Table 6 Key actors (and those suggested) for community engagement activities (observation and interviews data)

Administrative authority (includes District Officers, Chiefs and Village elders)

1. Consultation and entry. For example:

1. Conducted additional sensitisation activities in the absence of KEMRI staff and warn people to avoid politicizing the research process in community barazas (public meetings)

1. Contribute to success of the trial, defined primarily as achievement of sample size and general smooth running

• Seek support and permission to carry out the trial

2. Asked participants to speak about their experiences in public meetings

2. Community health benefits, for example, construction/ expansion of HF and improved quality of care (ambulatory services, skilled staff, and so on)

• Gather opinions on who should be targeted with study information and identify other opinion leaders

3. Intervened during low recruitment to emphasize others to join the trial, including through demanding from leaders why recruitment challenges are being faced (site A), and threatening to withdraw people from food for work project (site A), and to arrest rumour mongers (site C).

3. Personal or professional gains, for example, lifts from KEMRI vehicles, allowances when engaged in activities, increased status/recognition through affiliations with KEMRI/staff, assistance in constructing offices, and being seen as successful, that is, through introducing a (quasi) government project

2. Sensitisation and mobilisation. For example:

4. Made many requests for personal or professional gains, for self, or others.

• Create awareness of KEMRI and understanding of trial activities in their jurisdiction

• Assist with meetings for other opinion leaders and community members through barazas (public meetings)

3. On-going communication. For example:

• Be aware of trial and procedures if contacted by concerned community members

• Forward community issues to study team where necessary

Community organisations/forums (for example, a local district stakeholders’ forum)

1. Sensitisation and mobilisation. For example:

1. Assisted in giving simplified information at large meetings. Assisted in clearing community concerns about KEMRI’s work

1. Gains to the organisations that they are part of - for example membership fee to the organisation

• Create awareness of KEMRI and understanding of trial activities

2. Made some requests to KEMRI for the organisations that they represent

2. Protection of the community against risks and concerns

• Encourage interested community members to hear more about the trial

Fieldworkers (these are local community members employed to undertake certain study procedures)

1. Benefit community and build trust through employing members using transparent mechanisms

1. Communicating constantly with community members through their roles and in their personal lives as they live in the community, including through handling numerous questions

1. Meet recruitment targets to maintain jobs

2. FWs conduct their formal study roles which include sensitisation and mobilisation, constant feedback to study team, and feedback of individual and study findings

2. Emphasise study benefits in all interactions

2. Build relationships that support recruitment