The Information, Education and Communication (IEC) team developed strategies for communication about the work of the health research centre in general—and the specific trials in particular. This team was made up of Senior Social Scientists, who had conducted the formative research for the trials, and who served as the main link between the research team and the community. Through their formative work, the team had extensive knowledge of the trial participants and could both anticipate and solve problems with the participants’ view point in mind. When it was needed the team conducted additional qualitative trials to understand communication issues. For example, it became clear that in the ObaapaVitA Trial participants had varied understanding of issues such as placebo, the team thus conducted additional research and designed strategies to address the issue .
Importantly the IEC team formed an integral part of the trial management team that met weekly to discuss trial progress and make strategic decisions, this meant they could provide a community perspectives to discussions, and could identify issues that they may needed to consult with, or inform the community about, at an early stage.
The IEC team developed messages and communication strategies around core issues such as introducing trials to the communities, gaining informed consent, and providing feedback to the community at the end of the trial. Study closure was an important issue we considered especially in trials where community members at received an intervention for some time. In order to reach the maximum number of people they used a multi-pronged strategy including community meetings, posters, frequently asked question booklets, visits to schools, work associations, women’s groups, announcements in churches, mosques, health facilities and radio discussion programs. The communication methods were depended on the target audience, for example in urban areas people tended not to come to community meetings so radio broadcasts were the focus, and in areas without radio coverage vans with loudspeakers were used to play messages. The team also considered the credibility of the communication channel, for example if there was a radio discussion program on the trial, a trusted health worker would usually be asked to join. The IEC team also conducted sensitization activities with groups who community members seek advice from such as traditional healers, traditional birth attendants (TBAs) and health workers.
We considered developing good trusting relationships with the community from the earliest stages of the trial as essential, and considerable time and resources were put into strategies to introduce the trials. We adopted a cascade approach first meeting with the regional and then the district political and traditional administrations, then the community level administrations, the community itself, the family and finally the individuals being asked to participate. The community meetings started with religious and political leaders, as their permission was needed to work in the communities. Local traditions such as presenting a bottle of Schnapps (alcoholic drink) to the chiefs were always followed. The alcoholic drinks were then used by the chiefs to offer prayers to God for a successful implementation of the trial. Once the leaders had been informed about the trial, they facilitated organizing a community meeting at a time most convenient for the community members which was called by the traditional local announcer, the gong gong beater. In the meetings issues such as the rationale for conducting the research, why their communities had been chosen for the trials and the randomization process were explained. Care was taken to use local languages and to describe technical issues such as randomization and placebo in a meaningful way. Senior research staff were always present at these meetings to provide credibility and to ensure all questions were answered correctly.
Once community meetings had been held, fieldworkers assigned to each community visited each house in turn explaining the trial first to the family and then to the individual woman who was being asked to participate. At all events community members were encouraged to ask questions, and they usually did. Given that community meetings were not attended by all community members, and that some people may feel intimidated asking questions is such a forum, special attention was paid to how fieldworkers communicated at the family level. Fieldworkers were given information sheets that explained the trial in simple language and were trained in communication skills such as active listening by the IEC team. We believe that this communication training not only improved how the fieldworkers communicated, but also highlighted to them the importance of what the community has to say.
Throughout the trials the IEC team continued to conduct routine activities such as holding focus groups to understand community perspectives, and responding to any concerns raised by the community members. An example of this were issues related to collecting blood samples in a vitamin A supplementation trial . The recruitment of subjects into the trial was threatened by a rumour circulating in the community that the samples of blood which was collected for retinol assessment was intended for sale abroad for transfusion to the aged. This problem was rapidly identified and acted on by the IEC team who organised a series of community meetings to address concerns and to allay their fears about the true intention of the researchers. The IEC team explained why it was necessary for the samples to be collected using the analogy of blood sample analyses at hospitals when patients report for laboratory investigations. Some research participants were invited to visit the KHRC laboratories to observe the processing of blood samples being used for research purposes.