The Centre for Primary Health Care and Equity (CPHCE) provides unique and invaluable opportunities to learn and refine the skills of health research that translates across to policy and practice. Learn more about the student experience from some of our past PhD students.
My path to studying PhD in Public Health at the Centre for Primary Health Care and Equity (CPHCE) has most probably been longer than most. I choose CPHCE because of the uniqueness, flexibility and rigour of implementation research, and the opportunity to learn from some of the world's foremost experts in Implementation research.
After completion of my Master's degree in public health (Epidemiology) in 2014 from Manipal University, India, I started working as a Program Manager at INGO in Nepal. The community exposure in Nepal gave me great insights into community health problems, which was far more than one gets from book and journals. This inspired me to go for higher study, where I can merge both field and academic knowledge for the benefits of those whom I choose to serve in my life. I am always, troubled by the vast inequalities in health status and outcomes in Nepal and around the globe, particularly in chronic disease. Being afflicted with a non-communicable disease is more fatal in Nepal than in developed countries because of affordability, restricted accessibility to adequate medical treatment and poor self-management of the conditions. The poor are disproportionately vulnerable in Nepal. Seeking to make a difference, I committed myself to be a factor for change by intervening in the underlying structural determinants of health and wellbeing for chronic disease patients. Therefore, I decided to work on designing and piloting of self-management intervention for multi-morbid Chronic Obstructive Pulmonary Disease (COPD) patients of Nepal with the excellent team of CPHCE, UNSW, Prof. Mark Fort Harris, Associate Prof. Jane Lloyd and, Dr Hassan Hosseinzadeh (from the School of Public Health and Community Medicine).
Since I'm only in my first year, I'm still exploring opportunities to get involved in other research activities besides my PhD work to get further in-depth knowledge about Australian health systems and policies. I believe I will gain invaluable experience in community-centred program design, impact evaluation and data analytics, and the emergent field of action research. Having been involved in other research projects, it became increasingly apparent that to perform quality research; I required more knowledge about designing intervention, methodological considerations as well as further statistical expertise. This opportunity at CPHCE is a way for me to explore in-depth the full span of these topics areas and contribute to developing better quality evidence.
My interest in research began during my time as a student research dietitian at the Children’s Hospital at Westmead. As part of my Master of Nutrition at Dietetics at the University of Sydney, I completed a research project looking at serum vitamin B12 concentration of overweight and obese children and adolescents with insulin resistance and/or pre-diabetes in Australia. This ignited my interest in research and academic work.
Shortly after, I was fortunate enough to begin my journey as a PhD student at CPHCE. The topic of my thesis was exploring the interaction between ethnicity and health literacy for weight management among obese Arabic-speaking immigrants in Australian primary health care. My PhD was nested within a cluster RCT of weight management in general practice. It was participants and data from this trial that provided me with the core materials for my analysis, which was a combination of quantitative and qualitative data.
It was important to me that the topic needed to be relevant to primary health care. As a dietitian, I frequently deal with obesity and its management, so investigating a topic that could contribute in a small way to improving our understanding of weight management was a priority. Although I have completed my PhD, I still feel like my work is incomplete. I am keen to explore ways to translate my work into the primary health care setting to truly make a difference.
Since completing my PhD I have been lecturing in nutrition and public health subjects at The University of Technology, Sydney and Western Sydney University.
I am indebted to a group of people whom without their significant contribution, guidance and support this PhD would not have been possible. Namely my supervisors, Professor Mark Harris, Dr Catherine Spooner, Dr Nighat Faruqi and Professor Elizabeth Denney-Wilson, as well as the staff at CPHCE.
I started my PhD at the Centre for Primary Health Care and Equity in early 2016. Before this, I had joined the Centre as a Research Officer in June 2015 as a Research Officer working on various projects relating to equitable access and patient-centred care, including primary care innovations to improve access in vulnerable populations (IMPACT), health literacy of health care organisations, and using the Patient Activation Measure (PAM) as an intervention tool. All of these projects were instrumental in shaping my own PhD topic and have provided me with important contextual knowledge of Australian primary care that I use in my research today.
