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Parsons Leigh J, FitzGerald EA, Moss SJ, Cherak MS, Brundin-Mather R, Dodds A, Stelfox HT, Dubé È, Fiest KM, Halperin DM, Ahmed SB, MacDonald SE, Straus SE, Manca T, Ng Kamstra J, Soo A, Longmore S, Kupsch S, Sept B, Halperin SA. The evolution of vaccine hesitancy through the COVID-19 pandemic: A semi-structured interview study on booster and bivalent doses. Hum Vaccin Immunother 2024; 20:2316417. [PMID: 38390696 PMCID: PMC10896168 DOI: 10.1080/21645515.2024.2316417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
We sought in-depth understanding on the evolution of factors influencing COVID-19 booster dose and bivalent vaccine hesitancy in a longitudinal semi-structured interview-based qualitative study. Serial interviews were conducted between July 25th and September 1st, 2022 (Phase I: univalent booster dose availability), and between November 21st, 2022 and January 11th, 2023 (Phase II: bivalent vaccine availability). Adults (≥18 years) in Canada who had received an initial primary series and had not received a COVID-19 booster dose were eligible for Phase I, and subsequently invited to participate in Phase II. Twenty-two of twenty-three (96%) participants completed interviews for both phases (45 interviews). Nearly half of participants identified as a woman (n = 11), the median age was 37 years (interquartile range: 32-48), and most participants were employed full-time (n = 12); no participant reported needing to vaccinate (with a primary series) for their workplace. No participant reported having received a COVID-19 booster dose at the time of their interview in Phase II. Three themes relating to the development of hesitancy toward continued vaccination against COVID-19 were identified: 1) effectiveness (frequency concerns; infection despite vaccination); 2) necessity (less threatening, low urgency, alternate protective measures); and 3) information (need for data, contradiction and confusion, lack of trust, decreased motivation). The data from interviews with individuals who had not received a COVID-19 booster dose or bivalent vaccine despite having received a primary series of COVID-19 vaccines highlights actionable targets to address vaccine hesitancy and improve public health literacy.
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Affiliation(s)
- Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Canadian Center for Vaccinology & IWK Health Center, Halifax, Nova Scotia, Canada
| | - Emily A FitzGerald
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephana Julia Moss
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
- CRISMA Center, Department of Critical Care, University of Pittsburgh, Pittsburgh, USA
| | - Michal S Cherak
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology & IWK Health Center, Halifax, Nova Scotia, Canada
| | | | - Alexandra Dodds
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ève Dubé
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada
- Département d'anthropologie, Université Laval, Québec, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Donna M Halperin
- Canadian Center for Vaccinology & IWK Health Center, Halifax, Nova Scotia, Canada
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Sofia B Ahmed
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shannon E MacDonald
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Terra Manca
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
- Sociology and Social Anthropology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Josh Ng Kamstra
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Shelly Longmore
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bonnie Sept
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology & IWK Health Center, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Dube E, Trottier ME, Greyson D, MacDonald NE, Meyer SB, MacDonald SE, Driedger SM, Witteman HO, Ouakki M, Gagnon D. Use of narratives to enhance childhood vaccine acceptance: Results of an online experiment among Canadian parents. Hum Vaccin Immunother 2024; 20:2379093. [PMID: 39044701 PMCID: PMC11271131 DOI: 10.1080/21645515.2024.2379093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/18/2024] [Accepted: 07/09/2024] [Indexed: 07/25/2024] Open
Abstract
Identifying effective interventions to promote children's vaccination acceptance is crucial for the health and wellbeing of communities. Many interventions can be implemented to increase parental awareness of the benefits of vaccination and positively influence their confidence in vaccines and vaccination services. One potential approach is using narratives as an intervention. This study aims to evaluate the effects of a narrative-based intervention on parents' attitudes and vaccination intentions. In a pre-post experiment, 2,000 parents of young children recruited from an online pan-Canadian panel were randomly exposed to one of the three videos presenting narratives to promote childhood vaccination or a control condition video about the importance and benefits of physical activity in children. Pre-post measures reveal a relatively modest but positive impact of the narratives on parents' attitudes and intention to vaccinate their child(ren). The results also suggest that narratives with more emotional content may be more effective in positively influencing vaccine attitudes than the more factual narrative. Using narratives to promote vaccination can positively influence parents' views and intentions toward childhood vaccines, but research is still required to identify the best components of such interventions.
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Affiliation(s)
- Eve Dube
- Department of Anthropology, Laval University, Quebec, Quebec, Canada
| | - Marie-Eve Trottier
- Department of Biohazard, Quebec National Institute of Public Health, Quebec, Quebec, Canada
| | - Devon Greyson
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Noni E. MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Samantha B. Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Shannon E. MacDonald
- Faculty of Nursing, University, University of Alberta, Edmonton, Alberta, Canada
| | - S. Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Holly O. Witteman
- Department of Family Medicine, Laval University, Quebec, Quebec, Canada
| | - Manale Ouakki
- Department of Biohazard, Quebec National Institute of Public Health, Quebec, Quebec, Canada
| | - Dominique Gagnon
- Department of Biohazard, Quebec National Institute of Public Health, Quebec, Quebec, Canada
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Bronstein MV, Kummerfeld E, MacDonald A, Vinogradov S. Identifying psychological predictors of SARS-CoV-2 vaccination: A machine learning study. Vaccine 2024; 42:126198. [PMID: 39106578 DOI: 10.1016/j.vaccine.2024.126198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 07/29/2024] [Accepted: 07/29/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Major barriers to addressing SARS-CoV-2 vaccine hesitancy include limited knowledge of what causes delay/refusal of SARS-CoV-2 vaccination and limited ability to predict who will remain unvaccinated over significant time periods despite vaccine availability. The present study begins to address these barriers by developing a machine learning model that prospectively predicts who will persist in not vaccinating against SARS-CoV-2. METHOD Unvaccinated individuals (n = 325) who completed a baseline survey were followed over the six-month period when vaccines against SARS-CoV-2 were first widely available (April-October 2021). A random forest model was used to predict who would remain unvaccinated against SARS-CoV-2 from their baseline measures, including demographic information (e.g., age), medical history (e.g., of influenza vaccination), Health-Belief Model constructs (e.g., perceived vaccine dangerousness), conspiracist ideation, and task-based metrics of vulnerability to conspiracist ideation (e.g., tendency toward illusory pattern perception). RESULTS The resulting model significantly predicted vaccination status (AUC-PR = 0.77, 95%CI [0.56 0.90]). At the optimal probability threshold determined by the Generalized Threshold Shifting Protocol, the model was moderately precise (0.83) when identifying individuals who remained unvaccinated (n = 80), and had a very low rate (0.04) of false-positives (incorrectly suggesting that individuals remained unvaccinated). Permutational importance tests suggested that baseline SARS-CoV-2 vaccine intentions conveyed the most information about future SARS-CoV-2 vaccination status. Conspiracist ideation was the second most informative predictor, suggesting that misinformation influences vaccination behavior. Other important predictors included perceived vaccine dangerousness, as expected under the Health Belief Model, and influenza vaccination history. CONCLUSIONS The model we developed can accurately and prospectively identify individuals who remain unvaccinated against SARS-CoV-2. It could therefore facilitate empirically-informed allocation of interventions that encourage vaccine uptake. The predictive value of conspiracist ideation, perceived vaccine dangerousness, and vaccine intentions in our model is consistent with potential causal relations between these variables and SARS-CoV-2 vaccine uptake.
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Affiliation(s)
- Michael V Bronstein
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, MN, USA; Institute for Health Informatics, University of Minnesota, MN, USA.
| | - Erich Kummerfeld
- Institute for Health Informatics, University of Minnesota, MN, USA
| | | | - Sophia Vinogradov
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, MN, USA
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Houle SKD, Waite NM, Vernon-Wilson E, Dolovich L, Yang M. Uptake and outcomes of VaxCheck, an adult life-course vaccination service: A study among community pharmacists. Vaccine 2024; 42:126096. [PMID: 38955590 DOI: 10.1016/j.vaccine.2024.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/18/2024] [Accepted: 06/26/2024] [Indexed: 07/04/2024]
Abstract
Vaccination rates among Canadian adults remain suboptimal. Community pharmacists have increasingly adopted an active role in vaccination and are trusted by the public to provide vaccination-related advice and care. The aim of this prospective descriptive study was to develop and test a novel clinical service, VaxCheck, to support proactive life-course vaccination assessments by community pharmacists. From October 2022-May 2023, 123 VaxCheck consultations were performed at 9 community pharmacies within the Wholehealth Pharmacy Partners banner in Ontario, Canada. Patient age averaged 60 years and 35.8 % had at least one chronic disease risk factor, 17.7 % had lifestyle-related risk factor(s), and 15.4 % were immunocompromised. 95.1 % of VaxCheck consultations resulted in at least one vaccine recommendation, averaging three vaccines per patient. Most frequently recommended vaccines were those against pneumococcal disease, tetanus/diphtheria, herpes zoster, COVID-19, and influenza, with acceptance rates highest for those available without a prescription and at no charge at the pharmacy. Patient feedback was positive with 85 % of respondents agreeing or strongly agreeing that they would recommend the service to others. Vaccine administration at the time of the consultation occurred with only 5.9 % of recommended vaccines, frequently impacted by limitations to scope of practice related to pharmacist ability to prescribe and/or administer the vaccine and lack of pharmacy access to publicly funded vaccine supply for those meeting eligibility criteria. Community pharmacists performing a VaxCheck consultation can proactively identify indicated vaccines for patients. Expansion in scope of practice and access to publicly funded vaccine is recommended to further support vaccine uptake.
