Co-Creating Health Solutions - Participatory Research and Human-Centered Design for Immunization Programs

"Participatory research and design are powerful methodologies that place the perspectives and lived experiences of community members at the heart of both understanding and addressing complex issues."

This technical paper seeks to offer practical guidance on how to conduct participatory research and design within global health immunisation initiatives, drawing on the experiences of VillageReach, the Sabin Vaccine Institute, and partners. In particular, it focuses on the application of human-centred design (HCD) and community-based participatory research (CBPR) to generate actionable insights and to engage communities directly in co-designing solutions to improve vaccination access, acceptance, and demand.  

Looking at the difference between participatory research and participatory design, the paper explains that participatory research "engages those directly affected by an issue, ensuring their insights and knowledge shape the entire research process. This approach not only generates a deep understanding of the issue, but also fosters trust and collaboration between researchers and community members. Participatory design, in turn, focuses on co-creating solutions with the people most affected by the challenges. By involving community members in the design process, it acknowledges that they are the best suited to identify and develop solutions that are relevant and effective in their specific context. When combined, participatory research and design form a comprehensive framework to identify barriers and develop practical, community driven solutions." Participatory research and design are central to the work of both the Sabin Vaccine Institute and VillageReach, with both organisations leading, supporting, and facilitating participatory research to improve access to routine immunisation across low- and middle-income countries (LMICs).

The paper offers guidance, tips and further resources that are designed to support immunisation practitioners to: 
 

• Understand the core principles of participatory research and design;
• Use and adapt immunisation frameworks for data collection and analysis;
• Build and support a research team;
• Engage stakeholders and secure institutional support;
• Explore options for participant recruitment and verification of vaccination status;
• Select and implement participatory data collection methods;
• Apply participatory data analysis processes;
• Facilitate participatory design workshops with communities;
• Involve communities in disseminating the findings of the research process; and
• Identify key budget inputs and resource requirements for participatory approaches.

To illustrate the application and impact of these methods, the paper includes case studies that highlight successful initiatives in various settings. They include, for example:
 

• Malawi and Mozambique: Community researchers were engaged in the "Let's Talk About Vaccines" study to identify barriers and solutions to address dropout from the routine under-2 immunisation schedule. This study was conducted through a 3-phased approach: participatory research to identify barriers to immunisation from the perspective of health workers and caregivers of children under 2 years old; participatory co-design with health workers and government officials to design solutions based on findings from Phase 1, followed by piloting those solutions for 1 year; and an evaluation of the effectiveness of these solutions and the community engagement approach (See Related Summaries below for more information on this project).
• Guatemala: A trans-disciplinary team-building approach was used to address vaccine hesitancy among Indigenous Mayan communities. The trans-disciplinary team utilised a co-creation process and knowledge translation with local key stakeholders to solve societal challenges.
• India: CBPR was used to improve vaccine delivery and acceptance in an area with extremely low vaccination coverage.

The appendix includes information on different participatory data collection methods, looking at the pros and cons, as well as the logistics involved in implementation.