Qualitative phase
SSI
In total, 10 structured interviews and six focus groups were arranged with a total of 47 investigators across six countries. They included 34 surgeons, five anaesthetists, and eight research staff caring for patients in both urban and rural populations, and across a range of abdominal surgery disciplines. Interview duration ranged from 34 to 112 min, and focus groups lasted from 92 to 126 min. There was a median of 11 (range 6–16) participants involved in the focus groups. Interview and focus group data from site investigators confirmed that the assumption of a universalist approach to SSI was acceptable, and that symptomology and treatment paradigms were shared across settings. No divergence from this was identified during thematic analysis. This was also explored with the CEI partners; together, they confirmed content validity across settings. No new domains or concepts related to symptoms or treatment of SSI arose, suggesting content validity across contexts. A summary of qualitative data are presented for symptom items in Translation was successfully completed in five target languages after the qualitative phase: French (Benin), Hindi (India), Kinyarwanda (Rwanda), Punjabi (India), and Tamil (India). For some potential languages of delivery, there was no written version of the dialect (for example, Goun in Benin, Fante in Ghana), and, on rare occasions, patients would travel a very long distance for treatment and spoke a language that was uncommon to the local area (for example, Malayam in Northern India). Here, the questionnaire was translated ad hoc from English (source language) by the assessor in the cohort study.