Meet Charlene Ronquillo, a nursing informatician/implementation scientist interested in figuring out how to develop and implement digital health technologies!

What is your scientific background?

My background is quite diverse and largely shaped by my professional experiences working within the health system. I completed my BSc in Nursing at McGill University in Montréal. During this time, I had some vague idea of what health research was and what it involved, thanks to a short stint as a research assistant in a psychology lab. I then worked as a Registered Nurse in Vancouver, Canada after my basic training. After some time, I completed my Masters at the University of British Columbia that focused on understanding the historical influences that shaped migration of Filipino nurses in Canada. This was followed by some time spent back in practice in a knowledge brokering role. I am currently in the midst of my Ph.D. also based out of the University of British Columbia. I moved to England a couple of years ago and now have a part-time role as an Associate Research Fellow in implementation science at the PenCLAHRC, based out of the University of Exeter in the UK.

A rare, in-person meeting of the Student and Emerging Professionals’ Working Group of IMIA NI-SIG where I served as past Chair/ Charlene Ronquillo

Did you have a role model that influenced your decision to work in science?

Indirectly. I remember, for ages, begging my parents to buy these children’s encyclopedias. Keep in mind, this was in the Philippines where a lot of kids I grew up with couldn’t even afford to get books, supplies, or even shoes for school. We were very fortunate to be relatively well off, but still, these were very expensive and not easy to get. I think it took a couple of years but we eventually got these encyclopedias shipped in from overseas. It was a BIG deal.

My favourites were the Young Scientist series and Childcraft Series. I distinctly remember being antisocial hiding away and flipping through these precious books. I tried to absorb absolutely everything I could, even though a lot of the “experiments” that I so desperately wanted to try were not considerate of non-Western settings (Ooh, make a lemon clock! Wait, what’s a lemon and where do I find one? It costs how much?! Get outta here!). It is thanks to my parents’ generosity that I had these first encounters with science and discovered what scientists were. The kid in me still wants to figure things out.

Presenting on using rapid prototyping to design a smoking cessation website with end-users/ Charlene Ronquillo

Why did you choose to become a scientist and how did you choose your field of study?

Most things in my life – career included — tend to be driven by a combination of curiosity, pragmatism, ambition, all mixed in with incredible support and luck. There have been some key events/circumstances/decisions that have taken me to where I am so far. I’ve very helpfully called these “things” and listed them below.

Thing 1. I started my undergrad in Biology and decided to switch to a “more practical” field. I had reasoned that if I wanted to work as a biologist, that I would need, at a minimum, a Masters degree – why on earth would I want to do more schooling?! It was too late by the time I realized that I unsuspectingly played this hilarious joke on myself.

Thing 2. I worked for some time as a nurse in neurology & neurosurgery, and as a nursing research facilitator. Some key things happened in these jobs: 1) I wondered why there were so many of us Filipino nurses working in hospitals, 2) frustration related to why health care systems are so inefficient, resistant to change and at some many times, nonsensical, and 3) feelings of powerlessness and devaluing – why are things so often thrust upon nurses to implement when they are so rarely asked to be involved in the process? #1 resulted in a Masters. #2 and #3 is what drives most of what I do now. In the words of one of my mentors, one of the overarching goals I have in my career is to “Make nursing suck less.”

Thing 3. Many nurses I’ve met have had no opportunity, desire, or interest in doing research. Yet, nursing research needs happen. I was already interested. I seemed to be ok at this research thing. For me, it simply made sense to take advantage of these interests and leverage the opportunities that I was fortunate enough to have. I figured I can make more of a difference doing this work (that others don’t seem to want to do) than I could work as one nurse on one ward.

Recent presentation at the PervasiveHealth 2017 conference on our SuperNurse project in Barcelona – a collaboration between nursing practice, health informatics, engineering, and computer science/ Charlene Ronquillo

Thing 4. I needed to test out the utility of my Masters in the real world. I went back to practice as a nurse research facilitator. I was responsible for “promoting nurses’ engagement with research and facilitating the uptake of evidence-based practice”…in a region of over 8000 nurses. Month 1: “It would be great if you can finish the development and implement this strategic plan for nursing knowledge and exchange in the health region. And make sure it’s underpinned by theory.” Fortunately, I respond well to pressure, and besides, there was no time to waste panicking. Deep into the implementation science and knowledge translation literature I went. Although initially terrifying, this role was one of the most formative experiences of my career, thus far.

