Media has a major role in informing and changing the opinions of people during national health campaigns. Because polio is still found in Pakistan, sharing accurate information is important to ensure people get vaccinated. Over the years, the media has supported public knowledge of health and at the same time, sometimes shared stories that gave rise to doubt. After launching the Pakistan Polio Eradication Program in 1996, government and international groups saw how media could drive changes in behavior and policy discussions.

Whilst there has been a major development in fighting polio in the previous decade, challenges of false information, cultural opposition, and risk remain. Partly because of effective media campaigns and health measures, there were very few polio cases in Pakistan in 2022. It examines how Pakistani media talked about the polio eradication campaign at this important time and the result on public perception and vaccination adherence, mainly in high-risk areas of the country.

The media can activate the public's interest in polio vaccination, leading the masses to accept its importance. Media is very important in promoting health communication everywhere. Media and health communication have grown together as new technology has appeared, and public health issues have emerged. In past times, media assisted health campaigns mainly by providing information, but now it can significantly shape health behaviors, social standards, and government decisions. Health communication developed as an area in the early 20th century, mainly because of the increase in mass communication through print newspapers, radio, and television.

Traditionally, health messages were sent from the top to inform or convince people who did not take much part in decision-making. Scholars, later on, saw the importance of models that considered culture, society, and psychological aspects that could affect health behavior (Shahzad & Siraj, 2020). Because of this change, people can now participate more through digital media and social networking during the 21st century.

Media firms have helped people learn about the threats of polio by providing updated news stories, public announcements, special shows, and interviewing health officials. Involving television, radio, newspapers, and digital and social media, campaigns can inform a wide variety of people living in cities and towns. To increase their reputation, they have brought in known media personalities, religious leaders, and famous people. Such campaigns usually suggest that ridding the country of polio is something people should feel responsible for (Shahzad, Sadiq, & Hayat, 2024).

Its impact comes from how it creates touching stories that fit well with cultural attitudes. When stories of people affected by polio, the hard work of those protecting us, and the lasting value of protection are communicated through the media, more people become empathetic and want to help. Effective communication with hesitant groups can be achieved by pairing visual stories on TV and the internet with simple, nearby, and specific messaging. What's more, talk shows and call-in events offer a space for the public to involve themselves in public health discussions, ask experts and officials for advice, and get reassurance.

The media has faced some obstacles when trying to support the polio eradication campaign. At times in conflict-hit or politically tense regions, some news outlets have spread conspiracy theories through their reporting or have refused to question disinformation. Examples are false reports that vaccines are not safe, that they work with other countries' intelligence services, or that using them affects one's ability to have children. Past times, when these ideas were presented, led to greater mistrust, higher threats to health workers, and less effective efforts in eradication. Because these risks exist, media outlets - whether by the government or independently - have begun fact-checking claims, working with health specialists, and adding rules to fight false news. Extra efforts and online actions have been created to clarify polio and vaccination myths and encourage more belief inaccurate information.

Now, the Pakistani media acts to encourage public involvement in polio vaccination and at the same time fights against false information that endangers these efforts. The government, WHO, UNICEF, and the media now team up to highlight transparency, accuracy, and getting the public involved in public health. Their aim is to hand out correct information and also to overcome resistance caused by incorrect claims and cultural doubts (Abbas, 2017). As a result, the media now plays an important role in Pakistan's struggle to end polio. How it is shaped, the methods it uses to convince people, and its response to false information all support shaping attitudes and lasting results for elimination efforts.

health messaging were the Health Belief Model (Rosenstock, 1974), Diffusion of Innovations (Rogers, 1962), and later, Social Cognitive Theory (Bandura, 1986). These frameworks emphasized individual decision-making processes, the role of perceived risk, and the influence of social learning on health behaviors.

Everett Rogers' Diffusion of Innovations remains a cornerstone, particularly for vaccine-related campaigns. Rogers argued that innovations (such as polio vaccines) are adopted in social systems through stages-awareness, interest, evaluation, trial, and adoption-facilitated or hindered by communication channels. Media acts as a vital mechanism through which innovations are publicized, normalized, or questioned (Abbas, Shahzad & Sadiq, 2025).

