Retention in the <i>Bukhali</i> trial in Soweto, South Africa: a qualitative analysis using self-determination theory
Bibliographic record
Abstract
Introduction There is limited research on applying theory to retention in complex intervention trials. To address this gap, this study aimed to qualitatively examine retention in the Bukhali randomised controlled trial, from the perspective of trial participants and staff, through the lens of self-determination theory (SDT). The Bukhali trial is part of the Healthy Life Trajectories Initiative in Soweto, South Africa, with young women. Methods Nine focus group discussions were used to generate data from Bukhali trial staff (n=45, 23–64 years), and participants, including those currently enrolled (n=16, 25–31 years) and those who had withdrawn from the trial (n=20, 24–32 years). A codebook thematic approach was taken to data analysis; SDT was used to develop a conceptual model to analyse the data in context. The main themes identified were external influences on the trial, trial implementing environment, controlled motivation and intrinsic autonomous motivation. Results Our findings highlighted the contextual issues influencing the trial, including participants’ socioeconomic circumstances, and the presence or absence of social support, the trial complexity and participant burden. Issues related to controlled motivation comprised challenges of staying in contact, financial incentives and food, health services provided and other incentives. We also identified aspects of the trial supporting participants’ psychological needs of autonomy, competence and relatedness, which in turn contributed to their intrinsic autonomous motivation. These included participants’ interest in the trial and its relevance to them; participants’ sense of agency, meaning and purpose through their involvement; the building of their knowledge and awareness about their health; relating to other participants and the relationships built with staff and being treated well. Conclusion SDT provides a helpful frame for a contextualised understanding of the complexity of retention of Bukhali trial participants (longitudinal study and intervention). These findings have relevance for trials in under-resourced settings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.039 | 0.039 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.005 | 0.005 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".