Thing 5. As I explored possible Ph.D. programs, I discovered that informatics – and specifically, nursing informatics, was a field. I figured I might as well rekindle my brief past interests and experiences with technology that was installed when I was part of the Science Computer Taskforce in my undergrad, where we locked ourselves in the basement office all weekend having LAN parties with lots of pizza and BAWLS ran and maintained the campus computers for the science faculty students. Anyway, my point is, I was/am already a bit of a tech nerd. The field was, and still is, teeming with possibilities and will only become increasingly important. I discovered that UBC Nursing had just hired on its first and only nursing informatics faculty. Epiphany. It’s as though the stars aligned and all my experiences were leading up to…. just kidding. I met the new faculty member and she told me I should apply to do a Ph.D. with her and so I did.

Thing 6. Nursing informatics is an incredible field. I am constantly awed by the efforts to advocate for the needs of nurses at the point of care, which are still poorly considered in the design, development, and implementation of health information systems and technologies. Implementation science is equally exciting and something that I keep getting drawn back to. I moved to England about 2.5 years ago and have since had part-time positions focused on knowledge brokering and implementation science. Briefly at UWE Bristol, as a Research Fellow supporting commissioners put together funding applications for health service improvement projects. This helped me (somewhat) understand just how complex the NHS is. I joined the implementation science team at PenCLAHRC as an Associate Research Fellow in Autumn 2016. Our team helps develop and support implementation research in existing and future research projects. The more I learn and re-learn in this field, the more I am assured that the next stage in improving health and health systems lies in understanding how to make implementations successful and meaningful. My experiences, thus far, seem to be coalescing. In terms of future directions, my intention is to explore the opportunities that lie in intersections of these fields.

Testing the high fidelity prototype of the SuperNurse application/ Charlene Ronquillo

Which topic are you working on at the moment? Why did you choose this topic and how do you think you’ll make a difference?

My Ph.D. work investigates factors that may influence nurses’ adoption and usage of mobile health technologies (mHealth). I chose this topic because digital technologies like mHealth are being hailed by some as a panacea to solve all ails of health care. It is not unusual for mHealth to be introduced into systems with poor/short-sighted/no planning, with health care providers such as nurses being asked to use them. A lot of the time, these implementations fail because they do not consider how the technology might fit into the providers’ workflow or if they even meet a need that exists. Providers get blamed or are told, “why don’t you just use it!” This work aims to shed light on the fact that implementations are much more than health care providers being resistant. I’m trying to contribute to understanding how things like specific leadership behaviours, characteristics of mHealth, and nurses’ individual characteristics are related to whether or not nurses use these technologies. It’s one piece of a much bigger picture. I hope that this will make a difference in terms of informing what needs to be considered when planning to implement mHealth into their systems.

My work in implementation science is more varied and spread across different projects. For the moment, this includes exploring the potential role of operational modelling in implementation decision-making as well as topics related to de-implementation and disinvestment of health technologies. Much of this work is tied to relationships with the local organizations and so the potential impact of those projects, to me, seem much more immediately tangible.

What are the hardest parts related to this work?

Substantively, the same parts that draw me to this work: trying to hit two moving targets. Both mHealth and implementation science as emergent. Technologies are constantly and very rapidly changing and health systems are in constant flux. By the time you think you’ve got one bit figured out, it’s probably gone and changed on you.

Practically, it’s a great number of things that will be too long to mention here, but they have to do with job instability, therefore, resulting in the need for many lifestyle/life sacrifices that most academics are familiar with. I’ll also mention the challenges related to the vast difference in expectations of productivity of a “good” scientist some generations (but really not that long) ago versus now.

As someone having a clinician background, I also grapple with the constant tension between the things you need to do to become a “good scientist” (publications, grants) and actually contributing to improving health systems (which are often less sexy, fundable, or publishable).

Exploratory prototyping with the SuperNurse application/ Charlene Ronquillo

Did you ever doubt your abilities as a scientist? Why? How did you handle these situations/feelings?

Doubt is a constant. There is the standard imposter syndrome as an early career researcher and the questions of, am I good enough? Expert enough? Do I have any real authority to talk about anything when all I’ve learned is how little I know? For this group of doubts, it is helpful to speak with other academics as I’ve found that these are common sentiments.

If you were completely free to choose a scientific topic to work on, which would it be?

Purely for the fun of it: something around understanding domestic dogs or something around understanding things through food.

How does your family regard your career choice?

