Table 3 Tips for designing CEI activities in LMICs when based in the UK

General

• Work closely with a local team (if based in a high-income country)

• The better connected the local team is within their community, the easier it will be to access and establish relationships with relevant stakeholders, especially high-ranking community members

• The local team has to have capacity to lead on the CEI activities their end - it is helpful to identify one main point of contact in the collaborating LMIC research team

• Find out how much the local team knows about CEI and provide training, if needed

• Be aware that UK (or other guidelines) best practice involvement might not work in local context, remain flexible and let the local team lead on adapting the CEI activities

Planning stage

• Start brainstorming ideas and explore quality CEI activities early on in the research cycle with plenty of time to adapt and re-design

• Aim for the highest level of involvement possible (community-led, co-produced) and adjust from there according to feasibility and resources

• Be flexible and prepared to adapt - timelines/approaches will change not only at planning stage, but also when undertaking the activities - A rough guideline to start with might be sufficient to get the ball rolling

• Keep communication up with the local team when planning the activities, using pathways that suit everyone (WhatsApp, e mail, phone calls, Google docs)

• Payment of involved community members depends on local standards: Consult local team for appropriate rates

• An easily accessible advisory group with representative members (e.g. in your country/language) is of benefit when exploring initial steps of CEI planning in LMICs, e.g. informing on barriers, challenges, potential solutions

Undertaking of CEI activities

• Embrace the local culture and be aware of cultural differences – the local team can inform on this

• Travel with a local person/team (ideally someone well-respected in the communities you visit for better access to community groups, as well as potential meetings with community leaders)

• A good translator is crucial when aiming to have in depth conversations with community contributors in different languages or dialects

• Patients will feel more comfortable in conversations when they recognise someone from the research team (Previous relationship-building)

• Communicate your intentions and reasons for the visit clearly and provide context and background as appropriate to community contributors before undertaking any kind of discussion/focus group/general CEI activity. This will help the contributors feeling safe and understanding what is expected of them, but will also manage their expectations of what you will deliver on as a result of the activity

• Explore ways to build sustainable, lasting relationships with the engaged patients and communities – let them inform dissemination pathways and ways to keep in touch

After the CEI activities

• De-brief with the local team and explore ways to improve CEI in the future, if needed, with the aim for the local team to independently lead on future activities and incorporate CEI more widely

• Report the CEI activities (e.g. using the GRIPP-2 framework, shared learning platforms) and implement patient suggestions where possible in your study