While useful, these models have limitations. They often overlook the power dynamics inherent in health discourse, fail to fully address misinformation or resistance, and assume a linear, rational path from message reception to behavior change. Thus, more nuanced frameworks, like framing theory and cultural studies approaches, have gained traction, especially in complex sociopolitical settings like Pakistan.

According to framing theory, the way news is given can change how the audience sees and reacts to it. Goffman (1974) thought of "frames" as mental forms that let individuals see and understand reality. Entman (1993) introduced this idea to media studies by stating that the main functions of framing are to define issues, explain their sources, judge right from wrong, and recommend solutions.

For Entman, frames mean making certain information stand out, so it becomes more noticeable, significant, or memorable for people who view it. The purpose of framing is to ease understanding of difficult issues and direct the way people discuss politics and make choices (Hussain, Shukkar, & Shahzad, 2021).

Framing theory has been applied in health communication to understand how the news media shapes talks about diseases, vaccines, and public health actions. Different ways of introducing issues can lead people to view them differently, decide who is responsible for them, and support other ways of addressing them (Rehman, Abbas & Pahore, 2024).

It has been found in international studies that media framing can help or hinder efforts in public health. There was an increase in people following the guidelines during the H1N1 pandemic when there was messaging about the seriousness of the situation and the requirement for worldwide teamwork (Ahmed et al., 2018). During the COVID-19 pandemic, some messages either denied how dangerous the pandemic was or encouraged conspiracy theories which reduced trust among the public and made it harder for people to follow safety guidelines (Moorhead et al., 2013).

It has been found in India, Nigeria, and Afghanistan that how news covers vaccines influences the way people think about them. Reminding people that vaccines work, are safe, and benefit the entire community usually leads to better compliance rates. When messages are presented with a sensationalist or politically biased slant such information can boost suspicions, particularly among those already facing social tensions or violence (Iqbal, et al., 2025; Larson, 2018).

Pakistan stands out as a case where polio has remained a problem in spite of strong outcomes from international and national efforts. Many different factors lead to this such as misconceptions about religion, political disorder, violence against medical professionals, and ongoing lack of trust towards official bodies. In this situation, the media can act as a stage for conflict and also a link between people (Hussain, 2020).

Hussain et al. (2016) and Habib et al. (2019) found that many media factors are barriers to getting the vaccine in Pakistan. These include:

When people lack media literacy, face language difficulties, and misinformation is not adequately controlled on platforms such as Facebook and WhatsApp, the problem gets worse. Therefore, health officials have started to use leading media outlets to challenge this type of information and often employ religious leaders, celebrities, and community leaders.

In South Asia, studies have suggested that media stories about polio mostly center on case numbers, affected areas, and actions by the government, rather than on reasons within the community or possible solutions (Shah et al., 2015; Raza & Hossain, 2016). Often, reporting deals with individual cases such as outbreaks or deaths, instead of covering the bigger and more important factors that affect health (e.g., health inequalities).

Itttefaq et al. discovered in a 2020 study that narratives about families or health workers were more successful in persuading people than healthcare-related facts or advice from experts. This goes along with international data that emotional experiences and narratives matter a lot in promoting health.

Studies show that how effective a frame is can vary depending on how trusted the outlet is and on the background beliefs of the audience. Because of this, Dawn News produces messages that can shape important decisions, yet strictly rural and urban areas are most affected by Geo and ARY's fewer formal messages and lower levels of acceptance of vaccines.

To fully understand media reception, this study also draws on Stuart Hall's Encoding/Decoding model (1980), which emphasizes that media messages are not passively received. Rather, audiences actively interpret messages based on their own cultural frameworks, social positions, and lived experiences. Hall identifies three reading positions:

In the context of polio vaccination in Pakistan, oppositional readings may emerge from communities with historical grievances against the state or Western institutions. Hence, even scientifically accurate media messages may be rejected if they are perceived as coming from untrustworthy sources.

This reinforces the need for localized messaging-crafted in familiar languages, incorporating cultural symbols, and delivered by community-trusted figures. Only then can encoding (by media producers) align more closely with decoding (by audiences), thereby improving message reception and impact.

The rise of social media has introduced a new communication ecology where traditional gatekeeping roles are diminished, and anyone can produce or disseminate content. While this has democratized information, it has also blurred the lines between credible news and propaganda, especially in the context of health.

