Table 2 The list of ideated solutions and theory of change

School level

Awareness campaign in schools located within the community

Distribution of pamphlets with clear/correct messages regarding COVID-19 and COVID-19 pandemic, preventive measures, masking practice, role modelling by the volunteers and involvement of schoolteachers and secondary level students. Child to child approach and child to parents/family approach where every child/student will educate one child and/or family member

Schools as institutions and school children and teachers are highly trusted and respected in the community. They are the potent source of spreading misinformation. Improving their health literacy related to COVID-19 and better equip them with correct knowledge will not only block the spread of misinformation further but it will also decrease their susceptibility to future mis or disinformation. They are also highly trusted mode of delivery of correct information in this community

Madrasa (an educational institution offering Islamic education)

arranged separately for male and female

Awareness campaign regarding how to take preventive measures against COVID-19, how to get register for COVID-19 vaccination and information to counter widespread misinformation

Female and male religious scholars (Aalima and Aalim) should be trained and actively involved during these campaigns

Madrasas are considered sacred institutions which hold a special place in Pashtun society living in the target community. Both male and female religious teachers associated with these Madrasas and students of these Madrasas are highly respected in society and trusted for their words. Therefore, specifically, designed for female religious students who do not have access to radio, television or newspapers, smartphone, or any social media, in contrast to males

Awareness campaign will spread key messages focusing on hygiene and infection prevention, including hand washing using soap, social distancing, and identify widespread misinformation regarding COVID 19 and COVID 19 vaccination. This will also empower female population to register themselves for COVID-19 vaccination

Local clinics and maternity home

Active involvement of local informal and formal healthcare providers in co-design workshops, satisfying their concerns, queries, and misconceptions, providing them relevant health literature regarding COVID-19 pandemic and COVID-19 vaccination and sensitizing them to the widespread mis and disinformation. Distribution of pamphlets, flyers through their clinics and helping them counsel their patients regarding COVID-19 pandemic and vaccination if anyone seek their advice

Informal healthcare workers are the major service providers in target community. They are highly regarded, trusted, and consulted by the community regarding decisions of vaccination and/or preventive measures. Our baseline data also demonstrated that these informal healthcare workers lack optimum healthcare literacy and in fact they are also vulnerable to mis information and misconceptions regarding COVID-19. They are also disengaged in vaccination programs. Active involvement of this large informal force and better equipping them with correct information and health literacy will improve the community confidence in vaccination and debunk misinformation

Mosque

Masjid imams (religious leaders leading prayers in mosques) are the highly trusted people with a large following in target community. Their issues, concerns, and queries regarding the COVID pandemic should be addressed by mutual discussion and respect of their opinion. They will be satisfied and assured that by participating in this project they are not committing any sin but instead doing the public good to fight fake news. These Masjid imams should be empowered to tailor messages considering holy Quran e.g., a verse from a holy Quran which says “do NOT spread fake news” for the community

Megaphones/ loudspeaker and posters will be used to explain COVID-19 and to debunk myths and conspiracy associated with the virus, and COVID-19 vaccination

Masjid imams are the highly influential people in the target community and especially in the Pashtun population. Our baseline data showed they are highly trusted by the community, and they are considered an authority in every subject. People refer to them to seek their guidance regarding getting their children vaccinated. Empowering them with correct information and actively involving them to tailor messages which are acceptable from the religious point of view (and not contradictory to Islamic Sharia) and delivering those messages through them will dispel the misinformation and foster an environment of trust for vaccine acceptance

Role of youth in Harnessing social media

Creation of youth WhatsApp group in each neighbourhood. Since an enormous number of smartphones is used by youth, they are highly active in social media for communication with friends and family

They should be used to circulate educational videos which will be created by local actors (nursing students hired from same community and trained by research team) working in different hospitals

Mis and disinformation thrive in social media, where literacy rate is low and when access to digital and main media is narrow

These educational videos created by nursing students in local language will be circulated through WhatsApp, run by youth from local community. These youth will circulate the videos among friends, family, relative and help in discerning the truth

Promote positive and hopeful stories which will increase positive behaviour and attitude regarding COVID-19 pandemic, preventive measures, and vaccination uptake. Further, these groups will also respond to any viral misinformation or disinformation regarding COVID-19

Door-to-door visits

Door-to-door visits with the distribution of pamphlets. Research field staff along with trained volunteers will distribute pamphlets keeping in mind the very fact that this community is informationally vulnerable to place-based mis and disinformation especially with limited quality information sources at local levels, so it is exceedingly easy to misrepresent local-level events and conditions and provide fake evidence or a sense of momentum for broader disinformation narratives

This will help to control the spread of misinformation

Shed anti vaccination perception

Help in positive static attitudes for vaccine acceptance

Social Media

use of social media such as Facebook page, YouTube channel and twitter where members from the community can be encouraged to follow

Social Media platforms will facilitate an informational environment, where access to mass media and digital media is limited

Community suburbs

Conducting community concert type health Mela where loudspeakers can be used to disseminate correct information

Health mela with active involvement of community stakeholders, study volunteers and research team will use loudspeakers and music to attract local community and disseminate correct messages to address fear, misconceptions, rumours, and misinformation regarding COVID-19 and vaccination. Further to also improve trust in vaccines