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Abstract
Effective community entry processes influence community participation and acceptance of public health interventions. Though there is a growing body of literature on the importance of community partnerships, there is a lack of pragmatic and practical documentation of the experiences involved in the community entry process as it relates to culturally sensitive topics such as child marriage which can help to support researchers working in this field. This article highlights key themes related to knowledge of the community, effective communication, cultural sensitivity, coproduction and giving feedback which help to build trust between the community members and the research team. Institutional representation, not managing expectations, and lack of clarity, along with personal opinions of community gatekeepers can create challenges for the fostering of trustworthy relationships with the community. These realities must be actively addressed right at the onset of the process between the research team and community stakeholders. Researchers can develop trust, form connections and engage different communities by working with local groups and leaders, using culturally appropriate methods, and addressing community concerns. Future projects working with communities on child marriage in Nigeria and other countries would benefit from the reflections presented in this paper.
- Community-based survey
- Child health
- Global Health
- Qualitative study
- Public Health
Data availability statement
Data sharing not applicable as no datasets generated and/or analysed for this study.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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SUMMARY BOX
Researchers’ community knowledge helps with identifying key stakeholders and community gatekeepers.
Good communication brings about good relationships.
Managing expectations and cultural sensitivity builds trust among researchers and community members.
Coproduction engenders community acceptance and participation.
Introduction
Community entry is the process of establishing, nurturing and maintaining a positive relationship with the community to secure and maintain the community’s interest in programmes or interventions.1 It is a vital process that entails familiarising oneself with the community, initiating contact and gaining knowledge about community structures, leaders, customs and ways of life.2 This helps researchers to have access to the community and get the support of members and leaders. Neglecting or poorly executing this process can have negative implications on project outcomes or even result in the inability to carry out the project within the community. Given its critical role, community entry has emerged as an increasingly important aspect of research, as the success of a project essentially hinges on it.
The importance of effective community entry processes in community-based research is increasingly recognised, as it significantly influences community acceptance and participation in public health interventions. It entails building relationships with the affected communities, communicating with key stakeholders and gaining the trust and support of community members. It is encouraging to see the growth of articles being written on this very crucial precursor of successful community-based research3–6 However, the existing literature is often theoretically focused and does not cover community participation in research on sensitive topics such as child marriage, which is deeply entrenched in social, religious and cultural norms.
Child marriage research
Child marriage is a serious issue that has lasting effects on adolescent girls and their families. Nigeria is home to the largest number of child brides in Africa and the fifth-largest number of child brides in the world after India, Bangladesh, China and Indonesia.7 Child marriage occurs among all ethnic groups in Nigeria, but prevalence differs markedly between ethnic groups. Findings from a secondary analysis of nationally representative data revealed that child marriage is more prevalent among the Hausa/Fulani ethnic groups.8 Additionally, although child marriage is not exclusive to a particular religious group, it was more prevalent among Muslims compared with other religions.8 Drivers of child marriage include gender inequality, social norms and poverty.9 Understanding these drivers and developing effective intervention strategies to end child marriage is hinged on conducting research among affected communities and this is fraught with several challenges such as gaining the community’s trust and fostering community engagement, particularly in regions where the practice is deeply rooted in culture. Hence, we present a documentation of our community entry process which was done to promote acceptance and prevent resistance from the target communities due to the cultural and religious sensitivity of our project.
Ending Child marriage in Nigeria (ENCASE project)
This article provides an account of our experiences, the challenges faced and the lessons learnt as we worked together with selected communities to learn about child marriage in Southwestern Nigeria. The ENding Child mArriage in Nigeria through community-led media Series (ENCASE project) aimed to shift perceptions of and attitudes towards child marriage through radio programmes that were cocreated with Hausa community members in two Southwestern states in Nigeria (Oyo and Ondo). We conducted research that used both qualitative and quantitative methodologies (figure 1) in two cities in: Ibadan, the intervention site located in Oyo state, and Akure, the control site located in Ondo state.10 The radio playlets highlighted the consequences of child marriage, emphasising the benefits of allowing children to mature before marriage and exploring themes gotten from the initial situation analysis through qualitative interviews such as reproductive health issues (eg, vesicovaginal fistula, birth complications), mental health issues (depression, anxiety, suicide), social consequences (domestic violence leading to divorce, separation, stigma and abandonment) and socioeconomic challenges (limited access to education, and career opportunities, resulting in poverty). Radio is a popular source of information and entertainment among members of the community; thus, our entire intervention was oriented around that norm.10
ENding Child marriage in Nigeria through community-led media Series Project Implementation Phase.
