Table 9 Summary of feasibility and success criteria

1. Will the processes of a randomized cluster trial be possible?

The processes of the randomized cluster trial were possible

2. Will we be able to recruit at least 75% of the suggested sample size within 3 weeks?

The study was able to recruit the suggested sample size within 3 weeks. Following the suggested trial recruitment criteria as indicated in the protocol, we managed to communicate and sensitize community leaders within one week; interventionists were recruited within one week and the trial participants were successfully recruited within another week

The intended minimum numbers to be recruited were:

• Interventionists: 50 in total

• Trial participants: 100 in total

The actual numbers recruited were:

• Interventionists: 56, which is 12% more than the minimum suggested

• Trial Participants: 135, which is 35% more than the minimum suggested

3. Will we be able to retain at least 75% of the trial participants in the 9 months of the study?

The study was able to retain at least 75% of the trial participants in the 9 months of the study

To allow for any drop outs due to unforeseen challenges, we had recruited 25% above the minimum number we were expecting for the study. In addition and to support retention of participants, we recorded participants’ full names and contact details, which we then used remind participants of the data collection dates and venues as needed

The minimum number of trial participants required for the study was 100

• This meant that we had to retain at least 75% (n = 75)

• Results show that we recruited n = 135 and retained n = 108 at midline and n = 98 at endline

Because we recruited higher than the minimum of 100, we managed to retain the minimum retention figure. In addition, we managed to retain 80% of total trial participants recruited

4. Can we deliver the 9-cell bereavement intervention?

The 9-cell bereavement intervention was delivered successfully

5. Is the intervention delivered as intended and does process data suggest the planned effect is likely?

The intervention was delivered as intended with analysed data showing the positive effect of the intervention:

• Analysed data shows that the 9-cell bereavement tool was effective in that it allowed interventionists to share and learn from their own grieving process

• Participants were given a platform to openly talk about their grief, in an open, safe space. Though they may have suffered loss in a time period that seemed a long time ago, because they had not processed the grief, they still felt the pain. Being taken through the 9-cell bereavement tool, allowed them to address this grief and pain

• Data shows that participants reached out within their immediate vicinity, as required in the study, and in addition, reached out beyond their own communities

• A ripple effect was experienced with data showing that those who the interventionists had initially reached out to also reached out to additional individuals suffering from loss within their own communities and families

• There were several internal rewards that both the interventionists and the trial participants experienced. Firstly, just by participating in a program that allowed them to be open about the pain they experienced from the loss of loved ones. Secondly, it allowed them to heal and be able to share this process with others. Thirdly, through their own capacity and self-motivation, they were able to share lessons they learnt about grief and the bereavement process with others

• Opportunities to support more people were attained and are ongoing with requests for wider exposure to the 9-cell bereavement tool, making sure to include people in the rural areas where exposure to such programs were not as widespread or easily accessible

• Media, including the radio, was suggested as an additional means of information distribution for wider reach to rural areas

• Requests and the need for more information related to non-communicable diseases such as cancer, high blood pressure, stroke and diabetes, was requested as community members felt that these ‘modern day diseases’ were not well understood in the communities