Elders’ authority and evolving roles in death rituals in rural South Africa and their relevance for minimally invasive tissue sampling

In rural South African communities, elders hold significant authority and evolving roles in guiding death-related rituals and family decision-making. Understanding these roles is important when considering the introduction of post-mortem approaches such as Minimally Invasive Tissue Sampling (MITS), particularly in contexts undergoing social and religious transition. An exploratory qualitative study was conducted in the Agincourt Health and Demographic Surveillance Site in Mpumalanga, South Africa. Data were collected through 20 in-depth interviews and six focus group discussions with community members and key stakeholders. In-depth interviews explored personal experiences, while focus group discussions examined shared norms and collective perspectives. Data were analysed using an inductive thematic approach. Participants described elders as central figures in death-related rituals, with roles shaped by age, gender, and familial hierarchy. Three interrelated themes were identified: (1) authority and tradition, reflecting elders’ perceived roles in guiding rituals and confirming death; (2) adapting ritual authority amid social and religious change, highlighting evolving practices and decision-making dynamics; and (3) perceived influence on health interventions, where participants emphasised the importance of consultation, explanation, and leadership endorsement when introducing approaches such as MITS. This study suggests that elders are widely perceived as influential in contributing to how death-related practices and discussions around health interventions in this rural South African context. These findings highlight the importance of engaging with existing cultural and authority structures when introducing post-mortem approaches such as MITS, while recognising that findings reflect participants’ accounts rather than direct observation of decision-making processes.