Collecting behavioural insights into COVID-19 in Pakistan

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When Pakistan’s polio vaccination campaigns were suspended in late March due to the COVID-19 pandemic, my work researching vaccine acceptance in the country was also suspended. Lockdowns made it difficult to continue working with local communities about their vaccine beliefs, misconceptions and concerns.

Soon after, Deepa Pokharel, UNICEF Pakistan’s Chief of Communication for Development asked if I, and the two local researchers who work with me, could transition to collecting data on community behavioural patterns to help inform the work of the COVID-19 Risk Communications and Community Engagement (RCCE) task team.

Without being able to visit with community members directly, I knew that data collection would be a challenge, especially reaching women who do not have easy access to phones, television or social media. My colleagues and I would have to adapt our methodology to ensure equal representation of both men and women in our data collection efforts.

A known contact list

We started our research with an interview guide, a local researcher, and a list of contacts we knew best – the thousands of polio workers across the country. Polio workers are very  familiar with their communities so we knew they would have the best insights on how people were reacting to COVID-19, what their care-seeking behaviours were, what myths were circulating in the community, etc.

The predominantly female polio staff at local levels would also help us gain insights into the unique challenges impacting women and girls. Interview questions are specifically about women’s knowledge of COVID-19 signs and symptoms, where they are receiving their information from, whether they are continuing to go to antenatal or postnatal appointments, challenges seeking healthcare while pregnant during a pandemic, and experiences with stigma, violence and increased household responsibilities, among others.

Significant findings

As soon as we started contacting the polio workers, the flood gates opened. Once a telephone interview was completed, we would ask the interviewee if they knew of anyone else we could contact to gain community insights into how the COVID-19 outbreak was unfolding in their area and impacting their daily lives. Most would provide us additional names, including teachers, health care workers (particularly lady health workers), patients living in quarantine facilities, and domestic workers.

A group of women in hijaab sit around each other at a table
© UNICEF/PakistanRahat Batool, a qualitative researcher in Pakistan, conducts a focus group discussion on vaccine acceptance with female caregivers prior to the COVID-19 outbreak, in Bannu District, Pakistan.

Our explicit focus on female staff to collect data of relevance to Pakistani women – and to analyze data from an explicitly gender lens – revealed several trends which would not have been evident otherwise. For example:

  • women’s access to information on COVID-19 was often restricted to receiving news from male members of their households;
  • women and girls were often overburdened at home caring for patients who were too afraid of healthcare centres to seek treatment for their COVID-like symptoms;
  • if recommended precautionary measures were taken in a household to prevent infection, it was often at the behest of women (mothers and daughters) who continually reminded children and elders to wash their hands;
  • women and young girls who tested positive for COVID-19 were often subjected to stigma and suspicion (e.g. how could a women who spends most of her time at home have gotten this illness?);
  • mothers often had the added burden of homeschooling children once schools closed, and suffered feelings of inadequacy as a result of attempting to help their children navigate unfamiliar (or unavailable) digital learning platforms; and
  • it was women in particular who were subjected to documented spikes in domestic violence across the country, often due to the economic and mental stress of living under ‘lockdown’ conditions.

Weekly data trends fueled the response

Every week, we compile our interview data with overlapping information from national hotlines and social media monitoring (collected by UNICEF colleagues) and pull it into a RCCE report for UN agencies, the Ministry of Health, and other key partners. Each report provides recommendations on communications actions that should be considered to respond to the crisis. To date we’ve interviewed more than 200 people, and we’re continuing to receive new contact lists from partners, such as the Food and Agriculture Organization, UNHCR, and UNAIDS to help with ongoing data collection efforts.

The RCCE task team also formed a special sub-working group on gender as our findings, as described above, highlighted the need to support reducing gender-based violence and stigma against women and young girls.

It’s now been more than six months since we started this project, and our interview guide has changed significantly as cases have increased, plateaued, decreased and are now increasing again slightly with the reopening of schools in September 2020. While the unique challenges faced by the COVID-19 pandemic require adaptations to our approach to community-based research, it’s been one of the most collaborative projects among UN agencies (and across UNICEF sections) that I have yet participated in.

We’ve truly made this an organization-wide research project impacting the way we approach the COVID-19 response and, importantly, how we collect important qualitative insights which highlight the reality of what families and communities are facing in their daily lives.

This story is part of a series of field diaries from UNICEF staff focused on reimagining and delivering a gender equitable world, including living out the organization’s Five Actions for Gender Equality in the COVID-19 Response.

Ginger Johnson is a Medical Anthropologist with UNICEF Pakistan.

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