A nested mixed-methods study within the AWI-Gen Wave 2 cohort delivered personalized gut microbiome reports to 778 women aged 42–86 across three African sites—Agincourt and Soweto (South Africa) and Nairobi (Kenya)—at a cost of USD 29–59 per participant. Thematic analysis identified five cross-cutting engagement themes: comprehension of reports, emotional responses, perceived health relevance, institutional trust, and improvement suggestions. Local-language delivery and visual metaphors substantially improved understanding, while English-heavy sessions produced measurable confusion. Most participants reported dietary or lifestyle changes post-feedback, and trust was contingent on transparency and timely result return.
This work addresses a meaningful blind spot in microbiome research: the ethics and logistics of returning complex omics data to low-resource, underrepresented populations. The vast majority of microbiome studies are conducted in high-income, Western cohorts, and even fewer return individualized results anywhere. That a costed, replicable model now exists for African community settings is genuinely valuable for research equity. The finding that culturally tailored feedback motivates health behavior change—even in populations with limited prior exposure to microbiome concepts—suggests participant engagement is both an ethical obligation and a scientific asset, potentially improving long-term cohort retention. Limitations are notable: the all-female, older cohort constrains generalizability, and self-reported behavior change is not the same as measured health outcomes. Still, this is an incremental but practically important contribution, offering an actionable framework at a time when global microbiome research desperately needs inclusive, ethical data-return protocols.