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Affiliation(s)
- Sherilyn K D Houle
- School of Pharmacy, University of Waterloo, 200 University Ave. W., Waterloo ON, N2L 3G1, Canada.
| | - Nancy M Waite
- School of Pharmacy, University of Waterloo, 200 University Ave. W., Waterloo ON, N2L 3G1, Canada
| | - Elizabeth Vernon-Wilson
- School of Pharmacy, University of Waterloo, 200 University Ave. W., Waterloo ON, N2L 3G1, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON M5S 3M2, Canada
| | - Molly Yang
- Wholehealth Pharmacy Partners, 18-85 Citizen Court, Markham, ON L6G 1A8, Canada
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Pennisi F, Genovese C, Gianfredi V. Lessons from the COVID-19 Pandemic: Promoting Vaccination and Public Health Resilience, a Narrative Review. Vaccines (Basel) 2024; 12:891. [PMID: 39204017 PMCID: PMC11359644 DOI: 10.3390/vaccines12080891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/15/2024] [Accepted: 08/05/2024] [Indexed: 09/03/2024] Open
Abstract
The COVID-19 pandemic has underscored the critical importance of adaptable and resilient public health systems capable of rapid response to emerging health crises. This paper synthesizes the lessons learned from the COVID-19 vaccination campaign and explores strategies to enhance vaccine uptake in the post-pandemic era. Key challenges identified include logistical, economic, sociocultural, and policy dimensions that impact vaccination efforts, particularly in low-resource settings. The analysis highlights the need for resilient supply chains, effective communication, community engagement, and equitable access to healthcare resources. The rapid development and deployment of mRNA vaccines exemplify the potential of innovative vaccine technologies, though public trust and acceptance remain crucial. Strategies such as partnerships with local leaders, tailored messaging, and integration of digital tools are essential for combating vaccine hesitancy. By applying these insights, future vaccination campaigns can be more efficient, equitable, and resilient, ultimately improving public health outcomes globally. This paper aims to inform policy and practice, ensuring that public health strategies are evidence based and context specific, thus better preparing for future health challenges.
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Affiliation(s)
- Flavia Pennisi
- Faculty of Medicine, University Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Cristina Genovese
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy
| | - Vincenza Gianfredi
- Department of Biomedical Sciences for Health, University of Milan, Via Pascal 36, 20133 Milan, Italy
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6
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Garcia S, Shin M, Gill M, He Z, Dang E, Kast WM, Unger JB, Baezconde-Garbanati L, Tsui J. Identifying the intersection of parental HPV and COVID-19 vaccine hesitancy to inform health messaging interventions in community-based settings. Vaccine 2024:S0264-410X(24)00792-8. [PMID: 38997849 DOI: 10.1016/j.vaccine.2024.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/27/2024] [Accepted: 07/09/2024] [Indexed: 07/14/2024]
Abstract
PURPOSE Parental human papillomavirus (HPV) vaccine hesitancy contributes to delays or refusals in adolescent uptake. It is unclear if COVID-19 vaccine hesitancy has further impacted the low HPV vaccine uptake trends among underrepresented minorities. This study examines the relationship between COVID-19 vaccine intent and HPV vaccine hesitancy among parents for their adolescents in communities with low vaccine uptake in Los Angeles County. METHODS Parents from a school-based academic enrichment program serving low-income, first-generation immigrant families completed an online cross-sectional survey to understand parental HPV vaccine hesitancy, adolescent HPV vaccine behavior, and attitudes towards other vaccines, including intent to receive COVID-19 vaccines. In March 2021, parents with children ages 9-17 years completed online surveys. Using multivariate logistic regression models, we examined whether low parent intent to vaccinate their adolescent against COVID-19 was associated with hesitancy to vaccinate against HPV. RESULTS A total of 291 surveys were completed. Among parents with high HPV vaccine hesitancy for their adolescent, 33 % did not intend to vaccinate their adolescent against COVID-19 compared to 7 % among parents with low HPV vaccine hesitancy. Low parent intention to vaccinate adolescent against COVID-19 was associated with higher HPV vaccine hesitancy (p < 0.01) after controlling for parent nativity status, medical mistrust, receiving the flu vaccination and negative HPV information. DISCUSSION Our findings indicate associations between low parental COVID-19 vaccine intent and higher HPV vaccine hesitancy for their adolescent. Identifying community-relevant health interventions to address parental vaccine hesitancy across multiple child and adolescent vaccines may help to achieve equitable vaccine uptake.
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Affiliation(s)
- Samantha Garcia
- University of Southern California, Keck School of Medicine, Los Angeles, CA, United States
| | - Michelle Shin
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, United States
| | - Morgan Gill
- University of Southern California, Keck School of Medicine, Los Angeles, CA, United States
| | - Zehui He
- University of Southern California, Keck School of Medicine, Los Angeles, CA, United States
| | - Emily Dang
- University of Southern California, Keck School of Medicine, Los Angeles, CA, United States
| | - W Martin Kast
- University of Southern California, Keck School of Medicine, Los Angeles, CA, United States
| | - Jennifer B Unger
- University of Southern California, Keck School of Medicine, Los Angeles, CA, United States
| | | | - Jennifer Tsui
- University of Southern California, Keck School of Medicine, Los Angeles, CA, United States.
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Parsekar SS, Vadrevu L, Jain M, Menon S, Taneja G. Interventions addressing routine childhood immunization and its behavioral and social drivers. Front Public Health 2024; 12:1364798. [PMID: 38966698 PMCID: PMC11223502 DOI: 10.3389/fpubh.2024.1364798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/05/2024] [Indexed: 07/06/2024] Open
Abstract
Introduction Despite the advances in vaccination, there are still several challenges in reaching millions of children in low- and middle-income countries (LMICs). In this review, we present an extensive summary of the various strategies used for improving routine immunization in LMICs to aid program implementers in designing vaccination interventions. Methods Experimental and quasi-experimental impact evaluations conducted in LMICs evaluating the effectiveness of interventions in improving routine immunization of children aged 0-5 years or the intermediate outcomes were included from 3ie's review of systematic reviews. Some additional impact evaluation studies published in recent years in select LMICs with large number of unvaccinated children were also included. Studies were coded to identify interventions and the barriers in the study context using the intervention framework developed in 3ie's Evidence Gap Map and the WHO's Behavioral and Social Drivers (BeSD) of vaccination framework, respectively. Qualitative analysis of the content was conducted to analyze the intervention strategies and the vaccination barriers that they addressed. Results and conclusion One hundred and forty-two impact evaluations were included to summarize the interventions. To address attitudinal and knowledge related barriers to vaccination and to motivate caregivers, sensitization and educational programs, media campaigns, and monetary or non-monetary incentives to caregivers, that may or may not be conditional upon certain health behaviors, have been used across contexts. To improve knowledge of vaccination, its place, time, and schedule, automated voice messages and written or pictorial messages have been used as standalone or multicomponent strategies. Interventions used to improve service quality included training and education of health workers and providing monetary or non-monetary perks to them or sending reminders to them on different aspects of provision of vaccination services. Interventions like effective planning or outreach activities, follow-up of children, tracking of children that have missed vaccinations, pay-for-performance schemes and health system strengthening have also been used to improve service access and quality. Interventions aimed at mobilizing and collaborating with the community to impact social norms, attitudes, and empower communities to make health decisions have also been widely implemented.
