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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