I think they mostly don’t really know what I do or what it means. I’m ok with that as it’s also difficult to explain. Most of my family and relatives tend to have professional degrees and very practical jobs, so a nurse scientist is a novel concept. Progress is being made, however: My mom recently told me that a friend of hers googled and found me on the internet, which is proof that I am doing something.

Besides your scientific interests, what are your personal interests?

Maya the dog, cooking and eating all kinds of food, and I usually really get into some sort of physical activity depending on my whims (weight training right now, boxing earlier in the year, yoga for all time).

Some days are like this. Trying to convince Maya, my partner in crime, to keep me company as I cram in more reading and writing. Ph.D. work + researcher work ain’t no walk in the park (much to Maya’s dismay)/ Charlene Ronquillo

If you had the option to give advice to a younger version of yourself, what would that be?

I tend to take things in stride anyway and am making peace with all the bumps in the road shenanigans that can be part of this work. (Warning, cliché time). I wouldn’t be the same person I was now if it weren’t for the things I’ve messed up and the sometimes random decisions that I have made (see “Things,” earlier in the interview).

In saying that, however, I would give my younger self the following tips:

  • Work on liking yourself earlier in life. Make a real effort. Come on. You’re alright.
  • Maybe go to class once in a while in uni, especially that first year. High-speed internet is amazing but you really don’t need to watch 5 movies a day. And no, “going to school” to play Warcraft doesn’t count no matter how much strategy it involves.
  • You should probably find out what credit cards are about before you go and sign up for one.
  • Cherish people (and animal friends) and the time you spend with them. Really take it all in. They go too soon, sometimes. A wise mentor has told me: “No one ever looks back at their life and wish they spent more time writing that grant or paper.” (this one is in continuous development).
  • Don’t worry so much about achievements and just try to be a good person who does some good in this world (also in continuous development).
  • I don’t know what happens but you become incredibly awkward as you get older. No one can help you. Just embrace it.

What were the biggest obstacles you had to overcome? Did you ever have the impression that it would be easier/harder if you were male?

Being both a female AND ethnic minority scientist. The female aspect I feel a bit insulated from, given that nursing is probably at least 90% female. On the other hand, I think this comes out in a slightly different way when you think of the hierarchical relationship between nursing (considered a feminized profession) and medicine (historically male). This is a topic all on its own, so all I will say is that I do sometimes feel that things would be easier if I were an MD.

The ethnicity issue is an additional thing I wish I didn’t have to deal with. But I cannot escape from the constant question of merit versus tokenism. The question for me is always: Did they really think I was good or did they need to look more “diverse?” Are they just trying to score points because I am both female and ethnic? It doesn’t help that I know that these conversations happen or have had people tell me – all with good intentions – that “we would love to have people like you.” What does that mean?! What exactly are “people like me”?! I have yet to arrive at a good way to handle these feelings, so I am mostly (probably unhealthily) trying to ignore these, for now. I tend not to take things personally anyway, so that works to my advantage most of the time. But if anyone has suggestions of how they deal with this, please share in the comments!

Some days are like this. At the NI2016 post-conference book writing retreat in the Swiss Alps. Pictured here with friend and colleague, Lisiane Pruinelli (aka Big Data Queen)/ Charlene Ronquillo

In your opinion, which changes, if any, are needed in the scientific system to be more attractive to female scientists and possible future scientists?

First, I do want to point out that it is not just an issue of attracting new scientists, but retaining the ones who get pushed out. You can’t fill a leaking bucket.

I can probably give you a huge list of theories, models, and frameworks, to help analyze and pinpoint some of the bits of the scientific system that needs changing. In my view, we are essentially talking about a substantial paradigm and cultural shift that needs to happen within an entrenched, massive, interrelated, complex system. Totally overwhelming. I think the best we can do, in my supervisor’s words, is “chip away at it” as best as we can. I think senior female scientists have an important role to advocate for change, or at the very least, not contribute to the façade that everything is fine.

For me, one way to help shift this culture is challenging the status quo and asking questions to colleagues and those in leadership positions – Why do we do things in this way? Why is this/that a thing we value? According to whom? Who does it benefit? Who misses out? I acknowledge that this is scary for most, especially for those in junior roles. Having these difficult conversations takes practice and skill. Perhaps one takeaway from this profile is to highlight that there are resources out there to develop such skills, which I strongly believe is a key set of skills all female scientists should have under their belt.


You can find out more about Charlene’s work with the PenCLAHRC implementation science team on their blog:

You can also follow Charlene on Twitter!