Towards a Sustainable Model for a Digital Learning Network in Support of the Immunization Agenda 2030 - A Mixed Methods Study with a Transdisciplinary Component

"Collectively, the analyses highlight key aspects of voluntary collective action to achieve global immunization goals through local action, to inform efforts to ensure long-term sustainability of the Movement."

The Immunization Agenda 2030 (IA2030), the global immunisation strategy for 2021-2030, highlights several challenges for immunisation in countries and communities worldwide. Local health practitioners are frequently on the frontline of managing or mitigating the implications of such challenges. Peer learning enables health practitioners to learn from each other, sharing experience and expertise relating to specific local challenges. The Movement for IA2030 is a voluntary collective of immunisation practitioners, principally from low- and middle-income countries (LMICs), who have pledged to support each other to accelerate local action in support of this global strategy. The aim of this study was to explore two specific aspects related to the long-term sustainability of the Movement for IA2030: participants' rationale for joining the Movement and the personal resource commitments (time and money) made by participants. The study was grounded in collective action theory concepts.

This study defines collective action as a group of individuals who are cooperatively and voluntarily addressing a common problem, pursuing a shared goal. Collective action in the Movement is facilitated by the peer learning platform established by The Geneva Learning Foundation (TGLF). Key features of the programme include problem-based learning (participants apply learning while tackling a key local challenge), peer feedback (sharing experience and offering advice), and digital networking (one-to-one and group dialogue) that meets participants on the platforms of their choice (for example, synchronously in Zoom at live experience-sharing events and asynchronously through recordings, multiple social media platforms, and private communication on WhatsApp, Telegram, and other instant messaging platforms). Those joining the Movement made an "Immunization Scholar Pledge for Impact", signing up to work towards IA2030's and their country's goals, to adhere to the IA2030 core principles, and to provide support to their peers making similar commitments. 

This research was a sequential exploratory mixed-methods study with a transdisciplinary component, where quantitative data (from participant surveys) informed the qualitative and transdisciplinary phases (focus groups). The research was divided into three phases: (i) exploratory, (ii) survey, and (iii) transdisciplinary (the involvement of Movement members to reflect on, interpret and validate preliminary results from phases (i) and (ii)). The researchers reviewed existing data from Movement participants and collected additional survey data to explore two aspects of sustainability of the Movement: why immunisation practitioners participate and how much time and resources they contribute. Quantitative analyses of an existing large data set (n = 5,682 participants) were complemented by analyses of data collected through a new survey (n = 291) and focus groups of Movement participants.

The most commonly cited reason for participating (32% of responses) was to share experience and learn from others. This was generally true across all levels of experience, gender, and place of work, suggesting a common rationale among immunisation practitioners in different settings. It was a particularly strong motivation for the most experienced practitioners and those working in a setting with a strong organisational learning culture. When asked about the main reasons for interacting with peers, most respondents (68%) prioritised support for either applying what they are learning in the course or more generally seeking advice to solve a problem they face in their work context.

Participants in focus group discussions affirmed that their engagement was driven by the wish to collaborate and contribute. An additional comment made was that mutual trust and respect are fundamental aspects of this engagement. Participants ascribed value to relying on each other, believing that peers are competent and reliable, and valuing the contributions that each member has to offer.

Survey data revealed a high degree of intrinsic personal motivation to participate, through commitment of significant time and financial resources. Eighty-seven percent of respondents reported engaging in the peer learning activities (such as online learning sessions) at their own cost and without financial compensation, and 47% committed personal finances to implement an action plan. When Movement members were asked what they would find most helpful to sustain their commitment to achieving the goals of IA2030 through local action, the most favoured response was support from international partners (70%) and TGLF (68%). By contrast, only 16% of participants responded that funding from the community would be the most helpful towards sustainability, and 25% selected funding from their own organisation. In the focus groups, some participants further elaborated that support was not limited to funding but also in terms of visibility and recognition of their IA2030 activities and commitment.

In summary, this study found high levels of individual commitment to networking and learning from peers in order to achieve immunisation goals. As highlighted by focus group participants, the success of the IA2030 Movement depends on both collective action by individuals and support of organisations, such as TGLF, that facilitate it.

Findings from the research highlight two intertwined implications for the IA2030 movement:
 

1. The study demonstrates that shared goals, mutual trust, and personal dedication provide a solid foundation for the Movement, highlighting the critical role of social and human capital. The intrinsic motivation to engage is promising, yet it is too early to determine if the level of individual commitment will be sustainable in the long term.
2. For the Movement to endure and grow, complementary but relatively modest commitments from a network of funders or participants' employers into organisations that maintain the digital infrastructure and facilitate the peer learning approaches are necessary. 
    

Sustaining the Movement will involve engaging a diverse cross-section of stakeholders, such as:
 

• Local and national stakeholders and Movement members who could continue to define and articulate the value they want from digital peer learning networks, whether that be supporting local and national action, supporting peers in other countries, or advocating to international organisations and funders;
• International development organisation and funders who could increasingly incorporate knowledge generated and local action catalysed by decentralised networks, which may lead them to rethink what and how they invest in global health programmes;
• Policymakers who could urgently value and commit to collective action and experiential knowledge for addressing health problems in challenging LMIC contexts; and
• Researchers who could strengthen the understanding of collective action and intrinsic motivation in LMICs for addressing health and development challenges through digital peer learning networks, including the Movement for IA2030.

In conclusion: "Strengthening the networks and supporting local health workers to lead local change will be crucial to sustaining collective action and achieving national and global immunization targets."