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Affiliation(s)
| | - Lalitha Vadrevu
- International Initiative for Impact Evaluation (3ie), New Delhi, India
| | - Monica Jain
- International Initiative for Impact Evaluation (3ie), New Delhi, India
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Chan PSF, Fang Y, Cheung DH, Zhang Q, Sun F, Mo PKH, Wang Z. Effectiveness of chatbots in increasing uptake, intention, and attitudes related to any type of vaccination: A systematic review and meta-analysis. Appl Psychol Health Well Being 2024. [PMID: 38886054 DOI: 10.1111/aphw.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 05/16/2024] [Indexed: 06/20/2024]
Abstract
This systematic review and meta-analysis analyzed and summarized the growing literature on the effectiveness of chatbot-delivered interventions in increasing uptake, intention, and attitudes related to any type of vaccination. We identified randomized controlled studies (RCTs), quasi-experimental studies, and non-experimental studies from the following platforms: PubMed, Web of Science, MEDLINE, Global Health, APA PsycInfo, and EMBASE databases. A total of 12 eligible studies published from 2019 to 2023 were analyzed and summarized. In particular, one RCT showed that a chatbot-delivered tailored intervention was more effective than a chatbot-delivered non-tailored intervention in promoting seasonal influenza vaccine uptake among older adults (50.5% versus 35.3%, p = 0.002). Six RCTs were included in the meta-analysis to evaluate the effectiveness of chatbot interventions to improve vaccination attitudes and intentions. The pooled standard mean difference (SMD) of overall attitude change was 0.34 (95% confidence intervals [CI]: 0.13, 0.55, p = 0.001). We found a non-significant trivial effect of chatbot interventions on improving intentions of vaccination (SMD: 0.11, 95% CI: -0.13, 0.34, p = 0.38). However, further evidence is needed to draw a more precise conclusion. Additionally, study participants reported high satisfaction levels of using the chatbot and were likely to recommend it to others. The development of chatbots is still nascent and rooms for improvement exist.
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Affiliation(s)
- Paul Shing-Fong Chan
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Yuan Fang
- Department of Health and Physical Education, the Education University of Hong Kong, Hong Kong, SAR, China
| | - Doug H Cheung
- Center of Population Sciences for Health Equity, Florida State University, Tallahassee, FL, USA
| | - Qingpeng Zhang
- Musketeers Foundation Institute of Data Science, the University of Hong Kong, Hong Kong, SAR, China
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, SAR, China
| | - Fenghua Sun
- Department of Health and Physical Education, the Education University of Hong Kong, Hong Kong, SAR, China
| | - Phoenix K H Mo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, SAR, China
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Norman G, Kletter M, Dumville J. Interventions to increase vaccination in vulnerable groups: rapid overview of reviews. BMC Public Health 2024; 24:1479. [PMID: 38831275 PMCID: PMC11145854 DOI: 10.1186/s12889-024-18713-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/25/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE Groups which are marginalised, disadvantaged or otherwise vulnerable have lower uptake of vaccinations. This differential has been amplified in COVID-19 vaccination compared to (e.g.) influenza vaccination. This overview assessed the effectiveness of interventions to increase vaccination in underserved, minority or vulnerable groups. METHODS In November 2022 we searched four databases for systematic reviews that included RCTs evaluating any intervention to increase vaccination in underserved, minority or vulnerable groups; our primary outcome was vaccination. We used rapid review methods to screen, extract data and assess risk of bias in identified reviews. We undertook narrative synthesis using an approach modified from SWiM guidance. We categorised interventions as being high, medium or low intensity, and as targeting vaccine demand, access, or providers. RESULTS We included 23 systematic reviews, including studies in high and low or middle income countries, focused on children, adolescents and adults. Groups were vulnerable based on socioeconomic status, minority ethnicity, migrant/refugee status, age, location or LGBTQ identity. Pregnancy/maternity sometimes intersected with vulnerabilities. Evidence supported interventions including: home visits to communicate/educate and to vaccinate, and facilitator visits to practices (high intensity); telephone calls to communicate/educate, remind/book appointments (medium intensity); letters, postcards or text messages to communicate/educate, remind/book appointments and reminder/recall interventions for practices (low intensity). Many studies used multiple interventions or components. CONCLUSION There was considerable evidence supporting the effectiveness of communication in person, by phone or in writing to increase vaccination. Both high and low intensity interventions targeting providers showed effectiveness. Limited evidence assessed additional clinics or targeted services for increasing access; only home visits had higher confidence evidence showing effectiveness. There was no evidence for interventions for some communities, such as religious minorities which may intersect with gaps in evidence for additional services. None of the evidence related to COVID-19 vaccination where inequalities of outcome are exacerbated. PROSPERO REGISTRATION CRD42021293355.
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Affiliation(s)
- Gill Norman
- NIHR Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Maartje Kletter
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jo Dumville
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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10
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Lanke R, Chimurkar V. Measles Outbreak in Socioeconomically Diverse Sections: A Review. Cureus 2024; 16:e62879. [PMID: 39044898 PMCID: PMC11262914 DOI: 10.7759/cureus.62879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 06/21/2024] [Indexed: 07/25/2024] Open
Abstract
Measles outbreaks among socioeconomically weaker sections constitute a significant public health challenge. The objective is to highlight the specific vulnerabilities and contributing factors that make these communities more susceptible to measles outbreaks. Socioeconomically weaker sections, often characterized by poverty, inadequate healthcare access, overcrowding, and suboptimal immunization rates, face heightened risks of measles outbreaks. These outbreaks occur due to various interrelated factors, including limited healthcare infrastructure, low vaccine coverage, a lack of awareness about vaccination benefits, and difficulties in accessing healthcare services. The effects of measles outbreaks in socioeconomically disadvantaged areas are critical. Particularly among vulnerable groups, including newborns, expectant mothers, and malnourished people, measles increases morbidity and mortality. There is also a considerable financial impact on the healthcare system and the afflicted families. Measles outbreaks in these populations must be addressed using a diversified strategy. In order to improve vaccine coverage through targeted immunization programs, raise community vaccination awareness, and address social determinants of health, efforts should concentrate on bolstering the healthcare infrastructure. Effective epidemic control and prevention depend on coordinated efforts by healthcare practitioners, legislators, local leaders, and public health groups. Healthcare systems can lessen the impact of measles in socioeconomically disadvantaged areas and strive toward attaining equitable health outcomes for all populations by addressing the socioeconomic variables that lead to the vulnerability of measles.
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Affiliation(s)
- Ruchira Lanke
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vilas Chimurkar
- Anatomy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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11
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Evans WD, Bingenheimer JB, Long MW, Ndiaye K, Donati D, Rao NM, Akaba S, Agha S. Randomised experimental evaluation of a social media campaign to promote COVID-19 vaccination in Nigeria. J Glob Health 2024; 14:05018. [PMID: 38779876 PMCID: PMC11112529 DOI: 10.7189/jogh.14.05018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has challenged public health and behaviour change programmes, and has led to the development of innovative interventions and research. In low -and middle-income countries (LMICs) such as Nigeria, new strategies to promote vaccination, increase pro-vaccination social norms, and reduce vaccine hesitancy have been deployed through social media campaigns and evaluated using digital media platforms. Methods We conducted two randomised experimental evaluations of social media content designed to promote COVID-19 vaccination and to complement research on a nationwide vaccination promotion campaign in Nigeria run in 2022. We conducted two studies in March and August 2022 among Nigerians drawn from 31 states that had not been targeted in the aforementioned nationwide campaign. We randomised the participants to either receive the pro-vaccination social media campaign or not and collected data at pre- and post-test time points to evaluate psychosocial predictors of vaccination and vaccination outcomes following the Theory of Change based on Diffusion of Innovations; the Social Norms Theory, and the Motivation, Opportunity, Ability (MOA) framework. Data were collected through a novel intervention delivery and data collection platform through social media. Results We found that pro-vaccination social norms and vaccination rates increased, while vaccine hesitancy decreased among participants randomised to the social media intervention study arm. Conclusions Social media campaigns are a promising approach to increasing vaccination at scale in LMICs, while social norms are an important factor in promoting vaccination, which is consistent with the Social Norms Theory. This study demonstrates the capability and potential of new social media-based data collection techniques. We describe implications for future vaccination campaigns and identify future research priorities in this area. Registration Pan African Clinical Trial Registry: PACTR202310811597445.
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Affiliation(s)
- William D Evans
- Milken Institute School of Public Health, The George Washington University, Washington D.C., USA
| | - Jeffrey B Bingenheimer
- Milken Institute School of Public Health, The George Washington University, Washington D.C., USA
| | - Michael W Long
- Milken Institute School of Public Health, The George Washington University, Washington D.C., USA
| | - Khadidiatou Ndiaye
- Milken Institute School of Public Health, The George Washington University, Washington D.C., USA
| | - Dante Donati
- School of Business, Columbia University, New York, USA
| | | | - Selinam Akaba
- Milken Institute School of Public Health, The George Washington University, Washington D.C., USA
| | - Sohail Agha
- Behavioral Insights Lab, Seattle, Washington, USA
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12
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Melnikow J, Padovani A, Zhang J, Miller M, Gosdin M, Loureiro S, Daniels B. Patient concerns and physician strategies for addressing COVID-19 vaccine hesitancy. Vaccine 2024; 42:3300-3306. [PMID: 38627148 DOI: 10.1016/j.vaccine.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 03/19/2024] [Accepted: 04/04/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE COVID-19 vaccination is critical for reducing serious illness and hospitalizations, yet many remain hesitant. We conducted a survey of frontline physicians to identify patient concerns and physician strategies to address COVID-19 vaccine-hesitancy. METHODS A national random sample of physicians in frontline specialties selected from a comprehensive list of practicing physicians in the U.S. were emailed a survey in August 2021. Multiple choice and open-ended questions inquired about patient concerns related to the COVID-19 vaccines and strategies used by physicians to counter vaccine misinformation and encourage vaccine-hesitant patients. Weighting was applied to achieve representativeness and reduce non-response bias. Network analysis examined co-occurring patient concerns. Open-ended responses on communication strategies were coded via thematic analysis. Multi-variable logistic regression examined associations between physician and pandemic characteristics with patient concerns and use of communication strategies. RESULTS 531 physicians responded: primary care (241); emergency medicine (142); critical care (84); hospitalists (34); and infectious disease (30). Weighted response balance statistics showed excellent balance between respondents and nonrespondents. On average, physicians reported four patient vaccine concerns. Safety, side effects, vaccine misinformation, and mistrust in government were most common, and often co-occurring. 297 physicians described communication strategies: 180 (61 %) provided vaccine education and 94 (32 %) created a safe space for vaccine discussion. Narrative responses from physicians provided compelling examples of both successes and communication challenges arising from misinformation. Compared with emergency medicine, critical care (OR 2.45, 95 % CI 1.14, 5.24), infectious disease (OR 2.45, 95 % CI 1.00, 6.02), and primary care physicians (OR 1.66, 95 % CI 1.02, 2.70) were more likely to provide communication strategies. CONCLUSIONS Many physicians engage with vaccine hesitant patients using a variety of strategies. Dissemination of effective system and physician-level communication interventions could enhance physician success.
