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Establishing Social Norm through Increasing Visibility of Others' Vaccination and Health Status

We aim to change the social norm from “not vaccinating” to “vaccinating” by having caregivers compare their children's status with others.

Photo of Ryoko Sato

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Describe what you intend to do and how you'll do it in one sentence (required 250 Characters)

We aim to provide caregivers the social comparison feedback on own and others’ vaccination status and health outcomes, using a smart phone app, in Nigeria. To do this, we will partner with the local tech company to design the appealing app.

Explain the idea (less than 2,000 characters)

Challenge: Almost 20 million children lack basic immunization worldwide, and 4 million of those children live in Nigeria (WHO, 2017). In northern states in Nigeria which is the site of the proposed study, 71 percent of children are not fully vaccinated (NICS, 2018). Lack of awareness is the reason for the incomplete vaccination among almost 40 percent of caregivers who did not have their children fully vaccinated. This lack of awareness might be attributed to the lack of social norms on vaccination; lack of the consensus that caregivers take children to health clinics for vaccination a certain amount of times at specific timing, in the community. Our Target Population: End users are caregivers of young children aged 12 months old or younger. Our target is caregivers who reside in urban setting where the mobile phone service is easily accessible. Caregivers can directly benefit from improved vaccination status among their children, which can even improve their health outcomes in later life. Solution: The first step is to establish trust and build a consensus (social norm) among community members through community meetings that caregivers should take children to clinic for vaccination multiple times to protect own as well as other children. The community meeting gathers influencers of the community including village head and decision makers of households (males) as well as caregivers of children for it to be impactful. Vaccination can indirectly protect other children due to herd immunity. We introduce this notion of herd immunity to promote the establishment of social norm through social pressure. The next step is to provide caregivers the monthly update of vaccination rate and health outcomes in own and in different communities through a smart phone app. We will show them the simple positive correlation between the vaccination and health outcomes and point where they are situated in the app, and compare their status with others' who live in Lagos.

Which part(s) of the world does this idea target?

  • Western Africa

Geographic Focus (less than 250 Characters)

Northern Nigeria

Who are your end users and how well do you know them? (750 characters)

We have conducted a research in the region for the past 5 years in the region. The vaccination rate is low, thus has potential to substantially increase the rate to improve their health status.

How is the idea unique? (750 Characters)

We are unique in attempting to actively generate the positive social norm on vaccination, using the power of social network. Social network is proven to influence people's behavior. However, our idea is unique because we are trying to change the social norm, through the community meeting and by making others’ vaccination behaviors and health status visible to the users.

Idea Proposal Stage (Select 1)

  • Blueprint: We are exploring the idea and gathering the inspiration and information we need to test it with real users.

How many months are required for the project idea? (140 characters)

It will take us 1.5 years to implement phase one and achieve a desire impact of our unique App intervention on full immunization rate.

Organization Name (less than 140 characters)

Harvard T.H.Chan School of Public Health

Type of Submitter

  • We are a formal part of a University or Research Institution

Organization Location (less than 140 Characters)

Boston, MA, USA

What is the current scale of your organization’s work?

  • Community (working within one or a few local communities within a region)

Tell us more about your organization/company (1-2 sentences)

Our organization is a research institute. Our idea fits into our organization goal as the goal is to create and advance knowledge and its translation into discoveries that lead to actions that improve health of people and populations.

Who will work alongside your organization in the project idea? (750 characters)

Our partner is the local tech company in Nigeria, the local university in Nigeria and local primary healthcare development agency. We have been collaborating with local primary healthcare development agency. They support us in providing necessary support such as informing clinics for the project, as well as ensuring the sufficient vaccine supplies in each health facility.

How many people are on your team?


Overview of How Your Concept Has Evolved (5-6 sentences):

1. We learned that endusers find it easy& intuitive to understand the importance of vaccines through the comparison between their status and others' in Lagos. The picture of healthy baby ALONG WITH the vaccine picture encouraged endusers too. 2. Sustainability is the key! The engagement of national/local governments is the key to the success for the widespread use of the app. 3. Webinars (esp the Gates foundation) provided us the inspiration: the process of improving the idea/design is important. We aim to improve further by interacting more with the potential endusers. 4. Our prototyper provided useful thoughts, especially on things we did not think of. Based on our prototypers' feedback, we tested and improved some ideas in the f

Viability (3-4 sentences and activity upload):

Feasibility (3-4 sentences):

- Our prototyper gave us a great insight on the potential importance of the community meeting: we can introduce our solution in the community meeting -- this can be very effective and have a sustainable effect! - From our prototype we tested during this phase, we learned that 1) endusers really like the visual information, 2) they understand the information better if the picture of health baby is attached to the picture of vaccines, and 3) the comparison between two different cities seem effective in making them feel envious and imitate what others from other city is doing and doing good!

Desirability (3-4 sentences and activity upload):

- The problem is that women in endusers' community do not take children for vaccination much (low social norm) - Because of the limited access to information, the social norm in Lagos doesn't spread to their community. BUT women in the community are curious to know what other women do in a "good" place (like Lagos). - Our potential endusers in the field were very happy to gain the information on the importance of vaccine in general (importance of awareness). - They were particularly happy to observe the link between vaccination and happy baby - They also seemed to be inspired that other women in other city (Lagos) were doing good, and seemed encouraged to do the same.

Community Focus (2-3 sentences):

- Northern Nigeria suffers from extremely limited vaccination rate. - From our interviews with potential endusuers, we learned that the lack of awareness can be a primary barriers to the vaccination. - If we can change the social norm from "not vaccinating" to "vaccinating", we can significantly improve their health by reducing the risk of contracting diseases. - This social norm on vaccination can spread to other health behaviors, and to other cities as well.

Community Impact (2-3 sentences):

- The knowledge level among caregivers will improve, and it can lead to the increase in the vaccination rate in the town. - We might be able to observe the potential positive spillover effects to other neighboring towns in term of the usage of App, improvement of the knowledge & vaccination rate. - If successful in Jada town, we aim to engage the local/national government for a larger-scaled implementation of the App. - It can take 1 year to see if the full immunization rate among children improve in the town. It will take longer (up to 5 years) to see if the effect of App is sustainable


Join the conversation:

Photo of Shahed Alam

Ryoko Sato UX map looks good. Did you explore to show the comparison within the city itself? What if Aisha learns the status of how other kids are doing in her own city?

Photo of Ryoko Sato

Thank you for your comment Shahed!
Yes indeed! Originally we were thinking to do promote the information sharing within the neighborhood. However one concern is that if no one does it, other people wouldn't do it either (Aisha does not do it because her friends do not do it.). We hypothesize that we need some external push to move the social norm within the neighborhood from "not vaccination" to "vaccination".
There is evidence that peer can positively influence within the community, but our hope is that if they compare with others from other "better" places, maybe we can encourage them even further?

Photo of Shahed Alam

Make sense, good luck with your submission.

Photo of Ryoko Sato

Thank you Shahed!

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