Table 2. Examples of challenges facing frontline workers (FWs) in global health across five Wellcome Trust Africa and Asia Programmes (AAPs).

Category of labour undertaken by FWs	Main theme of challenge	Example of challenges facing FWs across the AAPs	Overlapping categories
PHYSICAL	Physical safety of FWs	• Risk of abuse and assault (especially among female FWs)	• Emotional
		• Risk of attack from stray dogs (risk of rabies disease)	• Emotional
		• Additional challenges due to COVID: Heightened risk of infection with COVID-19 among FWs visiting participants' homes	• Emotional
SOCIAL/relational	Relationships with research communities	• Being accepted into a community/building trust/relationship with community (relational work to gain acceptance)	• Emotional
		• Facing resistance and backlash from community and taking the blame when there are problems with the research	• Emotional
		• Accused of stealing money from community when there is a perception of inadequate 'payment' (compensation) for research study participation	• Emotional
		• Participants feel uncomfortable to have FWs in their home for an interview because they live in poverty, while study protocol requires FWs spend time in participants' homes	• Ethical/Political
		• FWs who are from the same community as study participants feel they need to work extra hard to bring benefits to their communities	• Ethical/Emotional
		• Additional challenges due to COVID: Difficulties building trust remotely when in person visits of community are restricted	• Political
ETHICAL/moral	Procedural ethics: Issues related to recruitment, informed consent, confidentiality, and trust	• FWs need to rush the consent process to meet demanding recruitment targets, aware that participants may lack understanding about study and informed consent may be undermined	• Political/Physical
		• FWs do not always understand study < protocols and just hand out info sheets, worried that community won't have confidence in them if they can't answer questions about the study	• Social/Political
Category of labour undertaken by FWs	Main theme of challenge	Example of challenges facing FWs across the AAPs	Overlapping categories
		• Participants join research because of hierarchal structures of relationships and trust in healthcare workers and research institutions, compromising informed consent	• Social/Political
		• Diversity of ethnicity at field sites cause challenges for translation and interpretation of study protocols and ethical terms, particularly when translators are not part of study team	• Social
		• FWs struggle to ensure privacy and confidentiality of participants as required by the study protocol in community-based studies when family and community members listen in during data collection	• Social
ETHICAL/moral & EMOTIONAL/psychological	Everyday ethics: ethical challenges and moral dilemmas	• FWs' personal values/world views conflict with the views they need to promote as part of a study (e.g. around COVID vaccination)	• Social
		• FWs' moral distress and discomfort when needing to ask difficult or sensitive questions when they know study won't help to address these issues	• Social/Political
		• Community expectations that FWs will solve community problems leads to high stress and burnout	• Social/Physical
ETHICAL/moral & POLITICAL/institutional/structural	Ambiguity surrounding fieldworkers' roles and responsibilities	• FWs face moral distress when working in contexts of deprivation and poverty, when research studies do not align with community interests or meet basic needs (e.g. for food)	• Emotional/Social
		• Communities expect FWs to provide basic necessities, but research protocols do not provide for this, putting FWs in uncomfortable positions (e.g. interviewing someone who is hungry, but being uncertain if they should share the lunchbox with them)	• Emotional/Social
POLITICAL/institutional/structural	Workload, lack of support and isolation of fieldworkers	• FWs work in silos and don't share their experiences/solutions together, partly due to concerns about confidentiality of research	• Social/Emotional
Category of labour undertaken by FWs	Main theme of challenge	Example of challenges facing FWs across the AAPs	Overlapping categories
		• FWs face significant workload and time pressure to recruit high sample sizes, often while working on multiple studies with different PIs, resulting in stress and burn out	• Physical/Emotional
		• FWs don't feel supported by PIs who do not understand the context of everyday fieldwork	• Emotional