From Polio to COVID-19: Factors Sustaining Community Influencer Motivation in the CORE Group Partners Project's Social Mobilization Initiatives for Vaccination in India

Introduction: Engaging Community Influencers (CIs) was a key strategy for polio eradication in India, also contributing to routine vaccination and COVID-19 vaccination. CIs were high status individuals selected for their pre-existing reach into vaccine-hesitant communities. This paper describes the factors that kept the CIs engaged over time. The findings add to our understanding of what drives CHW motivation. Methods: We performed a thematic analysis of 65 in-depth interviews conducted across six study districts of Uttar Pradesh, involving 36 CIs, 18 CGPP field staff, nine project managers and two representatives from other stakeholders. Findings: The most important motivational factors that emerged from the research were improved social status, altruism, and effective working relationships. The inputs required to foster these were information support; providing respect and visibility; and fostering robust working relationships between program staff, CIs, CHWs, and government functionaries. Conclusions: CIs' engagement in the program maintained and bolstered their pre-existing status. Deploying and sustaining this cadre requires a strategic approach to maintaining motivation over time. Providing respect and visibility and maintaining effective working relationships is key to sustaining the CIs' motivation.