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Affiliation(s)
- Joy Melnikow
- Center for Healthcare Policy and Research, University of California, Davis, CA, USA.
| | | | - Jingwen Zhang
- Department of Communication, University of California, Davis, CA, USA.
| | - Marykate Miller
- Center for Healthcare Policy and Research, University of California, Davis, CA, USA.
| | - Melissa Gosdin
- Center for Healthcare Policy and Research, University of California, Davis, CA, USA.
| | - Sabrina Loureiro
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA.
| | - Brock Daniels
- Department of Emergency Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA.
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13
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Curvino EJ, Woodruff ME, Roe EF, Freire Haddad H, Cordero Alvarado P, Collier JH. Supramolecular Peptide Self-Assemblies Facilitate Oral Immunization. ACS Biomater Sci Eng 2024; 10:3041-3056. [PMID: 38623037 DOI: 10.1021/acsbiomaterials.4c00525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Oral immunization is a promising strategy for preventing and treating gastrointestinal (GI) infections and diseases, as it allows for direct access to the disease site. To elicit immune responses within the GI tract, however, there are many obstacles that oral vaccines must surmount, including proteolytic degradation and thick mucus barriers. Here, we employed a modular self-assembling peptide nanofiber platform to facilitate oral immunization against both peptide and small molecule epitopes. Synthesizing nanofibers with d-amino acids rendered them resistant to proteases in vitro, whereas l-amino acid nanofibers were rapidly degraded. Additionally, the inclusion of peptide sequences rich in proline, alanine, and serine (PAS), increased nanofiber muco-penetration, and accelerated nanofiber transport through the GI tract. Oral immunization with PASylated nanofibers and mucosal adjuvant generated local and systemic immune responses to a peptide epitope but only for l-amino acid nanofibers. Further, we were able to apply this design to also enable oral immunization against a small molecule epitope and illustrated the therapeutic and prophylactic effectiveness of these immunizations in mouse models of colitis. These findings demonstrate that supramolecular peptide self-assemblies have promise as oral vaccines and immunotherapies.
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Affiliation(s)
- Elizabeth J Curvino
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, United States
| | - Mia E Woodruff
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, United States
| | - Emily F Roe
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, United States
| | - Helena Freire Haddad
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, United States
| | - Pablo Cordero Alvarado
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, United States
| | - Joel H Collier
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, United States
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14
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Bateman LB, Hall A, Hannon L, Ryan M, Osborne T, Whitfield S, Okoro G, Stager C, Driggers S, Jones V, Rhinehart J, Fouad MN. Partnering With Churches to Address COVID-19 Vaccine Hesitancy and Uptake in Trustworthy Contexts. Am J Public Health 2024; 114:S392-S395. [PMID: 38776503 PMCID: PMC11111367 DOI: 10.2105/ajph.2024.307683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/25/2024]
Abstract
The Black church has long been seen as a crucial partner in addressing public health issues. This paper describes the development, implementation, and evaluation of a community-engaged church intervention addressing COVID-19 vaccine hesitancy in underserved Black communities in Jefferson County, Alabama. We partnered with churches to implement and evaluate the intervention between March and June of 2022 and found that our church partners were capable of significant messaging reach, particularly through electronic means. (Am J Public Health. 2024;114(S5):S392-S395. https://doi.org/10.2105/AJPH.2024.307683).
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Affiliation(s)
- Lori B Bateman
- Lori Bateman, Melissa Ryan, Tiffany Osborne, Samantha Whitfield, Samantha, Grace Okoro, Catanya Stager, Susan Driggers, Jessica Rhinehart, and Mona Fouad are with the Heersink School of Medicine, University of Alabama at Birmingham. Allyson Hall is with the School of Health Professions, University of Alabama at Birmingham. Lonnie Hannon is with the School of Public Health, University of Alabama at Birmingham. Valerie Jones is with the New Rising Star Missionary Baptist Church, Birmingham, AL
| | - Allyson Hall
- Lori Bateman, Melissa Ryan, Tiffany Osborne, Samantha Whitfield, Samantha, Grace Okoro, Catanya Stager, Susan Driggers, Jessica Rhinehart, and Mona Fouad are with the Heersink School of Medicine, University of Alabama at Birmingham. Allyson Hall is with the School of Health Professions, University of Alabama at Birmingham. Lonnie Hannon is with the School of Public Health, University of Alabama at Birmingham. Valerie Jones is with the New Rising Star Missionary Baptist Church, Birmingham, AL
| | - Lonnie Hannon
- Lori Bateman, Melissa Ryan, Tiffany Osborne, Samantha Whitfield, Samantha, Grace Okoro, Catanya Stager, Susan Driggers, Jessica Rhinehart, and Mona Fouad are with the Heersink School of Medicine, University of Alabama at Birmingham. Allyson Hall is with the School of Health Professions, University of Alabama at Birmingham. Lonnie Hannon is with the School of Public Health, University of Alabama at Birmingham. Valerie Jones is with the New Rising Star Missionary Baptist Church, Birmingham, AL
| | - Melissa Ryan
- Lori Bateman, Melissa Ryan, Tiffany Osborne, Samantha Whitfield, Samantha, Grace Okoro, Catanya Stager, Susan Driggers, Jessica Rhinehart, and Mona Fouad are with the Heersink School of Medicine, University of Alabama at Birmingham. Allyson Hall is with the School of Health Professions, University of Alabama at Birmingham. Lonnie Hannon is with the School of Public Health, University of Alabama at Birmingham. Valerie Jones is with the New Rising Star Missionary Baptist Church, Birmingham, AL
| | - Tiffany Osborne
- Lori Bateman, Melissa Ryan, Tiffany Osborne, Samantha Whitfield, Samantha, Grace Okoro, Catanya Stager, Susan Driggers, Jessica Rhinehart, and Mona Fouad are with the Heersink School of Medicine, University of Alabama at Birmingham. Allyson Hall is with the School of Health Professions, University of Alabama at Birmingham. Lonnie Hannon is with the School of Public Health, University of Alabama at Birmingham. Valerie Jones is with the New Rising Star Missionary Baptist Church, Birmingham, AL
| | - Samantha Whitfield
- Lori Bateman, Melissa Ryan, Tiffany Osborne, Samantha Whitfield, Samantha, Grace Okoro, Catanya Stager, Susan Driggers, Jessica Rhinehart, and Mona Fouad are with the Heersink School of Medicine, University of Alabama at Birmingham. Allyson Hall is with the School of Health Professions, University of Alabama at Birmingham. Lonnie Hannon is with the School of Public Health, University of Alabama at Birmingham. Valerie Jones is with the New Rising Star Missionary Baptist Church, Birmingham, AL
| | - Grace Okoro
- Lori Bateman, Melissa Ryan, Tiffany Osborne, Samantha Whitfield, Samantha, Grace Okoro, Catanya Stager, Susan Driggers, Jessica Rhinehart, and Mona Fouad are with the Heersink School of Medicine, University of Alabama at Birmingham. Allyson Hall is with the School of Health Professions, University of Alabama at Birmingham. Lonnie Hannon is with the School of Public Health, University of Alabama at Birmingham. Valerie Jones is with the New Rising Star Missionary Baptist Church, Birmingham, AL
| | - Catanya Stager
- Lori Bateman, Melissa Ryan, Tiffany Osborne, Samantha Whitfield, Samantha, Grace Okoro, Catanya Stager, Susan Driggers, Jessica Rhinehart, and Mona Fouad are with the Heersink School of Medicine, University of Alabama at Birmingham. Allyson Hall is with the School of Health Professions, University of Alabama at Birmingham. Lonnie Hannon is with the School of Public Health, University of Alabama at Birmingham. Valerie Jones is with the New Rising Star Missionary Baptist Church, Birmingham, AL
| | - Susan Driggers
- Lori Bateman, Melissa Ryan, Tiffany Osborne, Samantha Whitfield, Samantha, Grace Okoro, Catanya Stager, Susan Driggers, Jessica Rhinehart, and Mona Fouad are with the Heersink School of Medicine, University of Alabama at Birmingham. Allyson Hall is with the School of Health Professions, University of Alabama at Birmingham. Lonnie Hannon is with the School of Public Health, University of Alabama at Birmingham. Valerie Jones is with the New Rising Star Missionary Baptist Church, Birmingham, AL
| | - Valerie Jones
- Lori Bateman, Melissa Ryan, Tiffany Osborne, Samantha Whitfield, Samantha, Grace Okoro, Catanya Stager, Susan Driggers, Jessica Rhinehart, and Mona Fouad are with the Heersink School of Medicine, University of Alabama at Birmingham. Allyson Hall is with the School of Health Professions, University of Alabama at Birmingham. Lonnie Hannon is with the School of Public Health, University of Alabama at Birmingham. Valerie Jones is with the New Rising Star Missionary Baptist Church, Birmingham, AL
| | - Jessica Rhinehart
- Lori Bateman, Melissa Ryan, Tiffany Osborne, Samantha Whitfield, Samantha, Grace Okoro, Catanya Stager, Susan Driggers, Jessica Rhinehart, and Mona Fouad are with the Heersink School of Medicine, University of Alabama at Birmingham. Allyson Hall is with the School of Health Professions, University of Alabama at Birmingham. Lonnie Hannon is with the School of Public Health, University of Alabama at Birmingham. Valerie Jones is with the New Rising Star Missionary Baptist Church, Birmingham, AL
