Table 2 Case study examples of UNICEF implementation research

Case study 1: India

Negative social media messages on vaccines: How can the resultant trust deficit between caregivers and health workers be overcome? A qualitative inquiry in Malappuram district of Kerala State in India.

This study partnered the Kerala Ministry of Health Vaccination Program with a research consultant as part of a joint WHO-UNICEF GAVI supported multi-country program Decision-Maker Led Implementation Research (DELIR) Initiative [17]. The focus of this research was not on developing and testing new interventions, but rather the generation of strategies and knowledge that will enable more effective implementation of existing immunization programs. The projects supported under DELIR address various aspects of system failures, implementation barriers and implementation strategies relating to immunization coverage and equity. Each immunization program developed their own priority question and was supported from protocol development through dissemination and program action. In Kerala State, India, the immunization team was facing an increasing problem of anti-vaccination messaging in the community and aimed to understand this messaging and how to combat it.

Research objectives:

1. Understand the role of anti-vaccine social media messages in influencing the relationship and trust between caregivers and health workers.

2. Understand how the deficit in caregivers’ trust in health workers influences their decisions on childhood vaccination.

3. Evaluate the current communication methods (e.g., information, education and communication (IEC) materials, websites etc.) vis-à-vis the ability to address anti-vaccine messages.

4. Suggest modifications in the current communication and social media activities to improve the trust between caregivers and health workers and thereby improve vaccination coverage.

5. Develop a set of tools for health workers (leaflets, FAQs, social media messages) and educational materials which can help to counter anti-vaccine messages.

Methods:

Qualitative key informant interviews and focus group discussions with immunization program staff and children’s caregivers, plus desk review of current IEC materials.

Results:

Examined how to counter anti-vaccine propaganda leading to a revised communication strategy, including a mobile social media app to target the primary platform for anti-vaccine messaging [26].

Case study 2: Malawi

Research to explore adolescent needs and barriers to service uptake and retention for pregnant and postpartum HIV-positive adolescents in Malawi’s PMTCT program

This project was part of a multi-country UNICEF program, funded by Sweden, to address retention of postpartum mothers and babies in prevention of mother-to-child transmission of HIV (PMTCT) program in four countries. After 2 years of implementation each country team identified in collaboration with the ministry of health and implementing partner a priority challenge facing the implementation of the retention program. In Malawi, the ministry had decided to prioritize adolescent PMTCT and HIV programming as adolescents were contributing disproportionally to HIV transmission. One of the local implementing partners Mothers2Mothers was running a mentoring program so the team wanted to examine the barriers and challenges faced by adolescents to participating in the program. The research was conducted by a local university research team in partnership with the ministry and implementing partner.

Study objectives:

1. Examine the beliefs, perceptions, social norms, and behaviours among pregnant and postnatal HIV+ adolescents in programme-supported districts surrounding the national PMTCT programme and mentor mother services

2. Describe perceived needs of pregnant and postnatal HIV+ adolescents in program-supported districts with regard to the national PMTCT programme and mentor mother services

3. Identify perceived barriers for pregnant and postnatal HIV+ adolescents to uptake/participation and retention in the national PMTCT programme and mentor mother services in program-supported districts in Malawi

Methods:

Qualitative focus group discussions with HIV-positive pregnant and postpartum adolescents who participated and did not participate in the mentor mothers program in program-supported districts.

Results:

Examined needs of HIV-positive adolescents within a mentoring support program. Based on study results, the mentor program hired and trained Adolescent Champions (same age peers) within 3 months of study completion to provide special services for adolescents in the program [31].