Table 2.

Communication Issues and Solutions During the STRIVE Clinical Trial

Issues	Solutions
Varied audience socioeconomic status, education level, medical understanding	Develop illustrated, plain language materials: STRIVE had suite of more than a dozen materials, ranging from frequently asked questions to flip charts. Incorporate anthropological understandings of health and medical concepts into materials: STRIVE incorporated culturally appropriate communication on complex issues, such as immunity. Create multiple ways to convey information (eg, written, key messages for conversations and dioramas): STRIVE created multiple formats to illustrate amount of blood drawn during blood specimen collection (an uncommon practice in Sierra Leone)
Strong need for community trust and support	Engage community stakeholders and social mobilizers to guide strategic development: STRIVE held community workshop months prior to launch to identify community priorities and needs. Build and maintain community stakeholder relationships: STRIVE held recurring (around every 6 weeks) meetings with local stakeholders in all trial districts. Employ local subject matter experts in communication to ensure cultural understanding and relevancy: STRIVE employed Sierra Leonean pharmacists and Peace Corp language and cultural facilitators as part of communication team
Unfamiliarity with informed decision-making communications	Incorporate Human Subjects Protection rights into all potential and enrolled participant materials and messages: STRIVE emphasized the voluntary nature of participation, confidentiality, and the rights of participants (and nonparticipants). Ensure trial staff are trained on informed decision-making communication: STRIVE conducted trainings and mentorship on communications issues, such as reading body language, interpersonal communication, and noncoercive communication
Accustomed to behavior change designed to solicit a particular outcome	Focus on transparency in communications: STRIVE communications materials were clear on potential benefits and risks, as well as what was unknown about the vaccine
Emerging administrative issues as trial evolved	Have way for participants to make trial leadership aware of concerns: STRIVE had a 24-hour hotline that participants could call with any questions concerns, and operators were debriefed every other week to identify emerging issues such as questions regarding follow-up, appointments, or reimbursements