| | - Mona N Fouad
- Lori Bateman, Melissa Ryan, Tiffany Osborne, Samantha Whitfield, Samantha, Grace Okoro, Catanya Stager, Susan Driggers, Jessica Rhinehart, and Mona Fouad are with the Heersink School of Medicine, University of Alabama at Birmingham. Allyson Hall is with the School of Health Professions, University of Alabama at Birmingham. Lonnie Hannon is with the School of Public Health, University of Alabama at Birmingham. Valerie Jones is with the New Rising Star Missionary Baptist Church, Birmingham, AL
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15
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Prettner R, Te Molder H, Humă B. How a 'good parent' decides on childhood vaccination. Demonstrating independence and deliberation during Dutch healthcare visits. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:664-682. [PMID: 37962985 DOI: 10.1111/1467-9566.13725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/26/2023] [Indexed: 11/16/2023]
Abstract
Childhood vaccination consultations are considered an important phase in parents' decision-making process. To date, only a few empirical studies conducted in the United States have investigated real-life consultations. To address this gap, we recorded Dutch vaccination conversations between healthcare providers and parents during routine health consultations for their newborns. The data were analysed using Conversation Analysis and Discursive Psychology. We found that the topic of vaccination was often initiated with 'Have you already thought about vaccination?' (HYATAV), and that this formulation was consequential for parental identity work. Exploring the interactional trajectories engendered by this initiation format we show that: (1) interlocutors treat the question as consisting of two types of queries, (2) conversational trajectories differ according to which of the queries is attended to and that (3) parents work up a 'good parent' identity in response to HYATAV, by demonstrating that they think about their child's vaccination beforehand and make their decisions independently. Our findings shed new light on the interactional unfolding of parental vaccination decisions.
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Affiliation(s)
- Robert Prettner
- Department of Language, Literature and Communication, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hedwig Te Molder
- Department of Language, Literature and Communication, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bogdana Humă
- Department of Language, Literature and Communication, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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16
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Shahoy S, Du M, Mostafa O, Parker A, Martirano D, Owens MT. Undergraduate-level biology students' application of central dogma to understand COVID mRNA vaccines. JOURNAL OF MICROBIOLOGY & BIOLOGY EDUCATION 2024; 25:e0016723. [PMID: 38661396 PMCID: PMC11044620 DOI: 10.1128/jmbe.00167-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/29/2024] [Indexed: 04/26/2024]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has underscored the importance of mRNA vaccines. The mechanism for how such vaccines work is related to the core biology topic of the central dogma, which students often misunderstand despite its importance. Therefore, we wanted to know whether students can apply their biology knowledge of central dogma to the real-world issue of how mRNA COVID vaccines work. Accordingly, we asked college biology students of different expertise levels how the COVID vaccine worked. Later, we cued them by telling them the vaccine contains mRNA and asked them what the mRNA does. We used thematic analysis to find common ideas in their responses. In the uncued condition, fewer than half of the students used central dogma-related ideas to explain what was in the vaccine or how the vaccine worked. Inaccurate ideas were present among all groups of biology students, particularly entering biology majors and non-biology majors, including the idea that the COVID vaccines contain a weakened, dead, or variant form of the COVID virus. After students were cued, many more students in all expertise groups expressed central dogma-related themes, showing that students could apply the knowledge of central dogma if prompted. Advanced biology majors were much more likely to state that the vaccines code for a viral protein, indicating their advanced application of central dogma concepts. These results highlight inaccurate ideas common among students and show changes in the ability to apply knowledge with student expertise level, which could inform future interventions to support student learning about vaccines and central dogma.
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Affiliation(s)
- Saya Shahoy
- Department of Neurobiology, School of Biological Sciences, University of California San Diego, La Jolla, California, USA
| | - Michelle Du
- Department of Neurobiology, School of Biological Sciences, University of California San Diego, La Jolla, California, USA
| | - Ola Mostafa
- Department of Neurobiology, School of Biological Sciences, University of California San Diego, La Jolla, California, USA
| | - Aliyah Parker
- Department of Neurobiology, School of Biological Sciences, University of California San Diego, La Jolla, California, USA
| | - Dylan Martirano
- Department of Psychology, California State University Northridge, Northridge, California, USA
| | - Melinda T. Owens
- Department of Neurobiology, School of Biological Sciences, University of California San Diego, La Jolla, California, USA
- Program in Mathematics and Science Education, University of California San Diego, La Jolla, California, USA
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17
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Thompson ESJ, Howe E, Kenworthy LaMarca T, Natale R, Jent JF. Diverse Parents Decision-Making to Vaccinate Their Child under Five Attending Childcare Programs. J Clin Med 2024; 13:2299. [PMID: 38673572 PMCID: PMC11051460 DOI: 10.3390/jcm13082299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/29/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
Background: On 18 June 2022, Moderna and Pfizer-BioNTech COVID-19 vaccines were authorized under an Emergency Use Authorization by the United States Food and Drug Administration to prevent severe coronavirus disease in children six months to four years of age. Despite approval of the COVID-19 vaccinations for young children, there remain ongoing challenges reaching widespread coverage due to parental decision-making. Parental decision-making plays a pivotal, yet understudied, role governing vaccine adoption among this priority demographic. Methods: This cross-sectional analysis examined COVID-19 vaccine intentions for 320 predominately Hispanic parents of two to five-year-olds attending Miami-Dade County childcare programs in Florida USA, several months following the June 2022 emergency authorization. Parent's self-reported survey data encompassed vaccine choices and rationales, social determinants of health, and parent immigrant status. Data analyses illustrate the associations between parent decision-making and these variables. Regression modeling and tests of independence identified predicting factors for parental vaccine decision-making. Results: Only 25% of parents intended to vaccinate their young child, while 34% resisted and 41% felt unsure, despite 70% personal vaccination rates. Household income under $25,000, identifying as a migrant, or testing COVID-19-positive significantly predicted unsure decision-making. The majority of hesitant groups expressed concerns around side effects (20%), safety (2.9%), and sufficiency of vaccine knowledge (3.3%). Conclusions: In this sample, the predominance of parents were unsure and resistant rather than accepting of having their child vaccinated despite emergency approval of the pediatric vaccine. Associations and predictive factors are examined.
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Affiliation(s)
| | | | | | | | - Jason F. Jent
- Mailman Center for Child Development, Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, FL 33136, USA (T.K.L.)
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18
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McNally K, Weinstein A, Lindley L, Wallin R, Roess A. Moving the Needle: A Qualitative Exploration of the School Nurses' Experience with Virginia's Human Papillomavirus Mandate. J Sch Nurs 2024:10598405241241229. [PMID: 38594950 DOI: 10.1177/10598405241241229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
In all US localities, students provide proof of compliance with vaccination requirements to attend school. Despite benefits, vaccine legislation remains contentious. The human papillomavirus (HPV) vaccine is recommended for adolescents and prevents cancer, but its inclusion in school immunization requirements is challenged. Virginia was the first state to mandate HPV vaccination. HPV is the only required vaccine in VA that allows caregivers to elect out. School nurses are trusted members of communities and enforce vaccine compliance. This study aims to understand Virginia school nurses' practice in implementing the HPV vaccine mandate through the exploration of their subjective experiences. Semi-structured interviews were conducted. Thematic analysis using the socioecological model guided data analysis. Factors that influence nursing practice were identified at all socioecological model levels The data from this study is intended to provide an understanding of school nursing practice so that interventions to improve HPV vaccination rates can be developed.
