Implementing self-injection (SI) of subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) is a key self-care strategy for sexual and reproductive health, but SI uptake remains low, and assertions about the potential of SI to increase women's control over contraceptive use lack evidence. We sought to qualitatively explore how women with diverse contraceptive experiences-including those with and without experience using SI-view the benefits and challenges of SI as compared to other methods. We conducted 241 in-depth interviews with women across four sub-Saharan African countries and found alignment between the perceived and experienced benefits of SI across our diverse sample. Through the benefits of privacy, easier access, and self-management, we found SI can promote greater control over the contraceptive experience by facilitating a woman's ability to act on her preferences and control who is involved in or aware of her contraceptive use. Interviews revealed SI's potential is, however, constrained by inherent limitations in the method; for example, it is often not private or accessible enough and many fear injecting themselves. SI has the most potential when implemented with programmatic solutions that mitigate challenges women experience or anticipate and allow more women to benefit from the privacy, easier access, and self-management that SI offers.

Establishing and proving methodological rigor has long been a challenge for qualitative researchers where quantitative methods prevail, but much published literature on qualitative analysis assumes a relatively small number of researchers working in relative proximity. This is particularly true for research conducted with a grounded theory approach. Different versions of grounded theory are commonly used, but this methodology was originally developed for a single researcher collecting and analyzing data in isolation. Although grounded theory has evolved since its development, little has been done to reconcile this approach with the changing nature and composition of international research teams. Advances in technology and an increased emphasis on transnational collaboration have facilitated a shift wherein qualitative datasets have been getting larger and the teams collecting and analyzing them more diverse and diffuse. New processes and systems are therefore required to respond to these conditions. Data for this article are drawn from the experiences of the Innovations for Choice and Autonomy (ICAN) Research Consortium. ICAN aims to understand how self-injectable contraceptives can be implemented in ways that best meet women's needs in Kenya, Uganda, Malawi, and Nigeria. We found that taking a structured approach to analysis was important for maintaining consistency and making the process more manageable across countries. However, it was equally important to allow for flexibility within this structured approach so that teams could adapt more easily to local conditions, making data collection and accompanying analysis more feasible. Meaningfully including all interested researchers in the analysis process and providing support for learning also increased rigor. However, competing priorities in a complex study made it difficult to adhere to planned timelines. We conclude with recommendations for both funders and study teams to design and conduct global health studies that ensure more equitable contributions to analysis while remaining logistically feasible and methodologically sound.

Much of the methodological literature on rapid qualitative analysis describes processes used by a relatively small number of researchers focusing on one study site and using rapid analysis to replace a traditional analytical approach. In this paper, we describe the experiences of a transnational research consortium integrating both rapid and traditional qualitative analysis approaches to develop social theory while also informing program design. Research was conducted by the Innovations for Choice and Autonomy (ICAN) consortium, which seeks to understand how self-injection of the contraceptive subcutaneous depot medroxyprogesterone acetate (DMPA-SC) can be implemented in a way that best meets women's needs, as defined by women themselves. Consortium members are based in Kenya, Uganda, Malawi, Nigeria, and the United States. Data for the ICAN study was collected in all four countries in sub-Saharan Africa. In order to both illuminate social phenomena across study sites and inform the program design component of the study, researchers developed tools meant to gather both in-depth information about women's contraceptive decision-making and data targeted specifically to program design during the formative qualitative phase of the study. Using these two bodies of data, researchers then simultaneously conducted both a traditional qualitative and rapid analysis to meet multiple study objectives. To complete the traditional analysis, researchers coded interview transcripts and kept analytical memos, while also drawing on data collected by tools developed for the rapid analysis. Rapid analysis consisted of simultaneously collecting data and reviewing notes developed specifically for this analysis. We conclude that integrating traditional and rapid qualitative analysis enabled us to meet the needs of a complex transnational study with the added benefit of grounding our program design work in more robust primary data than normally is available for studies using a human-centered design approach to intervention development. However, the realities of conducting a multi-faceted study across multiple countries and contexts made truly "rapid" analysis challenging.

Background: Adherence to recommended lifestyle modification regarding hypertension control remains a serious problem in Malawi, leading to poor blood pressure control. Objective: This study examined factors that facilitate adherence to recommended lifestyle modification among hypertensive clients’ at Malamulo hospital in Thyolo Malawi. Methods: A descriptive cross-sectional quantitative study was conducted with 108 clients who were recruited through a systematic sampling method. Data were collected through face-to-face interviews using a pre-tested structured questionnaire. Using statistical Packages for Social Sciences (SPSS) version 22, Chi-Square (x2) test was applied to test each predictor variable for statistical significance. The significant predictors were entered into the logistic regression model to determine the independent predictors of recommended lifestyle modifications amongst clients. Odds ratio (OR) at 95% Confidence Interval (CI) was used to declare the independent effect of each variable on the outcome variable. Results: 108 respondents were enrolled in the study, the majority of who were women (60.2%). Findings demonstrated that clients had adequate knowledge of lifestyle modification with an overall knowledge rate of 92% though the overall adherence rate was poor at 53.8%. Having family support (OR = 4.587, 95% CI: 1.625, 12.947, p = 0.004) and support groups (OR = 4.043, 95% CI: 1.496, 10.926, p = 0.006) are more likely to facilitate adherence to recommended lifestyle modification unlike situations of non-involvement of family and lack of support groups. Conclusion: Clients demonstrated adequate knowledge of recommended lifestyle modifications with poor adherence to them. The presence of support groups and a strong family support system are important factors for fostering adherence to the recommended lifestyle modifications regarding hypertension control.