Community description
The Hausa/Fulani people are from the Northern part of Nigeria where they predominantly reside; however, many of them move across different parts of the country including southwestern Nigeria where they live together in clusters as a community. Our study was conducted within Hausa communities in two southwest cities, Ibadan and Akure. The community speaks Hausa and retains their tradition and culture wherever they reside, and it is very common for them to live together as a cluster in different areas. Due to their migrant and enterprising nature, majority of them reside around commercial centres, market areas and farmlands in various parts of the country. These Hausa-dwelling settlements in the Southwestern parts of the country are usually referred to as Sabo or Shasha, with some living within existing host settlements like those who reside around the Bodija area in Ibadan.
Nigeria operates a ward system of administration with each Local Government Area further subdivided into a minimum of 10 to 12 wards. Each ward is administered by a councillor, supported by Community/Ward Development Committees (CDC). On the community administrative hierarchy, the ‘Sarkis’ are positional leaders within Hausa communities who oversee the affairs of the community and serve as key decision-makers. It is important to get the buy-in of these leaders in order to be able to conduct research within the communities as their support fosters trust between community members and researchers. Letters explaining the research objectives were submitted to the ‘Sarkis’ and approvals were obtained from them before commencement of the research. Consent was also obtained from all the participating community members, and they were assured of confidentiality and voluntariness to participate in the study and withdrawal without any negative consequences.
Community entry process
We bring together four key reflections generated by our team of researchers on what contributes to effective community entry and engagement for the purpose of conducting high-quality community-based research in two communities in Oyo and Ondo states. The aspects of our partnership with the community that have been effective show the importance of community resource mapping, good communication, managing expectations, cultural sensitivity and coproduction. But how did we come about these concepts? Such ideas are easy to write, and easy to aspire to, but often take a long time to develop and can depend on key moments and events. Paying deliberate attention to how community entry is done, and allowing sufficient time to do it well, is particularly crucial when the research subject addresses an issue that is closely tied to social and religious norms. Initial contact between our research team at the College of Medicine, University of Ibadan, and the Hausa communities in Ibadan and Akure took place in 2021, although there have been interactions by other research teams from across the main campus of the University of Ibadan. Our initial engagement with the communities focused on understanding the community networks and resources that we would need to familiarise ourselves with and the challenges we may likely face before going further in our child marriage research.
The process we refer to as ‘community entry’ throughout this paper lasted for the entire duration of our research project (table 1). It involved a series of planned and spontaneous interactions between various members of the research team, community leaders who occupied varying roles and research participants. The principal investigator who is a community physician had prior interactions (through clinical consultations) with the community in her line of duty before the initiation of the project. She had also visited the communities in person and interacted with some key members and leaders of the community who were introduced to her by the community members. On one of such visitations to the community, she met with the Chairman of the CDC and explained the project rationale and aims to him by speaking in clear language and welcoming questions to clarify grey areas. This key influencer played a crucial role in introducing the research team to the relevant community stakeholders including the ‘Sarkis’ in Ibadan and Akure and this improved community acceptance of our project among members.
Stepwise matrix of the community entry process
Subsequently, the project team followed up with a total number of four familiarisation visits to the communities over the course of the year before the project fully began in 2022. In the first few months, we sought verbal and written approvals from the community heads, and we identified key members of the community as recommended by community leaders and members.
We invited several of the individuals identified to participate as members of our Local Advisory Committee (LAC). This includes the community leaders, religious leaders, researchers from the academic community who spoke Hausa Language and younger and older male and female community members. The purpose of the LAC was to provide strategic insights for the project in the areas of community engagement and the development of culturally acceptable and relevant media contents which target the social norms that drive child marriage. LAC members held an advisory meeting once in each quarter all through the project period and gave useful inputs on important project milestones such as participants’ recruitment, data collection process, data analysis and intervention testing. Furthermore, to enhance community participation, the project team leveraged existing relationships with the Oyo State Primary Healthcare Board and the Ministry of Health. This engagement led to the introduction of the research team to the primary healthcare (PHC) facility in the community by the Medical Officer of Health of the Ibadan North Local Government. This facilitated communication with the chief matron and workers at the PHC in Sabo, who provided valuable support to our team.