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Affiliation(s)
- Kimberly McNally
- George Mason University College of Public Health, Fairfax, VA, USA
| | - Ali Weinstein
- George Mason University College of Public Health, Fairfax, VA, USA
| | - Lisa Lindley
- Lehigh University College of Health, Bethlehem, PA, USA
| | - Robin Wallin
- Alexandria City Public Schools, Alexandria, VA, USA
| | - Amira Roess
- Lehigh University College of Health, Bethlehem, PA, USA
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19
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Yashar-Gershman SG, Rosenberg AT, Sawhney M, Fernanda Machicao M, Moskowitz HR, Bernstein HH. Developing a novel screening tool to address pediatric COVID-19 vaccine hesitancy at point of care. Vaccine 2024; 42:2260-2270. [PMID: 38431443 DOI: 10.1016/j.vaccine.2024.02.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/29/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
Many children are still not vaccinated against COVID-19, often attributed to rising pediatric vaccine hesitancy. To address this complex public health issue, interventions that uncover parental thinking at point of care are needed to help facilitate discussions in the exam room. The cognitive science framework of Rule Developing Experimentation helps distinguish how people think about day-to-day topics by presenting respondents with a systematic combination of messages that determines the ideas primarily driving their decisions. We hypothesized that Rule Developing Experimentation can empirically assess and identify parental mind-sets in deciding to vaccinate their children to prevent COVID-19. Artificial intelligence was also incorporated to more efficiently help formulate messages. Through an iterative process, surveying a total of 600 participants, three mind-sets emerged regarding the types of messages which parents believe would convince them to vaccinate their children to prevent COVID-19. These three mind-sets are summarized by the following phrases - "Covid is Serious," "Science Says Vaccine Works," and "Vaccine Returns Kids to Normalcy". Using these mind-sets, a simple six-question instrument (i.e., Personal Viewpoint Identifier) was then created to quickly discern at point of care a parent's mind-set surrounding pediatric COVID-19 vaccination. By quickly identifying a parent's mindset at point of care, providers can then utilize the results of the assessment to deliver individualized messaging to parents about the benefits of COVID-19 vaccination. A future study is planned to evaluate the impact of incorporating the Personal Viewpoint Identifier into routine pediatric care settings on COVID-19 vaccination rates.
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Affiliation(s)
- Sarah G Yashar-Gershman
- Northwell, New Hyde Park, New York; Cohen Children's Medical Center, 410 Lakeville Road, Suite 311, New Hyde Park, NY, USA
| | - Alix T Rosenberg
- Northwell, New Hyde Park, New York; Cohen Children's Medical Center, 410 Lakeville Road, Suite 311, New Hyde Park, NY, USA
| | - Muskaan Sawhney
- Northwell, New Hyde Park, New York; Cohen Children's Medical Center, 410 Lakeville Road, Suite 311, New Hyde Park, NY, USA
| | - Maria Fernanda Machicao
- Northwell, New Hyde Park, New York; Cohen Children's Medical Center, 410 Lakeville Road, Suite 311, New Hyde Park, NY, USA
| | | | - Henry H Bernstein
- Northwell, New Hyde Park, New York; Cohen Children's Medical Center, 410 Lakeville Road, Suite 311, New Hyde Park, NY, USA; Zucker School of Medicine at Hofstra Northwell, 500 Hofstra University, Hempstead, NY 11549, USA.
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20
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De Waele A, Hendrickx G, Valckx S, Domínguez À, Toledo D, Castilla J, Tuells J, Van Damme P. The Vaccine Training Barometer: Assessing healthcare providers' confidence to answer vaccine-related questions and their training needs. Vaccine 2024; 42:2421-2428. [PMID: 38458873 DOI: 10.1016/j.vaccine.2024.02.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 01/19/2024] [Accepted: 02/25/2024] [Indexed: 03/10/2024]
Abstract
Healthcare providers (HCP) are seen by the public as the most trustworthy source of information about vaccination. While HCPs could be a valuable partner to increase vaccine confidence in general, it is not clear whether they feel confident themselves to address questions concerning vaccination. In the context of the EU Joint Action on Vaccination (EU-JAV), the Vaccine Training Barometer, an online survey tool, was developed to assess how frequently HCPs receive questions about vaccination, how confident they feel to answer these questions, and to what extent they are willing to follow extra training. After a pilot test in Flanders, Belgium, the Barometer was launched and completed by 833 HCPs in Flanders and 291 HCPs in the Spanish regions of Catalonia, Navarre and Valencian Community from November 2020 until January 2021, during the COVID-19 pandemic, just before and during the start of the first COVID-19 vaccination campaigns. In both countries, HCPs frequently received questions about vaccination (mostly on a daily or weekly basis), and about two thirds of them indicated that the frequency of questions had increased during the three months prior to completing the survey. Most questions were about the side effects and safety of vaccines. In both countries, a considerable proportion of HCPs did not feel confident to answer vaccine-related questions (31.5% felt confident in Flanders, 21.6% in Spain). A large proportion of HCPs received questions in the last three months before the survey that they could not answer (52.4% of respondents in Flemish sample, 41.5% in Spanish sample). Only 11.4% (Flanders) and 11.3% (Spain) of the respondents felt they gained sufficient knowledge through their standard education to be able to answer questions about vaccination. Almost all respondents were willing to follow extra training on vaccination (Flanders: 95.4%, Spain: 96.6%). The Vaccine Training Barometer is thus a useful tool to monitor HCPs' confidence to answer questions about vaccination and to capture their training needs.
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Affiliation(s)
- Aurélie De Waele
- Centre for Evaluation of Vaccination, University of Antwerp, Drie Eikenstraat 663, 2650 Edegem, Belgium; Departement of Communication Studies, Faculty of Social Sciences, University of Antwerp, Sint-Jacobsstraat 2, 2000 Antwerp, Belgium.
| | - Greet Hendrickx
- Centre for Evaluation of Vaccination, University of Antwerp, Drie Eikenstraat 663, 2650 Edegem, Belgium.
| | - Sara Valckx
- Centre for Evaluation of Vaccination, University of Antwerp, Drie Eikenstraat 663, 2650 Edegem, Belgium.
| | - Àngela Domínguez
- Universitat de Barcelona, Department of Medicine, C/ de Casanova, 143, 08036 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain.
| | - Diana Toledo
- Universitat de Barcelona, Department of Medicine, C/ de Casanova, 143, 08036 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain.
| | - Jesús Castilla
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain; Instituto de Salud Pública de Navarra (IdiSNA), C. de Irunlarrea, 3, 31008 Pamplona, Navarra, Spain.
| | - José Tuells
- Edificio Ciencias Sociales, University of Alicante, Carr. de San Vicente del Raspeig, 03690 San Vicente del Raspeig, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Avda Pintor Baeza, 12, 03010 Alicante, Spain.
| | - Pierre Van Damme
- Centre for Evaluation of Vaccination, University of Antwerp, Drie Eikenstraat 663, 2650 Edegem, Belgium.
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21
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Szászi ÁJ, Bíró-Nagy A. Controversies of COVID-19 vaccine promotion: lessons of three randomised survey experiments from Hungary. Public Health 2024; 229:192-200. [PMID: 38457939 DOI: 10.1016/j.puhe.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES This study aimed to investigate vaccine promotion messages, examine the heterogeneous effects of these messages and provide experimental evidence to help evaluate the efficiency of COVID-19 vaccine promotion campaigns in Hungary. STUDY DESIGN This study presents the results of three randomised survey experiments that were embedded in cross-sectional, representative, public opinion studies of Hungarian adults based on in-person interviews. Simple randomisation and blinding were applied to assign participants into the control group (no message) or treatment groups (vaccine promotion messages). METHODS The first experiment (March 2021) aimed to test vaccination promotion messages from politicians (N = 331) and medical experts (N = 342) by comparing experimental groups' trust in vaccines and conspiratorial beliefs with the control group (N = 327). The second experiment (September 2022) tested the impact of two communication strategies ([1] highlighting the safety and effectiveness of vaccines, N = 104; and [2] highlighting the wide variety of vaccines available, N = 110) on increasing vaccine uptake among those who were still unvaccinated (control group, N = 89). The third experiment (September 2022) tested one message aiming to increase COVID-19 booster uptake among those who received only the first round of vaccination (N = 172; control group, N = 169). The outcome variable in the second and third experiments was intent to get vaccinated. Robust regressions, logit models, Mann-Whitney U-tests and model-based recursive partitioning were run. The inference criteria (p < 0.05) was set in pre-registration of the experiments. RESULTS All treatment effects were insignificant, but exploratory research found significant conditional treatment effects. Exposure to vaccine promotion by medical professionals was associated with a higher level of trust in Russian and Chinese COVID-19 vaccines in older age cohorts (weighted robust regressions, 50-59 years old, Russian vaccine: +0.769, interaction term [i.t.] p = 0.010; Chinese vaccine: +0.326, i.t. p = 0.044; and ≥60 years old, Russian vaccine +0.183, i.t. p = 0.040; Chinese vaccine +0.559, i.t. p = 0.010) and with a lower level of trust in these vaccines among younger adults (<30 years old, Russian vaccine: -1.236, i.t. p = 0.023; Chinese vaccine: -1.281, i.t. p = 0.022). Receiving a vaccine promotion message from politicians led to a higher level of trust in Chinese vaccines among the oldest respondents (≥60 years: +0.634, i.t. p = 0.035). CONCLUSIONS Short-term persuasion attempts that aimed to convince respondents about COVID-19 vaccination were ineffective. Booster hesitancy, similar to primary vaccine hesitancy, was resistant to vaccine promotion messages. Significant conditional effects suggest that COVID-19 vaccine promotion by medical experts and politicians may have had adverse effects for some demographic groups in Hungary.
