Table 1

Learning cycles and their output in terms of reciprocal learning

S no	Name of output	Reciprocal learning process	Examples of reciprocal learning
Learning cycle 1: problem clarification and developing a ToC
1.	Situational analysis	Data from formative phase. Online group discussions with implementation staff from each site. Online debriefing and synthesis.	Focused on input, resources and opportunities for change in each site: limited facility care and self-management knowledge in Uganda; environmental barriers to behaviour change in South Africa and barriers to healthcare for disadvantaged groups in Sweden.
2.	Topic guide	Developed based on discussions related to the situational analysis. Scoping (grey and published) literature reviews conducted in two sites and fed into the topic guide. Tool modified based on joint online discussions with site teams led by the responsible work leader.	Common evaluation after data collection led to awareness of the difficult interpretation of individual behavioural concepts in all contexts.
3.	Theory of change (ToC)	First cross-contextual workshop. Data from topic guide discussed and incorporated. Findings from situational analysis incorporated.	Adaptation of common ToC with more emphasis on environment, linkage between actors in health system and community.
Learning cycle 2: development of the intervention framework and its contextualisation
4.	Intervention framework	Second cross-contextual workshop. Site visits by the responsible work leader. Site-specific stakeholder workshops to discuss implementation feasibility and strategies relevant for each context. Online team discussions by phone and email on strategies to be included in the generic model.	Identification of core common intervention strategies (organisation of care and strengthening patient role in facility; mobilisation, environmental support and community extension in community) and optional elements for each site. Strategies contextualised specifically to site needs and resources.
5.	Intervention tools	Each country team led the development of the most relevant tools, together with the topic team, followed by adaptation by other country teams.	Generic draft tools and finalised site-specific tools developed: patient flow algorithms, peer group manual, care companion guidelines, environment-related interventions for peer groups.
Learning cycle 3: implementation and evaluation of the adaptive implementation trial
6.	Community mobilisation, screening and recruitment	Third cross-contextual workshop. Field testing, discussion in conference calls and with trial and evaluation coordinator, adaptations.	Common development of information materials. Testing of different strategies, three contextualised testing and recruitment algorithms and strategies.
7.	Peer mobilisation	Testing strategies for peer mobilisation and peer leader selection and participant engagement strategies, sharing in cross-country conference calls.	Peer leader training and refresher strategy. Contextualised models for patient engagements to peer groups.
8.	Data collection tools	Third cross-contextual workshop and working groups. Field testing, feedback and adaptation.	Common data collection guide, with context-specific addendum.
9.	Process evaluation tools	Thematic cross-contextual workshop, site visits. First minimum set of process indicators. Comprehensive protocol developed in Uganda—informed other countries.	Minimum set of process indicators implemented, with country-specific extensions.