Platforms like Twitter and Facebook have become both tools for public health education and vectors for misinformation. For example, anti-vaccine pages and WhatsApp groups in Pakistan have propagated myths about vaccine sterility and foreign espionage, often accompanied by pseudo-scientific videos or religiously charged rhetoric. These messages often go viral faster than official corrections can catch up.

Digital media also presents opportunities. Influencer campaigns, mobile apps, and interactive health education modules have been deployed successfully in several districts. The Pakistan Polio Eradication Program has recently partnered with local YouTubers and TikTok creators to deliver vaccine-related content in entertaining formats, a promising direction that deserves more empirical study.

There are many critiques of framing theory, despite its strong analytical qualities. Tankard (2017) and Gamson (1992) believe that framing studies often focus too much on how the media shapes attitudes and ignore the role of people in viewing the news. Others such as Scheufele (1999), mention that framing is related to other theories such as agenda-setting and priming which blur the conceptual boundaries.

In addition, most research on the messaging of polio in Pakistan only looks at one aspect either the content or the audience's understanding but not at the same time. It is important to use different methods to look at media messages and also study how different people interpret and respond to them.

An additional issue is that health communication gives little attention to gender, class, and ethnicity. Some communities such as those in KP and Baluchistan, have been hesitant to be vaccinated, but few studies consider how this is affected by their ethnic or linguistic backgrounds. Knowing about these socio-cultural factors is very important for creating successful marketing campaigns.

The literature strongly suggests that media framing plays a critical role in shaping public understanding and behavior regarding polio vaccination in Pakistan. Framing theory provides a useful lens for dissecting these media narratives, while complementary perspectives like Hall's encoding/decoding model offer insights into audience reception.

What is clear is that a one-size-fits-all communication approach is inadequate in a country as diverse and politically complex as Pakistan. Future media strategies must be segmented by language, region, and cultural sensibility-grounded not only in science but also in empathy, cultural competence, and trust-building.

This study contributes to the growing body of work by offering a comparative analysis of framing patterns across four influential Pakistani media outlets. It serves as a basis for future research on the intersection of media, public health, and strategic communication in South Asia.

Based on the theoretical framework and the context of health communication in Pakistan, this research aims to address the following questions:

RQ1. What is the distribution of the frames (problem definition, diagnosis, cause & effect, and recommendations) in the selected Pakistani media outlets?

RQ2. What are the dominant framing strategies used by different media channels in covering the polio eradication campaign in Pakistan?

These questions guide the content analysis and allow for comparisons across media types (print vs. electronic) and languages (English vs. Urdu).

This study is grounded in the Framing Theory, a communication model that explores how media shape public discourse by emphasizing certain aspects of a message while omitting others. Originally introduced by Erving Goffman (1974) and later refined by Robert Entman (1993, 2003), framing theory outlines how messages are constructed to promote particular problem definitions, causal interpretations, moral evaluations, and policy solutions.

For this study, Entman's model is handy because it assists in examining the design of media information about polio in the country. The research applies four major ways to frame its analyses:

This way of looking at media analysis makes it possible to carefully review how Pakistani media frame polio eradication, focusing on the 25 high-risk districts.

This study uses quantitative content analysis which is a process for studying text and images to look for similar themes and patterns. This methodology aims for objectivity, makes research reproducible, and strives to be relevant to current theories, following Krippendorff (1980) and Neuendorf (2017).

Sampling and the range of data cover

All content regarding polio eradication published or aired by the four major Pakistani media outlets from January 2022 to December 2022 was studied with a census approach.

Researchers chose the media outlets using purposive sampling according to how widespread they are, how many people follow them, and how much influence they have on various groups in Pakistan.

The unit of analysis included:

Each unit was examined for the presence of framing elements corresponding to Entman's four functions.

A standardized coding frame was used to categorize content into one of the following codes:

Coders reviewed each news item and assigned it the most appropriate code based on its dominant theme. This categorical classification allowed for quantification and statistical analysis of framing strategies.

The research team collected a total of 1,270 entries across all four media outlets. The content was archived, categorized by a media source, and then analyzed using a structured coding protocol. Frequency distributions were calculated to identify the prevalence of each frame within and across media outlets.

