Social Behaviour Change Communications to address vaccine hesitancy
Deployment of a multi-partner learning engine to design interventions to address COVID-19 vaccine hesitancy
Year: 2021-2022
Location: India
Partners: The Gates Foundation, Friday and Theo, PCI India, CARE
Role: Creative Lead
Approach: HCD Research, Rapid prototyping ,Community Centred Design, Survey & sentiment Analysis
Team: Priyam Vadaliya, Sanchit Jain, Siddhant Damani, Akshiti Vas, Joy Kendi, Surabhi Bhanot, Shruti Goyal, Anureet Kaur, Prerak Mehta
Context
During the height of the COVID-19 pandemic, Bihar faced a complex public health challenge as the virus continued to shift and new variants emerged following the devastating Delta variant outbreak. Despite the ongoing nature of the crisis, many communities experienced a growing apathy toward vaccination, driven by a lack of trust and deep-seated hesitancy. The Vaccine Support Group was established as a collaborative response to this, bringing together a diverse coalition of stakeholders across grassroots community health, the private sector, digital technology, and local government.
A central goal of this work was to understand the drivers of vaccine hesitance and design hyperlocal Social and Behavioural Change Communication (SBCC), ensuring that health messaging was not only linguistically accurate but culturally resonant within specific community contexts to reach at-risk populations such as the elderly and pregnant women. This research study looked into the social and digital barriers to vaccine uptake in Bihar and offers insights into solutions that prioritise trust, localised messaging, and inclusive health delivery to improve pandemic resilience.
Takeaways
1. At the height of the pandemic, collaboration with local researchers was indispensable. We established a fast and efficient training system for Human-Centred Design (HCD) approaches, which informed a community-centred approach to research, relying on the expertise of local partners to navigate travel restrictions. By trusting their perspectives to elevate appropriate questions and identify local nuances, we ensured the research remained culturally grounded and responsive to the evolving crisis.
2. Mothers-in-law emerged as a critical messenger group and gatekeeper for rural Bihari households. This finding highlighted the powerful role of key household influencers in health-related decision-making, emphasising that vaccine interventions must look beyond the individual to engage the primary influencers who shape family health choices, especially for pregnant and lactating women.
3. In a complex, multi-partner engine, a "quick and dirty" system for defining roles was essential to maintain momentum. By replacing organisational rigidity with the necessity of speed, we integrated quantitative data to inform qualitative inquiries and surface real-time recommendations for visual asset design. This agile approach required a deliberate distancing from fixed ideas, prioritising only those that truly resonated with communities through easy-to-test prototyping. By institutionalising rapid testing, the team remained responsive to the urgent demands of the pandemic, ensuring a seamless flow of information without duplicating efforts.
Objectives
This work applied a behavioural lens to map the complex decision-making process behind vaccine uptake during an evolving crisis. Our primary goals were:
1. To better understand contextual, behavioural, and psychological variables related to acceptance and hesitancy of uptake, information seeking, and product use and retention, all grounded in an understanding of barriers and drivers at each step of the product uptake journey.
2. To get clarity around a) willing but unvaccinated, b) unwilling and vaccine hesitant population for the 1st and 2nd doses and what the root causes for systemic barriers and/ or vaccine unwillingness and hesitancy and co-create hyperlocal solutions.
Creative Exploration
We spoke to ~270 participants who consisted of community members, healthcare workers, community leaders and influencers (ASHAs (Accredited Social Health Activists), Anganwadi workers, ANMs (Auxiliary Nurse Midwives), Teachers, Religious leaders, Rural Medical Practitioners, Village heads). Across community Members, we diversified our recruitment to aim for a variation in age, gender, education, religion, caste, comorbidity, ownership of a mobile phone, occupation, COVID history and number of doses taken (if taken).
This project toolkit required a pivot away from rigid, exhaustive methodologies toward a high-velocity framework centred on the most critical research questions. We utilised streamlined participatory tools to surface persona insights at speed, relying on rapid sketch prototyping to test and edit early ideas in real-time. This "fast-and-focused" approach allowed us to move quickly from inquiry to action, utilising low-fidelity prototypes to validate messaging and concepts directly with the community. By prioritising the necessity of immediate insights over procedural rigidity, we were able to iterate on the fly, ensuring that only the ideas with the strongest community resonance moved forward into the visual asset design phase.
Highlights
Our analysis generated hyperlocal user segments that were defined by 1st and 2nd dose vaccine hesitancy and layered with demographic, structural, and behavioural insights. These segments informed a set of systemic, communication and process-based interventions (mass media, digital, social and on-ground support) that were prototyped and implemented across various districts in the state that had low vaccine uptake. Mass media campaigns built general awareness around the importance of booster doses and eligibility criteria for adolescents. We designed interventions using digital and in-person channels to boost uptake of and engagement with the Vaccine Mitra bot. Digital material addressing the need for adolescent and precautionary doses was shared with healthcare workers and the target audiences. We analysed how Rapid Response Teams (RRTs) can be modified to enable them to increase vaccine uptake and made suggestions on how RRTs can be reconstituted with enhanced supervision for adolescent booster doses.
Outcomes
The learning engine also benefited the multi-partner collaboration, as it informed:
1. Vaccine hesitancy response through the rapid deployment of hyperlocal interventions.
2. Learning and adaptation strategies that were necessitated by the fast-changing nature of the pandemic.
3. Stronger mobilisation and coordination efforts among multiple stakeholders.
Below are some snapshots of the various intervention materials developed for the different vaccine hesitancy segments.
Detailed Support Poster for Vaccine Support For Pregnant and Lactating Women.
Healthcare Worker Posters for Pregnant and Lactating Women.
A branded vehicle at a local community celebration.
Detailed Support Poster for Vaccine Support For Pregnant and Lactating Women.
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"I live with my parents and work a full day. By the time I get back from work, the vaccination camp is usually closed. If I miss work, how will the home function without my wages?"
Quote from a 20-year-old daily wage labourer speaking about the time and availability constraints of attending community vaccination camps in Mahuli, Patna.
