Building multinational interoperability in Defence Engagement (Health) training: outcomes from a two-cycle action research methodology

Background As global crises increasingly demand coordinated civil-military responses, the ability of military medical services to collaborate with other militaries and governmental partners has become essential. Despite the growing importance of international collaboration in Defence Engagement (Health) (DE(H)), North Atlantic Treaty Organization (NATO) lacked a unified training pathway to standardise approaches to multinational health engagement. Adapting the UK Military Global Health Engagement (MGHE) course (along with aspects of the equivalent US course) presented an opportunity to build a common platform for shared understanding of joint planning and interoperability across military partners. In doing so, it aimed to strengthen foundations for a coordinated approach among NATO member states. Method A two-cycle action research (AR) model based on Coghlan and Brannick’s model was used to iteratively design, deliver and improve the NATO MGHE course. Data were gathered through structured observation, participant surveys, faculty reflection and informal discussion across two course deliveries in February 2025 and 2026. Ethical approval was gained from Birmingham City University with all data anonymised and stored in alignment with UK and NATO information governance policies. Findings Analysis identified that a standardised DE(H) approach significantly strengthens international understanding of DE(H) by offering shared concepts, structures and planning tools applicable to both military and humanitarian health sectors. Students valued the multinational faculty, contextual learning and focus on ethical, culturally aware engagement. Adjustment between AR cycles including improved assessment transparency, enhanced support for non-native English speakers, more representative faculty and digital collaboration tools, further increased inclusivity, interoperability and relevance to real-world cooperation. Conclusions The NATO MGHE course provides a credible, scalable platform fostering collaboration and awareness in DE(H). Through AR, the course continues to evolve into an alliance-wide capability that strengthens shared learning, improves multinational interoperability, and creates a common language for DE(H).