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Affiliation(s)
- Á J Szászi
- HUN-REN Centre for Social Sciences, Institute for Political Science, Budapest, 1097, Tóth Kálmán u. 4., Hungary.
| | - A Bíró-Nagy
- HUN-REN Centre for Social Sciences, Institute for Political Science, Budapest, 1097, Tóth Kálmán u. 4., Hungary.
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22
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Leclercq S, Szaffarczyk S, Jardri R. Forged evidence and vaccine hesitancy during the COVID-19 crisis. L'ENCEPHALE 2024; 50:236-237. [PMID: 37813723 DOI: 10.1016/j.encep.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Salomé Leclercq
- Lille University, Inserm U1172, CHU of Lille, Lille Neuroscience & Cognition Centre, CURE platform, Fontan Hospital, 59000 Lille, France.
| | - Sébastien Szaffarczyk
- Lille University, Inserm U1172, CHU of Lille, Lille Neuroscience & Cognition Centre, CURE platform, Fontan Hospital, 59000 Lille, France
| | - Renaud Jardri
- Lille University, Inserm U1172, CHU of Lille, Lille Neuroscience & Cognition Centre, CURE platform, Fontan Hospital, 59000 Lille, France
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23
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Yu H, Bauermeister JA, Oyiborhoro U, Aryal S, Lipman TH, Tan ASL, Glanz K, Villarruel AM, Bonett S. Trust in federal COVID-19 vaccine oversight and parents' willingness to vaccinate their children against COVID-19: a cross-sectional study. BMC Public Health 2024; 24:830. [PMID: 38493101 PMCID: PMC10943829 DOI: 10.1186/s12889-024-18342-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Over half of the youth population in the United States, aged 6 months to 17 years, have not received the Coronavirus Disease 2019 (COVID-19) vaccine. Given parents' central role in vaccinating their children, we examined associations between parents' trust of the federal oversight of COVID-19 vaccine safety and their willingness to vaccinate their children against COVID-19. METHODS This cross-sectional study included 975 parents of minor children residing in Philadelphia who completed the online survey between September 2021 and February 2022. Trust was measured using a four-point Likert scale ranging from 'do not trust' to 'fully trust' for two variables: (1) trust in federal oversight of COVID-19 vaccine safety for children and (2) trust in federal oversight of COVID-19 vaccine safety for the general public. A multiple logistic regression evaluated associations between trust and parents' willingness to vaccinate their children, which was measured on a five-point Likert scale ranging from 'strongly disagree' to 'strongly agree.' The analysis was adjusted for race/ethnicity, age, sexual orientation, gender, education, insurance, and parents' vaccination status. RESULTS Analyses included 975 parents whose children had not previously been vaccinated against COVID-19 (mean age 36.79, standard deviation 6.4; 42.1% racial/ethnic minorities; 93.2% heterosexual; and 73.7% with a college degree). Greater trust regarding federal oversight of COVID-19 vaccine safety for children [adjusted odds ratio (aOR) = 1.52, 95% confidence interval (CI): 1.13-2.04] and for the public (aOR = 1.58, 95% CI: 1.17-2.14) were each associated with increased willingness to have their child vaccinated against COVID-19. Unvaccinated parents had decreased willingness compared to parents who had received at least one dose of the vaccine (aOR = 0.14, 95% CI: 0.04-0.41). College-graduate parents exhibited increased willingness compared to those without a college degree (aOR = 2.07, 95% CI: 1.52-2.81). Non-heterosexual parents showed increased willingness compared to heterosexual parents (aOR = 2.30, 95% CI: 1.20-4.76). CONCLUSIONS Trust in federal COVID-19 vaccine oversight was associated with parental willingness to vaccinate their children against COVID-19 among parents whose children have not yet been vaccinated. Identifying and addressing causes of mistrust are crucial next steps to promote child vaccination. Intervention efforts to address trust gaps should remain a public health priority.
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Affiliation(s)
- Hyunmin Yu
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA.
| | - José A Bauermeister
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
| | - Ufuoma Oyiborhoro
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
| | - Subhash Aryal
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
| | - Terri H Lipman
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
| | - Andy S L Tan
- Annenberg School for Communication, University of Pennsylvania, 3620 Walnut Street, Philadelphia, Pennsylvania, 19104, USA
| | - Karen Glanz
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, Pennsylvania, 19104, USA
| | - Antonia M Villarruel
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
| | - Stephen Bonett
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, Pennsylvania, 19104, USA
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24
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Al-Abdulla O, Alaref M, Kallström A, Kauhanen J. Individual and social determinants of COVID-19 vaccine hesitancy and uptake in Northwest Syria. BMC Health Serv Res 2024; 24:265. [PMID: 38429739 PMCID: PMC10908183 DOI: 10.1186/s12913-024-10756-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 02/19/2024] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION The COVID-19 outbreak devastated the fragmented health system in Syria, a war-torn country, and exaggerated the demands for humanitarian assistance. COVID-19 vaccination was rolled out in Northwest Syria, an area out of government control, in May 2021. However, vaccine acceptance rates are still minimal, which is reflected in the meager percentage of vaccinated people. The study aims to investigate the effectiveness of the humanitarian actors' plans to address the COVID-19 vaccine hesitancy and conclude practical strategies for boosting vaccine uptake in Northwest Syria. METHODS AND MATERIALS Two questionnaires were developed to collect data from humanitarian organizations involved in the COVID-19 vaccination campaign and people from northwest Syria. Data analysis was performed using SPSS 22 data analysis program. RESULTS According to the findings, 55.5% of people refused the COVID-19 vaccine. The results showed a knowledge gap and lack of evidence regarding humanitarian actors' strategies to address the vaccine's low uptake. Besides, it was found that doctors and medical workers were reliable sources of information about the vaccine. However, they were not systematically engaged in community mobilization and risk communication to promote people's perspectives on the vaccine. CONCLUSION Risk communication and community engagement programs were not significantly associated with increasing the COVID-19 acceptance rate. Humanitarian actors must reconsider their strategies to address vaccine hesitancy in Northwest Syria. These strategies should engage medical professionals through dialogue sessions on the realities of the pandemic and vaccine development mechanism based on a compelling and evidence-based approach.
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Affiliation(s)
- Orwa Al-Abdulla
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, The University of Eastern Finland, 70211, Kuopio, P.O. Box 1627, Finland.
