Faith, family, and the frontline: Integrating religious and cultural narratives in polio communication strategies in Pakistan

Despite decades of mass immunization campaigns, Pakistan remains one of the last countries where wild poliovirus continues to circulate. While logistical and biomedical challenges have been widely studied, less attention has been devoted to the religious, cultural, and familial narratives that shape vaccine acceptance and resistance. This study examines the impact of these narratives on polio communication strategies in Pakistan and proposes a contextual model of culturally embedded health communication. This study employed a case study design, collecting data from 30 in-depth interviews, three focus group discussions, and document/media analysis across three polio-affected Cases (regions): Khyber Pakhtunkhwa, Karachi, and Quetta. Thematic analysis, supported by NVivo, was conducted through the lens of the Health Belief Model, Theory of Planned Behavior, Cultural Framing Theory, and Faith-based Communication Frameworks. Findings reveal that religious beliefs, such as divine will and concerns about haram content, play a central role in vaccine hesitancy, alongside cultural norms, patriarchal family structures, and distrust in government. Lady Health Workers (LHWs), often the face of vaccination campaigns, act as frontline negotiators, adapting their messages to local contexts despite limited institutional support. Current communication strategies rely heavily on biomedical messaging and overlook opportunities for framing in religious and family-based contexts. The study proposes a “Faith-Family-Frontline” communication framework to guide more resonant, trust-building public health messaging. This model provides a pathway to enhancing vaccine uptake and eradicating polio in culturally diverse environments. • Explores how religion, culture, family, and frontline workers influence polio vaccine communication in Pakistan. • Analysis reveals divine fatalism, mistrust, and gendered decision-making as key barriers. • Integrates Health Belief Model, Theory of Planned Behavior, Cultural Framing, and Faith-based Communication frameworks. • Finds existing campaigns overly biomedical and detached from local worldviews. • Proposes a “Faith-Family-Frontline” model for culturally grounded vaccine communication.