Previously submitted to: Journal of Medical Internet Research (no longer under consideration since Jul 31, 2025)
Date Submitted: May 18, 2025
Open Peer Review Period: May 19, 2025 - Jul 14, 2025
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Methodological Review: Prioritizing a Future Research Agenda for Overcoming Immunization Implementation Barriers in Pakistan
ABSTRACT
Background:
This paper presents a methodological review of a priority setting workshop conducted to prioritize a future research agenda for overcoming immunization implementation barriers in Pakistan.
Objective:
The complexity of immunization programs in Pakistan, characterized by regional variations in healthcare infrastructure, varying levels of community engagement, and inconsistent data management systems. This highlights the need for methodologically sound approaches to prioritize research questions that address these challenges.
Methods:
In June 2024, an immunization priority-setting workshop was convened by the National Institute of Health (NIH) and Aga Khan University (AKU), and WHO-Alliance for Health Policy and Systems Research. Our review analyzes the design, implementation and effectiveness of the workshop methodology which integrated Dot Voting and Impact Feasibility Matrix and post-workshop theme categorization process. The research prioritized was via consensus among 29 subject matter experts from government, academia, and international organizations.
Results:
The methodology demonstrated effectiveness in creating coherent categories that maintain logical connections between related research priorities. Theme 1 , “Strengthening Immunization Programs through Improved Data Systems” successfully consolidated priorities related to data quality, surveillance, and tracking special populations. Theme 2: “Innovative Digital Health Approaches”, Theme 3: “Enhancing Workforce Capacity and Well-Being”, and Theme 4: “Ensuring Equitable Access to Immunization Services”.
Conclusions:
Our methodological review suggests that priority-setting approaches in Pakistan must balance technical rigor with contextual appropriateness methodologies that effectively balance stakeholder engagement, the existing institutional landscape, technical assessments, and practical constraints. This workshop experience underscored the importance of collaborative and evidence-based approaches in prioritizing implementation research for immunization. This review highlights the critical role of inclusive and systematic priority-setting in public health research, offering valuable insights for similar initiatives in low- and middle-income countries and contributing to the broader discourse on health system strengthening and public health improvement.
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