The Vaccine Trust - Methods - Covid19

Methods and Approach Investigating Trust and COVID-19 vaccines Read more: www.thevaccinetrustproject.com

ASSESSING

TRUST

This investigation was carried out over four major steps – leveraging the wealth of existing knowledge on vaccine acceptance to frame a deep-dive into trust Lit Review & Expert Interviews Framing of research topics was driven by a literature (manual & automated) and expert interviews

Social Media & News Listening Social media & news media listening provided direction for particularly salient public narratives to explore

In-depth engagements with Kenyans, Pakistanis and Nigerians from a variety of low to low-middle income backgrounds,

17,500+ posts from Twitter, Facebook, Instagram, YouTube, forums, and blogs), collected June-August 2021

100+ engagements with respondents and their ecosystems (observations, deep dives, key informant interviews and focus groups)

25+ Internal BMGF & external expert interviews

200+ documents (academic, journalistic and organizational) hand-reviewed & 9,000 automatically reviewed for keywords & themes

Fieldwork

Analysis (ongoing) Analysis (ongoing) Findings from the previous steps are collectively examined to pull out themes and eventually build up to a trust framework

A 4-step process, which includes data mapping, clustering, member checking, and a final round of social media listening 2

ASSESSING

TRUST

Fieldwork Kenya: We conducted deep dives with people from different positions in Kenyan society providing us with multiple perspectives on trust and vaccine hesitancy Research locations in Kenya

Recruitment criteria Age: Participants across generations were included

Isiolo County

Kisumu County

Gender: Equal representation of both women and men was ensured

Nairobi County

Kilifi County

Kisumu – Urban and rural. Majority Luo (politically dominated ethnicity) Nairobi – Major urban center. Ethnically mixed. Clear governmental presence.

Kilifi – Rural and medium-sized cities. Large tourism sector. Strong Swahili culture.

Isiolo – Rural. Smaller government presence.

Pastoralists

Status: Individuals who hold different positions (with differing levels of power) within their communities were recruited, i.e.

• 1/3 middle to upper class • 1/3 lower middle class • 1/3 impoverished

People profiles Community leader

e.g., religious leader, elder

Healthcare worker e.g., doctor, nurse

Health service provider

e.g., traditional healer, midwife

Experience with COVID e.g., direct & care experience

Local business owner e.g., shop owner

Mobile community member e.g., truck driver, boda boda driver

Youth

e.g., college student, unemployed 3

ASSESSING

TRUST

Fieldwork: We conducted deep dives with respondents from different positions in Pakistani society providing us with multiple perspectives on trust and vaccine hesitancy Research locations in Pakistan Islamabad Rawalpindi

Recruitment criteria

People profiles

Age: Participants across generations

Community leader

were included Lahore

Gender: Equal representation of both women and men was ensured Karachi

Dhok Hassu (Rawalpindi) – Low income. Ethnically diverse with a notable Pashtun presence.

France Colony (Islamabad) – Majority Christian. Low income.

Ethnically diverse. Highly internationally connected Manzoor Colony (Lahore) – Middle to low income. Majority Punjabi. Gentrifying.

Bheer Pind (Lahore) – Middle to low income. Majority Punjabi.

Emporium Slums (Lahore) – Very low income. Ethnically diverse.

Socially insular.

Ibrahim Hyderi (Karachi) – Low income. Ethnically diverse.

Fishing community.

Kharadar (Karachi) – Middle to low income. Ethnically diverse.

Status: Individuals who hold different positions (with differing levels of power) within their communities were recruited, i.e.

• 1/3 middle to upper class • 1/3 lower middle class • 1/3 impoverished

e.g., religious leader, elder

Healthcare worker

e.g., doctor, LHW, vaccinator

Health service provider

e.g., traditional healer, midwife

Experience with COVID e.g., direct & care experience

Local business owner e.g., shop owner

Mobile community member

e.g., truck driver, taxi or rickshaw driver

Youth

e.g., college student, unemployed 4

PROCESS

We conducted deep dives with respondents from different positions in Nigerian society providing us with multiple perspectives on trust and vaccine hesitancy Research locations in Nigeria

Kano

Recruitment criteria Age: Participants across generations were included

Respondent profiles Community leader

e.g., religious leader, elder

Healthcare worker e.g., doctor, nurse

Kwara

Lagos

Gender: Equal representation of both women and men was ensured

Edo

Lagos – South-west geopolitical zone. Major urban center and economic hub. Ethnically mixed.

Kwara – North-central geopolitical zone. Ethnically mixed with majority Muslims.

Edo – South-South geopolitical zone. Linked to the historic kingdom of Benin.

e.g., traditional healer, midwife

Experience with COVID

Status: Individuals who hold different Kano – North-west geopolitical zone. Majority Hausa and Muslim

Health service provider

positions (with differing levels of power) within their communities were recruited, i.e.

• 1/3 middle to upper class • 1/3 lower middle class • 1/3 impoverished

e.g., direct & care experience

Local business owner e.g., shop owner

Mobile community member e.g., truck driver, taxi driver

Youth

e.g., college student, unemployed

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ASSESSING

TRUST

We studied how trust plays out in peoples’ experience of the health system – which required defining ‘health systems’ according to how people understand and experience them: as holistic ideas, interconnected with larger systems People define health holistically, linking it to other areas of life such as wellbeing and financial success….

... And perceptions of the ‘health system’ are embedded in and explicitly related to other government interactions

“For instance, if a person wants to eat but can’t – he doesn't have the physical, emotional or financial strength – then the person is not healthy. Physically, maybe the person is sick and can’t eat. Emotionally, maybe the person is depressed or lonely and doesn’t have the appetite to eat, and financially if the person doesn't have the money to buy food to eat”

“The narrow streets, shabby infrastructure, drug addict youth, and poor sewerage system made me sick in the initial year. I still overthink a lot and pray to God to keep my son safe from this terrible environment”

– Alfa Sule, 50 (Ilorin), defines health as encompassing physical, emotional, and financial wellbeing

– Hania, 32, blames the poor conditions in France Colony (Islamabad) for various health issues 6

ASSESSING

TRUST

Fieldwork: A variety of research methods were used to provide a comprehensive understanding of communities studied Recruitment funnel Micro-conversations & Focus Groups

Observations

Informant Interviews

Deep dives

Talking with students in university room

Observing a vaccination site in Isiolo

Interview with a Nairobi entrepreneur

Deep dive with a poultry farmer

10-15 minute conversations, as well as 1-2 hour focus groups, to gain entry points and quickly capture a broad range of opinions & perspectives

Staying at community or health sites to observe how people navigate their surroundings for up to several hours at a time

1-2 hour conversations with with relevant profiles who provided key opinions on health, religion, politics, and more

Multi-hour engagements with participants in their homes, workplaces and communities to get not only what they say but also what they do

21 short conversations & 8 focus groups in vaccine sites, basketball courts, vegetable markets and more

16 observations including rural villages, private clinics, places of worship, vaccinations sites

40 informant interviews, from busy health care providers to university students in final weeks

20 deep dives, from mobile community drivers at work, to mothers in their homes

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