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Using a cross-contextual reciprocal learning approach in a multisite implementation research project to improve self-management for type 2 diabetes
  1. Josefien van Olmen1,2,
  2. Peter Delobelle3,4,
  3. David Guwatudde5,
  4. Pilvikki Absetz6,7,
  5. David Sanders8,
  6. Helle Mölsted Alvesson9,
  7. Thandi Puoane4,
  8. Claes-Goran Ostenson10,
  9. Göran Tomson11,12,
  10. Roy William Mayega5,
  11. Carl Johan Sundberg12,13,
  12. Stefan Peterson9,14,
  13. Meena Daivadanam9,15
  1. 1 Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
  2. 2 Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
  3. 3 Chronic Disease Initiative for Africa, Faculty of Health Sciences - University of Cape Town, Cape Town, South Africa
  4. 4 School of Public Health, University of Western Cape, Bellville, South Africa
  5. 5 Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
  6. 6 Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
  7. 7 Collaborative Care Systems Finland, Helsinki, Finland
  8. 8 School of Public Health, University of the Western Cape, Cape Town, South Africa
  9. 9 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
  10. 10 Department of Molecular Medicine and Surgery, Diabetes and Endocrine Unit, Karolinska Institutet, Stockholm, Sweden
  11. 11 Department of Public Health Sciences, Karolinska Institutet and Swedish Institute for Global Health Transformation (SIGHT), Stockholm, Sweden
  12. 12 Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
  13. 13 Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden
  14. 14 Uppsala University, Uppsala, Sweden
  15. 15 Dept of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
  1. Correspondence to Dr Josefien van Olmen; jvanolmen{at}itg.be

Abstract

This paper reports on the use of reciprocal learning for identifying, adopting and adapting a type 2 diabetes self-management support intervention in a multisite implementation trial conducted in a rural setting in a low-income country (Uganda), a periurban township in a middle-income country (South Africa) and socioeconomically disadvantaged suburbs in a high-income country (Sweden). The learning process was guided by a framework for knowledge translation and structured into three learning cycles, allowing for a balance between evidence, stakeholder interaction and contextual adaptation. Key factors included commitment, common goals, leadership and partnerships. Synergistic outcomes were the cocreation of knowledge, interventions and implementation methods, including reverse innovations such as adaption of community-linked models of care. Contextualisation was achieved by cross-site exchanges and local stakeholder interaction to balance intervention fidelity with local adaptation. Interdisciplinary and cross-site collaboration resulted in the establishment of learning networks. Limitations of reciprocal learning relate to the complexity of the process with unpredictable outcomes and the limited generalisability of results.

  • diabetes
  • health services research
  • health policies
  • prevention strategies
  • health systems
  • international collaboration
  • global health
  • type 2 diabetes
  • implementation research
  • multi-country study
  • low and middle income country
  • reverse innovation
  • self-management
  • health services research
  • community interventions
  • research partnerships

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

https://doi.org/10.1136/bmjgh-2018-001068

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    Footnotes

    • JvO and PD are joint first authors.

    • SP and MD are joint senior authors.

    • Handling editor Seye Abimbola

    • Contributors JvO, PD and MD conceptualised the format of this paper and developed the several drafts. SP gave conceptual input to the development of the study and of the paper. DG, GT and PA provided textual and structural comments to the different versions of the manuscript. CG-O, DS, CJS and TP participated in the development of the approach and gave comments on the manuscript. All authors read and approved the final version of this manuscript.

    • Funding This work was supported by the European Commission's Horizon 2020 Health Coordination Activities (Grant Agreement No 643692) under call 'HCO-05-2014: Global Alliance for Chronic Diseases: prevention and treatment of type 2 diabetes'. The content of this article is solely the responsibility of the authors and does not reflect the views of the EU.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The study was approved by the ethics committee in each of the respective countries, including the Higher Degrees, Research and Ethics Committee of Makerere University School of Public Health and the Uganda National Council for Science and Technology (Ref HDREC-309 and HS 1894, respectively) in Uganda; the Office of the Dean, Department of Research Development (Ref 15/3/17) of the University of Western Cape, South Africa; the Regional Ethics Review Board in Stockholm (Ref 2015/712-31/1), Sweden; and the Institutional Review Board (Ref 993/14), Institute of Tropical Medicine, Belgium. Patients participating in the trial have signed informed consent to participate in the trial.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data sets used and/or analysed during the current study are available from the corresponding author on reasonable request.