Table 1 Summary of the main findings of the paper per theme developed

Perceptions of informed consent

-Many community members had some understanding of consent. They described informed consent as a condition of knowing about the research, and making a decision based on this knowledge.

-This knowledge of consent was attributed to their previous involvement in agricultural as well as health research (widespread campaigns against HIV/AIDS, other sexually transmitted infections and malaria)

Authority structures in these communities

-Community leaders (fons, quarter heads) and family heads were considered to play an important role in the informed consent process.

-The fon was said to be the materialisation of the invisible, that is, the ancestors and as such, was highly respected in the society.

-The fons constituted a very influential class of people who could not be by-passed as far as issues of permission were concerned.

-However, these findings were not in line with national and international guidelines for ethical conduct in research which recognize that whatever the cultural context within which research is conducted, individual informed consent should be given voluntarily by competent participants involved in the study and not by others.

-In our cultural context, researchers are therefore recommended to obtain permission to approach from community leaders (fon, quarter heads) and family heads before seeking individual informed consent.

Routes and strategies for approaching the communities

- Several possible routes of entry were raised, including the fon, the quarter heads and the health centre. Most community members recommended the fon as the entry point, once clearance from the health system at Regional level was given (Figure 2).

-Health workers were seen to be very important in the sensitization process; however they themselves must be clear about the nature of informed consent and the distinction of this process from one of maximising recruitment.

Factors facilitating or hindering recruitment to research

-Approach to the community: contacting the community leaders and family heads may facilitate the recruitment process

-Involvement of health staff in the sensitization process may also facilitate both the informed consent and recruitment process. However the health staff must be familiar with the research protocol.