Reflection 1: knowing the community helps with identifying key stakeholders
Having a good knowledge of the community structures helped us with our community entry process and this played an important role in the level of receptiveness towards our research. It is important to have a comprehensive understanding of community structures and cultural dynamics. Such understanding empowered us to effectively identify key stakeholders, thereby facilitating meaningful collaboration and successful implementation of our project. The recruitment of our study participants and the cooperation we got from the communities was impacted by involving our LAC members who as community members themselves are familiar with the community structures. They guided and helped us on how to involve and engage the community members all through the research process. By familiarising ourselves with the communities, we were able to successfully identify the crucial factors influencing the research outcomes and engage community members effectively. For instance, interruptions during data collection, to accommodate prayer times, as our study participants were predominantly Muslims who prayed at specific intervals during the day, would have been a challenge, but this was overcome by prior knowledge of the community as we had factored this into our project implementation plan. Additionally, a community gatekeeper had initially denied that child marriage existed in their community, but we reassured him that we would only document whatever we found in the community. This level of engagement and familiarity can significantly impact the willingness of community members to participate in a study.3 4
Reflection 2: good communication brings about good relationships
Effective communication and feedback are important elements of community engagement. As none of our research team members could speak Hausa language, employing Hausa speakers as data collectors was essential in facilitating communication between the research team and the participants. In addition to the Hausa language, majority of the participants understand Yoruba, another widely spoken language in the region, and this also helped with communication with the research team as a majority of our research team are native Yoruba speakers.
For instance, we met and communicated in Yoruba with the gatekeepers from the communities in the two cities; Ibadan and Akure as we explained the purpose of the research to relevant stakeholders in the communities. This was possible because the local Yoruba language of the host communities is well understood by these gatekeepers. Before every visit to the community, a preceding call was made to the community gatekeepers to remind them of the upcoming visits. Additionally, our LAC members had the phone numbers of the research team members and apart from the face-to-face communication, there was also frequent communication via phone calls and WhatsApp messages about the project. This open line of communication helped facilitate information management between the community and the research team members in a timely fashion. In addition to this, during the in-person quarterly meetings with the LAC members, we ensured that we deviated from the existing gendered norms and deliberately requested that women speak first in the LAC meetings to help ensure that their voices were heard and not overshadowed by the men’s voices.
Communities may be reluctant to grant researchers access for various reasons including lack of trust and these challenges can be overcome by employing effective community engagement strategies.11 When conducting research, it is important to establish a strong connection within the community and ensure effective channels of communication.12 13 Communicating effectively with key stakeholders and community members helped facilitate our community entry process as well as improved the participation of the community members. During our first visit to the community, we briefed the stakeholders and community members about the project and this fostered trust. There was clear communication on what the research objectives were and what we aimed to achieve right from the point of entry into the community and the research team visited the community leaders several times to keep them up to date on the progress of the project. This proved helpful in ensuring that we achieved a successful community entry and continuous community engagement. Feedback on the research process is important for future and continued engagement when carrying out community-based research. Through active engagement with community members and responsive feedback on the content of the drama episodes, research instrument and other key research processes, we successfully built a strong sense of trust and rapport. As a result, when the data collectors returned for the quantitative surveys, the participants were receptive towards the study. This positive response can be attributed to the solid foundation of trust we established within the communities, coupled with the increased awareness about the study. This positive reception for the research team highlights the importance of building strong partnerships with communities when conducting research.
Reflection 3: managing expectations and cultural sensitivity helps to build trust
When carrying out community-based research, it is important to communicate clearly about the objectives of the research and manage the expectations of community members. Some of the community members initially perceived the research team as representatives of the government and were making demands from that standpoint. For example, the usual reaction of community members to perceived government presence is to make their needs known and to request services from the government. To address this misconception, the team proactively clarified our role as researchers from the academic community and we clearly stated our objectives and emphasised that our project was focused on research rather than governmental initiatives. By doing this, we were able to manage expectations and foster a shared understanding of the research purpose within the community.
