“When selling anything to an audience, visible publicity is key:” experiences, barriers, and enablers to participation in a COVID-19 study in Malawi.

Background Many studies in infectious struggle to recruit participants. The SARS-CoV-2 infection, transmission dynamics, and household impact in Malawi (SCATHIM) study in Malawi noted a refusal rate of 57.2%. Adequate publicity can lead to more people participating in studies. This study explored reasons for participating in the SCATHIM study. Methods A descriptive qualitative study informed by the Theory of Reasoned Action was conducted in Blantyre between January 2022 to March 2022 to assess factors associated with participating in a COVID-19 study among 10 index cases, 10 caregivers, 10 study decliners, and 5 research staff. Data were collected using in-depth interview guides, audio recorded, transcribed, managed using NVIVO and analysed following a thematic approach. Results The factors that motivated participation in the study included one’s knowledge on COVID-19, potential access to medical services including free COVID-19 tests for members of the household, financial reimbursements, and zeal to contribute to scientific knowledge. The barriers to participation included minimal publicity of the study amidst a novel condition, perceived stigma and discrimination, perceived invasion of privacy, discomfort with the testing procedures and suboptimal financial reimbursements. Conclusion Effective publicity and outreach strategies have the potential in decreasing the refusal rates in study participation especially if a condition is novel. Studies on infectious diseases should address stigma and discrimination to promote participation and ensure participant safety.