My PhD study is on measuring the experience of chronic disease patients in Australian general practice, and how their feedback can be used to improve the quality of care they receive. In Australia, patient reported experience measures (PREMs) are captured mainly in acute care settings but at the primary care level this is not well developed beyond surveys administered for accreditation of general practices. No standardised, practice-based survey tool exists in this context in Australia and certainly not for service improvement. Part of this research is aiming to develop a patient experience survey tool that is tailored to the experiences of Australian chronic disease patients, with the direct input of these patients, their carers, and care providers. And a well-designed patient survey tool, administered in the right context using the right method, can generate the kind of information that not only benefits the patients, but makes the clinician’s job easier down the line.
It’s been a great experience so far: I have been able to travel to many different suburbs of Sydney to interview practitioners ranging from experienced GPs and practice nurses who have been working in their community for decades, to GP registrars who are brand new to their job. Some are solo GPs, others work in large group practices; some are practice owners, and some work in several different clinics throughout the week. The clinicians I’ve interviewed work with a diverse group of patient populations across Sydney but all share the same thing in common: they really want to do the best they can – with the resources available – to give their patients ‘good quality’ care. And needless to say, how they defined ‘quality’ varied greatly depending on their circumstances. That’s been a very interesting finding so far.
Interviewing these participants has been eye-opening, sometimes challenging, and mainly very encouraging. In addition to hearing their stories, I have been really enjoying the opportunity to explore different corners of Sydney that I would otherwise not have even heard of. As an international student, it’s given me an even deeper appreciation for Sydney and the diversity of communities that make up this vast city. Sometimes I even feel a little bit guilty going on these interviews because it feels like a fun field trip rather than academic research! I am very excited for the next set of interviews – this time with patients and their carers.
I am extremely happy with my PhD experience so far, and feel very grateful to be doing my research at CPHCE. The support I receive from my supervisors – Prof Mark Harris, Dr Sarah Dennis, and Dr Jean-Frederic Levesque – has been so helpful in shaping me into a better, more confident, researcher. The best advice I’ve received from them so far has been to not worry about doing a ‘perfect’ project and to just keep things moving. My PhD experience has been an exercise in self-reassurance, and trying to move past some of my insecurities as a researcher and as a person. And in that sense, choosing to do a PhD has been one of the most gratifying decisions I’ve ever made.
One year on from completion of my PhD, it is both satisfying and a relief to be able to reflect on the whole experience. Undertaking a PhD on a part-time basis means you devote a significant chunk of your life to it – in my case almost seven years. Things happen along the way, both to you and the people around you, and yet you still seem to be enrolled and being asked the perennial question “How is your PhD going?” I am thoroughly enjoying not having to answer that question any longer.
I came to a PhD via a career in general practice. My earliest foray into teaching and research was via an academic registrar post. That experience allowed me to see the possibility of developing another set of skills apart from being a clinician and kindled an interest in pursuing academic work. Following some years of involvement in general practice teaching, I found myself working at the GP Unit at Fairfield Hospital, one of CPHCE’s research hubs. It was there that I had the opportunity to become involved in primary care research in a substantial way.
After testing the waters for a while by contributing to various projects, I found myself enrolling in a higher degree at UNSW, twenty years after graduating in medicine from the same institution. What tipped me over that line and decide to commit to a PhD? I had never really envisaged doing a PhD early in my career and then slowly after working in academic departments the idea started to rub off on me, probably helped by subtle and sometimes not so subtle hints from some of my senior colleagues. I think it was partly almost a challenge to myself, and partly that I wanted to have choices in the future about what I could do in general practice.
The topic of my thesis was absolute cardiovascular risk assessment and its impact on prescribing in general practice. One of the things that was important to me in undertaking a PhD was that the topic needed to be important and relevant to clinical general practice. Cardiovascular risk and medications are bread and butter general practice work. I deal with it all the time as a clinician, so investigating something that could contribute in some small way to improving our understanding of this topic seemed a really useful thing. My experience has been that when I talk with GPs they get the topic and they can see how it is relates to their practice. This really reassures me that I wasn’t just living in some ivory tower for seven years.
