This study reports findings from formative research conducted to assess the feasibility and inform the design and implementation of the Addressing Hidden Hunger with Agronomy (AHHA) trial. The AHHA trial was a randomised, controlled trial conducted in rural Malawi, in which participants were given maize flour biofortified with selenium or control flour not biofortified with selenium for a period of 10 weeks, after which blood samples were taken to measure selenium status. Formative research was conducted in villages near to the AHHA trial study site 1 year before the planned intervention. A short questionnaire with adult women (n = 50), focus group discussions with male (n groups = 3) and female (n groups = 3) community members, and in-depth key informant interviews (n = 7) were conducted to understand community practices and perceptions. Meals were typically cooked and eaten at home in this community, while participants reported that maize flour would be less readily sold than maize grain – important considerations for the design of the trial. Regarding intervention delivery, we identified potential concerns around effects on fertility, links between blood sampling and witchcraft, and the potential for social stigma if community members considered participants lazy for receiving free flour. Participants reported that involvement of the Malawi government partners including health extension workers would increase trust. Following the formative research, the AHHA trial appeared feasible. However, community sensitisation would be essential to address potential fears and concerns; effective sensitisation would support recruitment and treatment adherence, and would protect the safety and wellbeing of participants and researchers. People in positions of authority and trust including village headmen, religious leaders, health and agriculture extension workers, and community care groups should be involved in community sensitisation.

中文翻译：

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准备在马拉维农村开展以社区为基础的农业到营养试验：形成性研究以评估可行性并为设计和实施决策提供信息

本研究报告了形成性研究的结果，这些研究旨在评估“用农学解决隐性饥饿”(AHHA) 试验的可行性并为设计和实施提供信息。AHHA 试验是在马拉维农村进行的一项随机对照试验，参与者在 10 周内接受生物强化硒的玉米粉或未生物强化硒的对照面粉，然后采集血液样本以测量硒状态。在计划干预前 1 年，在 AHHA 试验研究地点附近的村庄进行了形成性研究。对成年女性（n = 50）进行了简短的问卷调查，与男性（n 组 = 3）和女性（n 组 = 3）社区成员进行了焦点小组讨论，并进行了深入的关键知情人访谈（n = 7）以了解社区实践和观念。在这个社区，膳食通常在家里煮熟和食用，而参与者报告说，玉米粉比玉米粒更难卖——这是试验设计的重要考虑因素。关于干预措施，我们确定了对生育能力的影响、采血与巫术之间的联系以及如果社区成员认为参与者懒惰接受免费面粉可能带来的社会耻辱的潜在担忧。参与者报告说，马拉维政府合作伙伴（包括卫生推广人员）的参与将增加信任。在形成性研究之后，AHHA 试验似乎是可行的。然而，社区宣传对于解决潜在的恐惧和担忧至关重要；有效的宣传将支持招募和治疗依从性，并将保护参与者和研究人员的安全和福祉。包括村长、宗教领袖、卫生和农业推广人员以及社区护理团体在内的权威和受信任的人都应该参与社区宣传。