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Facilitators and Barriers of ‘Doing Reflection’ in Action Research: Lessons Learned from the PERFORM2Scale Health Systems Research Project in Ghana, Uganda, and Malawi

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posted on 2022-03-18, 22:16 authored by Stephanie HuffStephanie Huff, Adelaine Aryaija-Karemani, Samuel Agyei Agyemang, Kingsley Chikaphupha, Justine Namakula, Samuel Amon, Hastings Mayingira, Kassim Jailosi Kwalamasa, Lifah Sanudi, Susan Bulthuis, Rebecca Murphy

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 with district 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.


H2020- EU.3.1.6., grant agreement number 733360


Declaration of conflicts of interest


Corresponding author email

Lead author country

  • Ireland

Lead author job role

  • Higher Education Researcher

Lead author institution

Maynooth University

Ethics statement

This scholarship was nested within the larger 5-year P2S project and multinational consortium, funded by the European Commission’s Seventh Framework program (FP7 Theme Health: H2020- EU.3.1.6., grant agreement number 733360). Led by principal investigators from the Liverpool School of Tropical Medicine (LSTM), the project was granted clearance to conduct this scholarship by The Research Ethics Committee at LSTM (Ref. 17-046), Maynooth University (Ref. SRESC-2019-2384349) Makerere University (Ref. HDREC539), Reach Trust, Malawi (Ref. NCST/RTT/2/6), and University of Ghana (Ref.GHS-ERC:009/12/19). All participants provided informed consent prior to engaging in the study and subsequent interviews.

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