I was lucky to receive a RACGP grant that allowed me to conduct a pilot study for the first stage of my thesis, and then was part of the team at CPHCE that was successful in obtaining an NHMRC primary care grant to conduct a RCT exploring absolute cardiovascular risk assessment. It was data from this trial that provided me with the core material of my analysis. Conducting the pilot study and being an investigator on an RCT gave me invaluable experience in how to do research. My work involved a combination of quantitative and qualitative methods, and just like medicine, research has its own language and processes. Having now completed a PhD, I guess I feel like I get the language a bit better.
Research is rarely about an individual and I would never have been able to complete this PhD without the guidance of numerous people. I was fortunate to have very skilled and supportive supervisors as well as the opportunity to work with a great research team at CPHCE. You often hear people say they hated their research topic by the time they got to the end. I think one of the few advantages of completing a PhD part-time while working full-time (apart from not being poor) is that you are never truly immersed in the work and so you probably don’t get time to be sick of your topic. I did get a small taste of immersion when I took a year out from employment to write up my thesis. I think I can honestly say I wrote most of my thesis working at home in my pyjamas.
Having taken the risk of leaving my job, I have been fortunate to land on my feet post-PhD. Earlier this year I took up the position of Deputy Director of Primary Care and Clinical Associate Professor at Macquarie University Health Services Centre. We are trying to expand the role of the GP Clinic here and develop innovative models of integrated care with specialist services. The Faculty of Medicine and Health Sciences at the university sees the three pillars of clinical work, teaching and research as integral in the provision of health care and my role here is to help develop this in the primary care setting. I’m still finding my feet to some extent but it is an exciting opportunity. I certainly hope to make use of the skills I have acquired in research. I guess I would say that although the PhD is complete, the future is a work in progress.
Back to front and probably upside down describes my pathway to both academia and the completion of a PhD with the CPHCE. I have been a general practitioner for 25 years and have worked in a variety of practices in NSW and now Queensland. I am a true generalist, interested in everything and everyone. This describes my research interests as well as my clinical interests.
After many years of working in clinical practice and doing some research and teaching with the RACGP, I embarked on an academic career with UNSW in 2003. I was responsible for developing one of the courses for the new medical program, Society and Health 2 and also taught general practice skills to the more senior students. I did a number of small projects investigating different aspects of chronic disease prevention and had several publications to my name. I finally was dragged kicking and screaming into a PhD in 2007 when I was lucky enough to be included as CI on a large NHMRC project with Professor Mark Harris and colleagues. I developed my proposal in conjunction with the project and investigated the mental health aspects of the intervention designed to address cardiovascular risk factors in general practice patients. I conducted a mixed method study motivated by my patients who were always telling
me (literally or otherwise) that “stress” prevented them making lifestyle changes that might benefit their health. I thought I would explore psychological distress in the participants in the randomized controlled trial and see if indeed stress played a part in either facilitating or blocking attempts at lifestyle behavior change.
So, seven publications later (three as first author) and lots of hard work, a thesis was written and the PhD awarded in July 2014. The answer to the question, not surprisingly, is complex and the thesis a good read. To get there, it was 7 long years of persistence peppered with significant personal and professional challenges and you might say it was all worth it in the end. I moved to James Cook University in north Queensland in 2010 and am now the Head of the Discipline of General Practice and Rural Medicine, Director of Clinical Studies for the College of Medicine and Dentistry, the Primary Health Care Coordinator for the Anton Breinl Research Centre for Health Systems Strengthening, the Clinical Coordinator for the North Queensland Practice Based Research Network and, in my spare time, the Assessment Panel Chair for the RACGP North Queensland Sub- Faculty.