Hausa communities in Nigeria have unique cultural practices, beliefs and social structures that influence their attitudes towards child marriage. Understanding these dynamics allowed the researchers to develop community engagement methods that were culturally sensitive and respectful. To facilitate effective engagement, our team included data collectors who were fluent in the Hausa language, which was mostly spoken in the community. These language skills proved invaluable during each visit to the community. During the research team’s visit to the communities, interactions took place in Hausa, English (which is an official language in Nigeria), and Yoruba languages because some of the community members could converse fluently in Yoruba language which is spoken in the cities where they reside. As a sign of respect for the culture of the Hausa people, the research team were always dressed appropriately, particularly, the females dressed in acceptable modest clothing anytime they visited the communities and composed themselves in manners that were not offensive to the cultures of the community members. For example, we ensured gender concordance by assigning male interviewers to male participants and female interviewers to female participants during the coordination of interviews.
Reflection 4: coproduction helps with community acceptance and participation
Involving community members in the design and implementation of research is important as this contributes to the success of the research within these communities.6 13–16 Notably, enlisting the support of community gatekeepers was a crucial strategy that contributed to the positive outcomes achieved during community entry and engagement in our project.
We held quarterly meetings with the LAC members where they work together with the research team to contribute to project execution. This high level of involvement at every stage of the project drove commitment on their part and improved ownership. During the quarterly meetings, members of the committee reviewed the survey questionnaires, helped develop the radio drama, suggested radio stations that are popular among Hausa speakers and listened to some of the playlets before they were aired. They also acted in some of the playlets, reviewed transcripts of the playlets and pointed out some radio drama scenes that seemed out of place in Hausa culture; their feedback and suggestions were incorporated in the final production of the radio playlet and in rolling out the intervention. The LAC members were excited to be a part of the study and they continued to reach out to the research team of their own accord throughout the project.
Challenges
We encountered some challenges during different phases of conducting this research in the communities.
Gaining the trust of the community required time and effort, as community members needed reassurance that the research team’s intentions were not to portray the community negatively, with some community members getting defensive and insisting that such practice does not occur in their community. We were able to mitigate this challenge by assuring them that we were only there to gather available data for research purposes only.
Likewise, endline data collection coincided with the rainy seasons and some of the participants in our control site had left the communities for the hinterlands or travelled back to the North to farm. This challenge was mitigated by conducting the interviews via telephone calls to improve participation and response rates.
Unanticipated challenges
There was an unprecedented cash scrounge/scarcity around the National elections in Nigeria which occurred at some point during our project. This led to untold hardship in getting cash to facilitate community visits by our data collectors and to also purchase souvenirs for participants. We got around this by spending extra money to purchase cash from point-of-sale vendors.
Many of the female participants from our target communities required the permission of their husbands before they granted interviews to the data collectors; this sometimes led to rescheduling the interviews and was sometimes mitigated by a phone call to the husbands or timing the interviews to when the husbands were around to give permission. The fact that the project and the presence of the data collectors had been previously announced at the mosques by religious leaders and within the community by the community leaders and workers at the health facility helped build trust with the participants.
Conclusion
Community involvement and understanding of cultural dynamics are essential for carrying out quality research. This article highlights the need for effective strategies to engage with community members when carrying out research in a community, particularly when conducting research on a sensitive topic like child marriage. The study shows that using successful community involvement methods requires a thorough understanding of the social and cultural dynamics of the communities. Researchers can develop trust, form connections and engage different communities by working with local groups and leaders, using culturally appropriate methods, and addressing community concerns.
Data availability statement
Data sharing not applicable as no datasets generated and/or analysed for this study.
Ethics statements
Patient consent for publication
Ethics approval
This study involves human participants and was approved by University of Ibadan College of Medicine Institutional Review Board (UI/EC/22/0134) McGill Faculty of Medicine and Health Sciences Research Ethics Board (A08-B77-22B). Participants gave informed consent to participate in the study before taking part.
Acknowledgments
We thank the Sarkis in Ibadan and Akure. We also thank the entire Hausa Community members in Ibadan, Oyo State, and Akure, Ondo State Nigeria for their support during data collection. We acknowledge the support of the Chairman of the Community Development Committee in Sabo Ibadan.
Footnotes
Handling editor Helen J Surana
Contributors Not applicable.
Funding Funding for this study was provided by Grand Challenges Canada through the Stars in Global Health Program (Grant Number: ST-POC-2206-53579).
Disclaimer The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.