Data analysis.
The audio recordings were concurrently translated into English and transcribed into Microsoft Word by individuals fluent in English and one or both local languages. A mixed inductive-deductive approach was used for coding. An initial codebook was created a priori based on the questions in the instruments. During the coding process, additional sub-codes were added as themes emerged. All coding and analysis was conducted in Nvivo v12 (QSR International, Doncaster, Australia). Three study personnel conducted the coding. At the beginning of each round of analysis, personnel each coded the same interviews to measure inter-rater reliability. We used the Nvivo Coding Comparison query and considered the resulting kappa coefficients. We ensured that the coefficients were over 0.75 each time, per Nvivo’s recommendation, and that coding was as similar as possible among individuals.Although findings from this analysis could not be validated by the participants, they were triangulated with previously published quantitative data from the same communities on attendance at community gatherings and adherence to guidelines.Demographic data were cleaned and analyzed in SAS v9.4 (SAS Institute Inc., Cary, NC). Descriptive characteristics are presented by respondent type. Means and standard deviations were calculated for age highest grade completed. Proportions were calculated for respondent sex, marital status, and clinical position of health center staff. We only collected marital status for FGD respondents. We first present the demographic characteristics of the respondents and then the qualitative results by theme.