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Article History

Received: 16 February 2026

Accepted: 12 August 2026

First Online: 8 September 2026

Declarations

Ethics approval and consent to participate: This study was conducted in compliance with the Helsinki Declaration and abided by national and international standards for human subjects research. The protocol was reviewed and received ethics approval from multiple entities including University of Arizona, Addis Ababa University, and Albert Einstein College of Medicine. The first author (BEL) had affiliation with both University of Arizona and Addis Ababa University as a Global Health Emerging Scholar when the study was funded and data were collected. The study was approved by both University of Arizona and Addis Ababa University IRBs. Written informed consent was obtained for all participants, prior to focus group discussions. Consent forms were prepared using University of Arizona consent templates and were available in English and Amharic. Consent details were orally read aloud in Amharic, with on-demand translation into Afan Oromo also available, and participants were encouraged to ask questions prior to signing the consent document to ensure that consent was fully informed. Each participant received a copy of the consent form to take with them, in addition to the copy they signed and returned to the study team. Analysis of data was conducted after BEL had established affiliation with a new institution and as such, ethics approval for data analysis was obtained from Albert Einstein College of Medicine IRB. The student research team held volunteer research roles at Einstein and analyzed de-identified transcripts, in compliance with the Einstein exempt determination.

Consent for publication: Not applicable. The manuscript does not contain any identifiable data from any individual person.

Competing interests: The authors declare no competing interests.