Who is the emergency care community? A qualitative exploration of stakeholder roles and relationships in engaged research within a South African provincial emergency care system

Abstract

Introduction

Effective emergency care (EC) in low- and middle-income countries (LMICs) depends on evidence that is relevant, implementable, and locally informed. Engaged research offers a means to achieve this, yet practical understanding of how to identify and involve communities remains limited. Defining the “community” is a critical but underexplored step, and little is known about how engagement operates within LMIC EC systems. This study explored stakeholder perspectives on the composition and relationships of the EC community.

Method

This was a qualitative study using semi-structured interviews and descriptive content analysis exploring stakeholder perspectives on the EC community. Purposive and snowball sampling ensured diverse representation. Transcripts were analysed inductively drawing on Braun and Clarke’s thematic framework and reported in accordance with COREQ guidelines.

Results

Thirty stakeholders participated, including emergency physicians, nurses, prehospital providers, academics, policymakers, and community representatives, many holding overlapping roles. Analysis identified three overarching categories:(1) breadth, variability, and ambiguity within the community;(2) fragmentation and exclusion; and (3) engagement potential and the role of frontline clinicians.

Conclusions

This study highlights the complexity of defining the EC community, with boundaries that are broad, variable, and often contested. Participants identified the absence or unclear roles of key stakeholders, including patients, decision-makers, and frontline clinicians, within research processes. Fragmentation and limited trust were viewed as major barriers to meaningful engagement, reinforcing the need for stronger, more transparent relationships within the community. Frontline clinicians were consistently recognised as underutilised yet uniquely positioned to connect clinical realities with academic research and community priorities. Strengthening engaged research in this context will require clearer guidance on how and when to involve stakeholders, structured mechanisms to build and sustain trust, and practical support for clinician participation. Together, these steps could help embed engagement more deeply into research culture and enhance the relevance and impact of EC scholarship.