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Table 2 “Periodic Reflections” Guided Discussions Template

From: Periodic reflections: a method of guided discussions for documenting implementation phenomena

Main Components Rationale and Guidance
 Goals and Focus: These reflections are intended to provide an opportunity to check in regularly about how implementation efforts are going. Our main goal is to take a few minutes to discuss, document, and reflect on key activities, events, and changes occurring over the course of implementation.
Sets stage for core goals of observing, documenting, and reflecting on implementation-related events and phenomena. Serves as instructive language during early reflections, helping participants become accustomed to the process. In later sessions, provides an orienting reminder of the goals of the activity.
 Completed by reflection lead
Allows linkage to implementation phase, events. Periodic reflections provide a means to gather repeated, consecutive information regarding implementation events and conditions occurring at specific moments over the course of an implementation effort. Data can be reviewed retrospectively to reveal changing phenomena and/or sensemaking over time, and, in longitudinal analyses, can aid in understanding fluctuations in implementation or clinical outcomes.
Participant Names/Roles
 Completed by reflection lead
Provides information on the role of participating team members. Key agents may vary across time according to changing teams or study needs, implementation phase, or site involvement.
Status update
 What are the current main activities for the project? How is it going?
Open-ended invitation to discuss the implementation project generally, including major activities and current sense of challenges and successes. Prompts may be used as needed to encourage discussion of day-to-day efforts, recent accomplishments and completed tasks, as well as barriers that have arisen and the sensemaking and problem-solving that has occurred in response. Open discussions may help the group to strengthen connection and gain new insights on recent events. When multiple team members are participating, open dialogue and turn-taking is encouraged.
Adaptations to Intervention
 Have there been any changes to how the intervention is delivered in the past month or so?
Observing, documenting, and reflecting on adaptations to the intervention aids in understanding mechanisms and outcomes of program impact.
Adaptations to Implementation Plan
 Have there been any changes to the implementation plan in the past month or so?
Observing, documenting, and reflecting on adaptations to the implementation plan, with value for understanding what implementation strategies were undertaken and how agents responded. Aids in refining plans for scale-up and spread.
Stakeholder Engagement
 Have there been any stakeholder engagement efforts in the past month?
Tracking of specific outreach efforts made in service of research or implementation efforts; provides an opportunity to capture formal and informal activities aimed at supporting interdependencies with local and national partners.
 Have you seen any recent changes in the local or national environment that you think may have impact for implementation?
Acknowledges the unpredictability of implementation settings, as well as how changing conditions across multiple levels (local, regional, national) can impact the success of implementation efforts. Prompts continued attention to contextual conditions, supporting opportunities for study documentation, novel sensemaking, and/or adaptation as needed.
 What are the next steps going forward?
Provides opportunity for discussing expected activities over the coming weeks, helping to link discussion of recent events and conditions to plans for future action.
Additional Prompts (for use as needed)
 • Have particular barriers/concerns have arisen recently? What solutions have been tried? How is that going?
 • Who have been the key people involved in recent activities, efforts, and discussions? What have been their primary concerns, hopes, and/or suggestions?
 • Have there been any surprises lately, or unexpected events?
 • What lessons have been learned?