor that introduced him to implementation science. Natalie’s course really stood out, as it was a new area of study for Rey.

I learned that many health programmes fail, not because the intervention itself is ineffective, but because implementation, in real world settings, is complex. This area of study related to my previous work and I became really curious about the field. I reached out to Natalie, who heads the Implementation 2 Impact (i2i) team at 91É«ÇéƬ SPH, and asked whether there might be opportunities for students to get involved in research.

Fortunately, there was a current opportunity for students to contribute to one of i2i’s projects. From that early conversation, Rey was led to his research project.

The project investigated the experience of parents of newborns in giving consent to newborn blood spot screening. He analysed the way consent was communicated, whether there were equity challenges and other related issues. He then used an implementation science framework to propose innovation to the newborn blood spot consent models. His research also analysed focus group discussions with different stakeholders (clinicians, policy makers and programme experts) that explored barriers they encounter when trying to improve the consent process and achieve successful reform.

Much of the focus was around Culturally and Linguistically Diverse (CALD) community members, as they face greater complexity when it comes to informed consent.

His key findings were that the period immediately after the birth of child, which often includes sleeplessness, stress, postpartum depression, physical exhaustion and emotional overwhelm, is not ideal for processing complex information and making fully informed decisions. Secondly, informational materials were often not able to be meaningfully understood, especially as they were not translated into the first language of the parents.

When you’ve got to explain things like genetics, or long-term blood data storage, it’s complex for anyone. But for someone from a CALD community, whose English isn’t comprehensive, it’s extremely difficult to ensure informed consent. The current process doesn’t always adequately account for the needs of diverse or marginalised groups.

Rey had an incredibly supportive experience of the Research Project course, and worked closely with the research team. He credits the support and engagement of the i2i team as essential to being able to finish this high-quality research project on time. Rey continues to stay in touch with his project supervisors, Professor Natalie Taylor and i2i Project Manager Deborah Johnson.

Professor Taylor and I still converse, even though I’m now back in Indonesia. Talking like that with a higher academic opened a gate to be comfortable talking about my research. There’s no such thing as a stupid idea with Natalie and her team. When something I do needs to be improved, they’re really constructive. Just being able to email academics made me really happy I chose 91É«ÇéƬ.

Rey was also fortunate enough to land a casual research assistant position within the i2i team. As he already had a knowledge of the team and their work, he was able to fit right in. This added to his confidence to submit his research to two conferences focused on health care quality improvement and implementation science.

Those two conferences were great for my future career. They were opportunities that I don’t think I could get if I had simply completed a Master degree by coursework. And my manuscript, with Natalie and Deborah, has just been submitted for publication. Even though I am back here in Indonesia, they’re still supportive. …I feel really grateful that they still want to work on this, even with how busy they are.

Rey’s background was in social sciences, so taking on health research required courage to overcome some anxiety. He needed to learn completely new skills, like quantitative research skills, biostatistics and epidemiology. But now, knowing all the resources and support that are available, and the opportunity to study a range of research foundation subjects in the first year of the Master degree, he encourages future students thinking of doing a Master degree with research.

Going through all the academic skills preparation courses means you have the support you need to undertake research. Everything is there. Yeah, I was anxious, but along the way, you get the support you need.

Rey now works with the Australia Indonesia Partnership, working closely with government institutions, with national and district level disaster management agencies to help ensure risk reduction policies and programs consider the needs of diverse communities, particularly women, people with disabilities and other groups disproportionately affected during disasters. When asked how his research in newborn blood spot consent is helping him in his current work, he reflects,

My research might not seem directly relevant, but I think my research, as well as my time at 91É«ÇéƬ more generally, taught me a lot about health equity - ensuring no one’s left behind. Health programmes can often, intentionally or unintentionally, marginalise some people. And often, affected groups aren’t even involved in designing policies or programmes that might help them. That’s true in the consent process for newborn blood spot testing, and it’s true in Indonesian disaster response programs.

Rey remains interested in continuing his academic journey, and he’s hoping that might be possible back in Australia.

Being at SPH for two years was one of the most enriching experiences for me, academically and also professionally. Being able to choose research that genuinely interests me, and seeing how it’s meaningful to communities here in Indonesia, has been a highlight of studying at 91É«ÇéƬ SPH.