I teach medical students in all 6 years of the undergraduate medical program at JCU, have supervised two MBBS honours students, am a research mentor for a Masters student and have just accepted my first PhD student. I travel extensively in north Queensland as we have students and staff spread out over an area that is more than twice the size of NSW, from the Torres Strait in the north, down to just south of Mackay and west to Mt Isa, Winton and Longreach. As I fly over the Barrier Reef for a day or two of work in Cairns, or over the red dirt and cattle country of western Queensland on the way to Mt Isa, I pinch myself about how lucky I am. As I cross the Gulf of Carpentaria and see
all the massive rivers flowing north on the way to see students in Darwin, I wonder how a GP from northern Sydney ended up in this wonderful part of the world. A part of Australia which is a land of great beauty but where we still have great health disparities and where we have populations that are underserved. A land where we are training a health workforce who have the right skills and attitudes to work in the places of most need and know how to make a difference to their communities. What a privilege to be able to use the skills and knowledge that have been entrusted to me by my teachers and mentors to contribute to this cause.
My journey towards becoming a researcher and PhD student at CHETRE started in my home country New Zealand where I studied Law and Psychology. I was always curious about understanding how other people think and feel and the thought of standing up in court arguing for people’s rights appealed to me. My parents tell me how already at primary school, I would come home and tell them about various injustices I thought teachers had been perpetrating on children - I always had sympathy for the underdogs (or who I perceived to be underdogs) and a strong sense of fairness.
After completing my professional studies and being admitted to the bar I left New Zealand – following a nice German boy I had met rock climbing. My studies took a new turn, and I ended up studying a Masters in Public Health at Bielefeld University. I thought I had finished with law until one day in the library I came across a new book that looked at the relationship between health and human rights. It resonated with me. I clearly remember sitting on the floor in the library reading and reading feeling excited, which to be honest didn’t happen to me that often in my studies! I decided to focus my master’s thesis on health and human rights. At the same time, I began working part time at the State Institute of Public Health North Rhine Westphalia in an EU funded project developing policy health impact assessment (HIA) methodology. HIA soon became the main focus of my research career. What I particularly liked about HIA is that it provided an opportunity for applied research that can make a direct difference to people’s lives. I also liked the focus on equity, and the potential for communities to use HIA as a tool for to protect and enhance their wellbeing.
We then moved from Germany to northern England, where I went to the International Health Impact Assessment Consortium (IMPACT), which is based at the University of Liverpool and forms part of the WHO Collaborating Centre for Policy Research on the Social Determinants of Health. I undertook HIAs and did research and teaching, a welcome change after years of being a student. The nice German boy had come with me and during our time there we had a daughter – Aife. The long-wet winters and a desire to be closer to my family combined with a great opportunity to join the HIA team at CHETRE (not to mention the appeal of rock climbing in the Blue Mountains) then led us to Australia at the beginning of 2011. At CHETRE I have been encouraged and supported to begin a PhD that has given me the opportunity to combine HIA with human rights. CHETRE feels like a good fit for me – there is a sense of shared values with people working here despite the content of our work being so varied. This also translates into a work environment which values people as a whole not just what they contribute to the job.
I can’t wait to see what happens next…
My journey into has been on a winding country lane rather than a freeway. Initially I worked as a therapy radiographer in some of Sydney’s major hospitals. I enjoyed the teamwork and contributing to the healing process for many patients, and also the rewards and emotional demands of palliative care, with all the additional care, understanding and support for patients and their families that this required.
I left when my son was born and became fascinated with the rapid learning and development that takes place in early childhood. The arrival of twin girls a short time later saw me extremely busy, but somehow, I found the time to start a playgroup for multiple birth families. I then followed a friend into an Early Childhood Education course, shifting a year later to a distance learning program at Macquarie University. My studies were put on hold by the birth of my fourth child, another boy. However, before life descended into a round of nappies and night feeds, I received an unexpected offer to work as a teacher’s aide at the local school, thanks to the many hours I had enjoyed volunteering in the classroom, reading with and supporting children there. I started in February, juggling three young children and a new baby. There were some initial challenges but everything fell into place, as it always does, despite my worrying.
My career then took another twist: an unexpected return to study in a condensed course Certificate III (Special Education) program for teacher’s aides. A chance meeting towards the end of this course with a lecturer from Macquarie University inspired me to return to university to complete my degree. The experience of participating in a group research project the following year ignited my passion for research. I became fascinated by the process of transition to school, particularly for children experiencing difficulties. In my honours thesis I documented the experiences of a child with language impairment in the transition from Kindergarten to Year One.