Institute for Global Health, University College London, London, UK.
Department of Paediatrics, University College Hospital, Ibadan, Nigeria.
Trials. 2023 Jun 7;24(1):385. doi: 10.1186/s13063-023-07320-1.
Current debates in Global Health call for expanding methodologies to allow typically silenced voices to contribute to processes of knowledge production and intervention design. Within trial research, this has typically involved small-scale qualitative work, with limited opportunities for citizens to contribute to the structure and nature of the trial. This paper reports on efforts to move past typical formative trial work, through adaptation of community conversations (CCs) methodology, an action-oriented approach that engages large numbers of community members in dialogue. We applied the CC method to explore community perspectives about pneumonia and managing the health of children under-5 in Northern Nigeria to inform our pragmatic cluster randomised controlled trial evaluating a complex intervention to reduce under-5 mortality in Nigeria.
We conducted 12 rounds of community conversations with a total of 320 participants, in six administrative wards in Kiyawa Local Government Area, Jigawa state, our intervention site. Participants were male and female caregivers of children under five. Conversations were structured around participatory learning and action activities, using drawings and discussion to reduce barriers to entry. During activities participants were placed in subgroups: younger women (18-30 years of age), older women (31-49 years) and men (18 years above). Discussions were conducted over three 2-h sessions, facilitated by community researchers. Following an initial analysis to extract priority issues and perspectives on intervention structure, smaller focus group discussions were completed with participants in five new sites to ensure all 11 administrative wards in our study site contributed to the design.
We identified enabling and limiting factors which could shape the future trial implementation, including complex power relationships within households and wider communities shaping women's health decision-making, and the gendered use of space. We also noted the positive engagement of participants during the CC process, with many participants valuing the opportunity to express themselves in ways they have not been able to in the past.
CCs provide a structured approach to deep meaningful engagement of everyday citizens in intervention and trial designs, but require appropriate resources, and commitment to qualitative research in trials.
ISRCTN39213655. Registered on 11 December 2019.
当前全球健康领域的讨论呼吁扩大方法，以使通常被沉默的声音能够为知识生产和干预设计过程做出贡献。在试验研究中，这通常涉及小规模的定性工作，公民很少有机会为试验的结构和性质做出贡献。本文报告了通过适应社区对话（CC）方法努力超越典型的形成性试验工作的情况，CC 方法是一种面向行动的方法，使大量社区成员参与对话。我们应用 CC 方法来探索社区对尼日利亚北部肺炎和 5 岁以下儿童健康管理的观点，为我们在尼日利亚评估一项旨在降低 5 岁以下儿童死亡率的复杂干预措施的实用群组随机对照试验提供信息。
我们在我们的干预地点吉加瓦州基雅瓦地方政府区的六个行政病房进行了 12 轮社区对话，共有 320 名参与者参加。参与者是 5 岁以下儿童的男性和女性照顾者。对话围绕参与式学习和行动活动进行，使用绘画和讨论来减少进入障碍。在活动期间，参与者被分成小组：年轻女性（18-30 岁）、年长女性（31-49 岁）和男性（18 岁以上）。讨论由社区研究人员进行，每次持续 3 个 2 小时的会议。在进行初步分析以提取干预结构的重点问题和观点之后，在五个新地点完成了与参与者的小型焦点小组讨论，以确保我们研究地点的所有 11 个行政病房都为设计做出了贡献。
我们确定了可以影响未来试验实施的有利和限制因素，包括家庭和更广泛社区内部复杂的权力关系对妇女健康决策的影响，以及性别化的空间利用。我们还注意到参与者在 CC 过程中的积极参与，许多参与者非常重视以他们以前无法表达的方式表达自己的机会。
CC 为日常公民深度参与干预和试验设计提供了一种结构化的方法，但需要适当的资源和对试验中定性研究的承诺。
ISRCTN39213655。于 2019 年 12 月 11 日注册。
