Perceived influence of media campaigns and immunization awareness in rural Muzaffarabad, Azad Jammu and Kashmir: A cross-sectional evaluation of selection Bias in digital survey methodology

Despite ongoing Expanded Programme on Immunization (EPI) activities, immunization coverage (IC) in rural areas of Azad Jammu and Kashmir (AJK) remains below the herd-immunity threshold of 95%. This study assessed the perceived influence of media campaigns on immunization awareness among rural caregivers in Muzaffarabad and examined methodological implications of WhatsApp-based data collection in a partially connected population. A cross-sectional survey was conducted with 300 parents/caregivers of children under five, using a WHO 30 × 10 cluster design across 30 rural Union Councils. Households were identified in person by Lady Health Workers (LHWs); the structured questionnaire was then administered via WhatsApp. Descriptive statistics, Pearson correlations, and chi-square tests were computed in IBM SPSS v.25. Social media was the most frequently used source of health information (M = 4.08), and awareness (M = 3.72) and perceived campaign effectiveness (M = 3.76) were moderately high. Media exposure was positively associated with awareness (r = 0.363, p < .001), and awareness was strongly associated with perceived effectiveness (r = 0.720, p < .001). The sample's self-reported vaccination rate (98.67%) was substantially higher than the district's official baseline (82%); we interpret this gap cautiously as consistent with, though not conclusive proof of, selection bias associated with digital survey administration, given the study's cross-sectional design and lack of a non-digital comparison arm. We propose a Hybrid Communication Model integrating social media, religious networks, and community health workers to strengthen immunization communication in rural AJK.