Descriptive statistics and visualizations (e.g., bar graphs, and pie charts) were used to highlight differences in framing preferences. For instance, the initial analysis showed that Dawn News predominantly framed polio in terms of "problem definition," while ARY News displayed a more diverse use of frames, including substantial attention to "cause & effect" and "recommendations."

To ensure reliability, the coding team conducted a pilot test with a subset of media items. Inter-coder reliability was assessed using Cohen's Kappa, achieving a strong agreement level (κ > 0.80). The coding guide was refined based on this initial test to improve clarity and consistency.

The content analysis of 1,270 news items from four major Pakistani media outlets-Dawn, Geo News, Express News, and ARY News-provided critical insights into how polio eradication efforts were framed in the media during the period from January to December 2022. The data were analyzed through the lens of four framing functions defined by Entman: definition, diagnosis, cause and effect, and recommendations.

The framing patterns varied notably across the four media channels. A summary of the frame distribution is presented below:

These results indicate that Dawn News heavily prioritized framing polio eradication as a definitional issue-emphasizing the existence and seriousness of polio as a public health problem. Geo News selected the definition frame as well but added more explanations for vaccine hesitancy and how this keeps the virus from being dealt with. Unlike the previous channels, Express News and ARY News gave both concerns and proactive advice about vaccination a central role in their programming.

The comparative analysis reveals several key insights:

It is based on current media targeting ways. English channels are made for an elite, urban, and international audience, but Urdu ones often target rural and less informed communities.

Entman's framing theory claims that the way media portrays an issue changes how viewers see it. The study suggests that Pakistani media highlight some ideas (or frames) more than others, based on their approach and who they target:

By varying these frames, media outlets play distinct roles in the polio campaign's communication ecosystem, shaping public awareness, influencing attitudes, and potentially affecting policy and health behavior outcomes.

To eradicate polio in Pakistan which is one of the last two countries where it is found, it is necessary for the media to support effective communication strategies in addition to making vaccines available and hardworking health workers. The purpose of this study was to see how each of these four major Pakistani media outlets-Dawn, Geo, Express, and ARY-reported on the polio eradication campaign last year. By applying Entman's framing theory and conducting a quantitative content analysis of 1,270 media items, the research revealed clear distinctions in how different outlets constructed public narratives around polio.

Findings indicate that while all media sources acknowledged polio as a significant public health issue, their framing strategies varied considerably based on language, medium, and target audience. As Pakistan's role in global health was important, the newspaper underlined it by mostly adopting an approach that defined what the issues were at hand. It made efforts to explain the main factors behind vaccine hesitancy to its viewers. Express News emphasized cause-and-effect relationships, helping audiences link vaccination decisions with broader health consequences. ARY News offered the most holistic coverage, balancing problem definition with practical recommendations and emotional appeals.

These framing differences reflect the functional role each media outlet plays in the larger ecosystem of health communication. English media cater to policymakers, development partners, and urban professionals, while Urdu media, especially electronic outlets, are pivotal in reaching grassroots populations. The way a story is framed-whether it highlights urgency, blames systemic failures, or calls communities to action-affects not only how audiences understand the issue but also how they respond to it. In contexts where misinformation, fear, and distrust run high, particularly in high-risk districts, effective framing can be the difference between resistance and cooperation.

From a theoretical standpoint, this study reaffirms the utility of framing theory in health communication research. Entman's four-function model proved effective in capturing the nuances of media messaging across platforms. It also highlights a need for deeper audience research to understand how these frames are decoded by different demographic groups-a potential area for future inquiry. Furthermore, integrating Stuart Hall's encoding/decoding model could enrich the understanding of how framed messages are interpreted differently based on cultural, social, and political contexts.

In practical terms, the findings underscore the importance of tailored communication strategies in health campaigns. For media professionals and policymakers, this means co-designing content that resonates with local values, speaks to specific community concerns, and employs credible messengers-whether they be doctors, parents, or religious leaders. Media must also work collaboratively with public health authorities to proactively combat misinformation, clarify vaccine safety, and build long-term public trust.

In conclusion, while medical interventions are essential to eradicating polio, media plays a parallel and equally critical role. Its power lies not merely in reporting facts but in shaping the national conversation. When used responsibly, strategically, and empathetically, media can be a force multiplier-mobilizing public opinion, transforming attitudes, and driving the final push toward a polio-free Pakistan.