Facilitators and Barriers of ‘Doing Reflection’ in Action Research:
Lessons Learned from the PERFORM2Scale Health Systems Research Project
in Ghana, Uganda, and Malawi
Abstract
While Action Research (AR) in health systems is well established, there
is a dearth of research about how its reflection phase is pragmatically
employed with time-poor healthcare teams, especially within AR
implemented in the Global South. This paper presents the findings of a
nested qualitative study within PERFORM2Scale, a 5-year Health Systems
AR project in Ghana, Malawi, and Uganda. It aimed to unpack the
challenges, facilitators, and lessons learned about enacting the
reflection phase of the AR cycle withdistrict health management teams
(DHMTs) implementing a management strengthening intervention (MSI).
Semi-structured interviews and focus groups with district health
managers and country research teams (CRTs) were conducted, and
thematically analysed. Study findings indicate that pragmatic barriers
such as time constraints, high staff turnover, and challenges utilizing
a reflection diary impeded enaction of reflection. However, DHMTs more
effectively engaged in reflection when conducted collectively and
dialogically, and when the mechanism of reflection aligned with existing
workplace processes and context. The findings indicate that for the
reflection phase to be effective, it requires consistent engagement and
focused support throughout all phase of the AR cycle and in ways which
are contextually relevant, responsive, and collaborative.