Focus group discussions (FGDs) and key informant interviews (KIIs)

Six FGDs comprising 7–15 mixed gender participants were conducted. Participants in the FGDs were selected to represent caregivers and adults with children in order to capture knowledge, attitudes, and practices related to malaria, malaria prevention, and vaccination of people who might be responsible for decisions about children’s health. FGDs lasted for 15–20 minutes and were conducted by three teams of three research assistants: two members facilitated the discussion, and the third member took notes. For the KIIs, interviewees represented both male and female key community health leaders, including government hospital staff, community healthcare workers, researchers, and public health officials; these interviews were conducted to gain understanding of healthcare workers’ perspectives on community knowledge, attitudes, and practices related to malaria and malaria prevention, as well as insights on vaccinations in the community. KIIs lasting approximately 20 minutes were conducted with community health leaders by research assistants. FGDs and KIIs were conducted in English, Krio, or Mende, whichever language was preferred by the participants. Both FGD and KII teams led discussions using a set of guidelines (see Additional file 2) and recorded the sessions on their mobile devices to later transcribe and translate from Krio or Mende (as necessary) to English. At the onset of the focus group and individual interviews, the research team obtained verbal consent. Once the research team reached what they considered to be a high level of saturation of key themes—the point where the same responses and information were emerging in each session [42, 43]—the FGDs and KIIs were concluded. This decision was also influenced by logistical and time constraints, and further research is recommended to clarify specific qualitative findings in more depth, as herein.

After two members of the survey team checked the transcriptions for accuracy, the FGD and KII audio recordings were deleted for participants’ privacy. Additionally, no names were included in the transcripts. The qualitative data were analysed manually using a coded thematic approach. A codebook was developed based on themes included in the qualitative discussion guideline and was reviewed by the research team. Data were compiled and divided by subthemes, which were further grouped by similar concepts and ideas. The main findings from each subtheme were then reviewed by two researchers and summarized and interpreted (see Additional file 3).