Table 1

Learning cycles and their output in terms of reciprocal learning

S noName of outputReciprocal learning processExamples 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.