Table 2. Results of the coding and framework analysis.
| Categories of codes (mirroring pre-defined objectives) | Codes (used in Nvivo) | Themes (identified through analysis of framework matrix) | Sub-theme (detailed aspects of themes) | Key findings (Interpretation) |
|---|---|---|---|---|
| Knowledge of malaria | Malaria names | Malaria Literacy | The term ‘malaria’ is often used interchangeably with ‘fever’ | |
| Malaria health effects | Multiple causes of malaria | Confusion over promoted health messages | ||
| Malaria causes | Risk aware | Children are recognised as a vulnerable group | ||
| Malaria seasons | Prevention practices aware | Behaviours reflect CHWs’ health messages | ||
| Malaria vulnerability | Prevention medication unaware | Malaria-related health education may not improve uptake of SMC | ||
| Malaria general prevention in adults or in general | ||||
| Malaria general prevention in children | ||||
| Malaria prevention—IPT experience | ||||
| Malaria prevention—IPT knowledge | ||||
| Malaria treatment seeking behaviour | ||||
| Perceived effect of SMC on children's health | SMC good effects on children | Perceived Influence of SMC | Varied uptake and interpretation of side-effects | Uptake varied despite positive health effects |
| SMC bad effects on children | Supportive networks (f) | Supportive assurances may counteract negative influences | ||
| SMC effects on caregivers | Non-health benefits | Wider indirect benefits beyond child health | ||
| Trust (facilitated uptake) | Hierarchical trust (f) | Caregivers sought government and medical experts to sanction medication | ||
| Trust in the status quo (f) | CHWs are a conduit of that trust | |||
| A trust learnt though experience (f) | Learnt trust and positive testimony may encourage others | |||
| Experiences and attitudes concerning the concept of SMC | Blood testing | Understanding of Chemoprevention and Treatment Philosophy | Poor recall despite experience | Purpose of SMC could be made more clear and acceptable |
| Understanding SMC | Medical testing seen as a precursor to any medication (b) | Caregivers conditioned to RDT and medication to treat versus medication to protect | ||
| CHWs’ role in SMC trial | Medication for healthy children a difficult concept (b) | Challenge asking caregivers to re-prioritise their time | ||
| Experiences and attitudes concerning the regimen of the chemoprevention, in particular the extended period of SMC delivery | SMC reported dosage | Access to Medication and Dosing Regimen (was sometimes challenging) | Three-day regimen may be difficult to follow (b) | Close supervision of consumption and /or a single day regimen may aid uptake |
| SMC 3-day adherence ease and motivation | Five monthly cycles acceptable | Desire to collect SMC | ||
| SMC 3-day adherence challenges and reasoning | Access (b) & (f) | Limited communication of access and restricted modes of access to medication | ||
| SMC 5-month adherence ease and motivation | ||||
| SMC 5-month adherence challenges and reasons | ||||
| Preferred place of administration of SMC | Proposed SMC law in Ghana | Preferred distribution method | Caregivers and CHWs give little support for child welfare clinics | Multiple mechanisms of delivery will support users’ needs |
| Community meeting point—merits | Caregivers and CHWs give more support for community gatherings and home visits | Better communication and multiple distribution methods would support uptake | ||
| Community meeting point—challenges | CHWs propose community kiosks | Participants suggested meaningful ways to improve delivery and administration including Community Kiosks staffed by CHWs. | ||
| Community weighing centre—merits | CHWs to be trained | |||
| Community weighing centre—challenges | Finances required to resource CHWs to support delivery | |||
| At home–merits | ||||
| At home—challenges | ||||
| Other | Questions for the Interviewer at the end of interview | - |
NB: [(f) = cited facilitator of uptake and (b) = cited barrier of uptake)]