| | - Maher Alaref
- Strategic Research Center (Öz SRC), Incili Pinar MAH, Gazi Muhtar Paşa BUL, Doktorlar Sitesi, 38E, 104, 27090, Sehitkamil, Gaziantep, Türkiye
| | - Agneta Kallström
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, The University of Eastern Finland, 70211, Kuopio, P.O. Box 1627, Finland
- Strategic Research Center (Öz SRC), Incili Pinar MAH, Gazi Muhtar Paşa BUL, Doktorlar Sitesi, 38E, 104, 27090, Sehitkamil, Gaziantep, Türkiye
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, The University of Eastern Finland, 70211, Kuopio, P.O. Box 1627, Finland
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25
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Hakim H, Driedger SM, Gagnon D, Chevrier J, Roch G, Dubé E, Witteman HO. Digital Gamification Tools to Enhance Vaccine Uptake: Scoping Review. JMIR Serious Games 2024; 12:e47257. [PMID: 38421688 PMCID: PMC10906656 DOI: 10.2196/47257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/22/2023] [Accepted: 01/02/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Gamification has been used successfully to promote various desired health behaviors. Previous studies have used gamification to achieve desired health behaviors or facilitate their learning about health. OBJECTIVE In this scoping review, we aimed to describe digital gamified tools that have been implemented or evaluated across various populations to encourage vaccination, as well as any reported effects of identified tools. METHODS We searched Medline, Embase, CINAHL, the Web of Science Core Collection, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Academic Search Premier, PsycInfo, Global Health, and ERIC for peer-reviewed papers describing digital gamified tools with or without evaluations. We also conducted web searches with Google to identify digital gamified tools lacking associated publications. We consulted 12 experts in the field of gamification and health behavior to identify any papers or tools we might have missed. We extracted data about the target population of the tools, the interventions themselves (eg, type of digital gamified tool platform, type of disease/vaccine, type and design of study), and any effects of evaluated tools, and we synthesized data narratively. RESULTS Of 1402 records, we included 28 (2%) peer-reviewed papers and 10 digital gamified tools lacking associated publications. The experts added 1 digital gamified tool that met the inclusion criteria. Our final data set therefore included 28 peer-reviewed papers and 11 digital gamified tools. Of the 28 peer-reviewed papers, 7 (25%) explained the development of the tool, 16 (57%) described evaluation, and 2 (7%) reported both development and evaluation of the tool. The 28 peer-reviewed papers reported on 25 different tools. Of these 25 digital gamified tools, 11 (44%) were web-based tools, 8 (32%) mobile (native mobile or mobile-enabled web) apps, and 6 (24%) virtual reality tools. Overall, tools that were evaluated showed increases in knowledge and intentions to receive vaccines, mixed effects on attitudes, and positive effects on beliefs. We did not observe discernible advantages of one type of digital gamified tool (web based, mobile, virtual reality) over the others. However, a few studies were randomized controlled trials, and publication bias may have led to such positive effects having a higher likelihood of appearing in the peer-reviewed literature. CONCLUSIONS Digital gamified tools appear to have potential for improving vaccine uptake by fostering positive beliefs and increasing vaccine-related knowledge and intentions. Encouraging comparative studies of different features or different types of digital gamified tools could advance the field by identifying features or types of tools that yield more positive effects across populations and contexts. Further work in this area should seek to inform the implementation of gamification for vaccine acceptance and promote effective health communication, thus yielding meaningful health and social impacts.
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Affiliation(s)
- Hina Hakim
- Department of Family and Emergency Medicine, Université Laval, Québec City, QC, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Dominique Gagnon
- Direction des risques biologiques, Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Julien Chevrier
- Bibliothèque Louise-Lalonde-Lamarre, Polytechnique Montréal, Montréal, QC, Canada
| | - Geneviève Roch
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- Centre hospitalier universitaire (CHU) de Québec-Université Laval, Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Université Laval, Quebec City, QC, Canada
| | - Eve Dubé
- Direction des risques biologiques, Institut national de santé publique du Québec, Quebec City, QC, Canada
- Département d'anthropologie, Université Laval, Quebec City, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec City, QC, Canada
- Centre hospitalier universitaire (CHU) de Québec-Université Laval, Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Université Laval, Quebec City, QC, Canada
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26
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Dong E, Nixon K, Gardner LM. A population level study on the determinants of COVID-19 vaccination rates at the U.S. county level. Sci Rep 2024; 14:4277. [PMID: 38383706 PMCID: PMC10881504 DOI: 10.1038/s41598-024-54441-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/13/2024] [Indexed: 02/23/2024] Open
Abstract
Multiple COVID-19 vaccines were proven to be safe and effective in curbing severe illness, but despite vaccine availability, vaccination rates were relatively low in the United States (U.S.). To better understand factors associated with low COVID-19 vaccine uptake in the U.S., our study provides a comprehensive, data-driven population-level statistical analysis at the county level. We find that political affiliation, as determined by the proportion of votes received by the Republican candidate in the 2020 presidential election, has the strongest association with our response variable, the percent of the population that received no COVID-19 vaccine. The next strongest association was median household income, which has a negative association. The percentage of Black people and the average number of vehicles per household are positively associated with the percent unvaccinated. In contrast, COVID-19 infection rate, percentage of Latinx people, postsecondary education percentage, median age, and prior non-COVID-19 childhood vaccination coverage are negatively associated with percent unvaccinated. Unlike previous studies, we do not find significant relationships between cable TV news viewership or Twitter misinformation variables with COVID-19 vaccine uptake. These results shed light on some factors that may impact vaccination choice in the U.S. and can be used to target specific populations for educational outreach and vaccine campaign strategies in efforts to increase vaccination uptake.
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Affiliation(s)
- Ensheng Dong
- Department of Civil and Systems Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA.
- Center for Systems Science and Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA.
| | - Kristen Nixon
- Department of Civil and Systems Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
- Center for Systems Science and Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Lauren M Gardner
- Department of Civil and Systems Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
- Center for Systems Science and Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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27
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Wang B, Andraweera P, Danchin M, Blyth CC, Vlaev I, Ong J, Dodd JM, Couper J, Sullivan TR, Karnon J, Spurrier N, Cusack M, Mordaunt D, Simatos D, Dekker G, Carlson S, Tuckerman J, Wood N, Whop LJ, Marshall H. Nudging towards COVID-19 and influenza vaccination uptake in medically at-risk children: EPIC study protocol of randomised controlled trials in Australian paediatric outpatient clinics. BMJ Open 2024; 14:e076194. [PMID: 38367966 PMCID: PMC10875525 DOI: 10.1136/bmjopen-2023-076194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/23/2024] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION Children with chronic medical diseases are at an unacceptable risk of hospitalisation and death from influenza and SARS-CoV-2 infections. Over the past two decades, behavioural scientists have learnt how to design non-coercive 'nudge' interventions to encourage positive health behaviours. Our study aims to evaluate the impact of multicomponent nudge interventions on the uptake of COVID-19 and influenza vaccines in medically at-risk children. METHODS AND ANALYSES Two separate randomised controlled trials (RCTs), each with 1038 children, will enrol a total of approximately 2076 children with chronic medical conditions who are attending tertiary hospitals in South Australia, Western Australia and Victoria. Participants will be randomly assigned (1:1) to the standard care or intervention group. The nudge intervention in each RCT will consist of three text message reminders with four behavioural nudges including (1) social norm messages, (2) different messengers through links to short educational videos from a paediatrician, medically at-risk child and parent and nurse, (3) a pledge to have their child or themselves vaccinated and (4) information salience through links to the current guidelines and vaccine safety information. The primary outcome is the proportion of medically at-risk children who receive at least one dose of vaccine within 3 months of randomisation. Logistic regression analysis will be performed to determine the effect of the intervention on the probability of vaccination uptake. ETHICS AND DISSEMINATION The protocol and study documents have been reviewed and approved by the Women's and Children's Health Network Human Research Ethics Committee (HREC/22/WCHN/2022/00082). The results will be published via peer-reviewed journals and presented at scientific meetings and public forums. TRIAL REGISTRATION NUMBER NCT05613751.
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Affiliation(s)
- Bing Wang
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Prabha Andraweera
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Margaret Danchin
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre (QEIIMC), Perth, Western Australia, Australia
| | - Ivo Vlaev
- School of Business, Warwick University, Warwick, UK
| | - Jason Ong
- Melbourne Sexual Health Clinic & LSHTM, Monash University, Carlton, Victoria, Australia
| | - Jodie M Dodd
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Women's and Babies Division, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Jennifer Couper
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Division of Paediatrics, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, Adelaide, South Australia, Australia
| | - Jonathan Karnon
- Discipline of Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Nicola Spurrier
- SA Health, South Australian Government, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Flinders University, Adelaide, South Australia, Australia
| | - Michael Cusack
- SA Health, South Australian Government, Adelaide, South Australia, Australia
| | - Dylan Mordaunt
- Discipline of Paediatrics, Flinders University, Adelaide, South Australia, Australia
| | - Dimi Simatos
- Discipline of Paediatrics Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Gustaaf Dekker
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Discipline of Women's Health, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Samantha Carlson
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Jane Tuckerman
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas Wood
- Discipline of Paediatrics, University of Sydney, Sydney, New South Wales, Australia
- Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Lisa J Whop
- Discipline of Public Health, Australian National University, Canberra, ACT, Australia
| | - Helen Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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28
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Yoon S, Kim H, An J, Jin SW. Exploring human papillomavirus vaccine hesitancy among college students and the potential of virtual reality technology to increase vaccine acceptance: a mixed-methods study. Front Public Health 2024; 12:1331379. [PMID: 38414894 PMCID: PMC10896851 DOI: 10.3389/fpubh.2024.1331379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/16/2024] [Indexed: 02/29/2024] Open
Abstract
Background Human papillomavirus (HPV) can cause cancers in men and women. Despite the availability of an effective vaccine, HPV vaccination coverage remains suboptimal among college students. Literature showed that hesitancy for HPV vaccination is a leading barrier to the uptake in this group. However, prior interventions have shown limitations in reducing HPV vaccine hesitancy in college students. Thus, this study examined a conventional educational approach using a vaccine information statement (VIS), and subsequently explored college students' HPV vaccine hesitancy and the potential of virtual reality (VR) technology to overcoming the limitations of interventional efforts. Methods We employed a mixed-methods design along with convenience sampling, constituting a one-way pre- and post-intervention (HPV VIS) survey (Study A) and individual interviews (Study B). All data collections occurred with 44 college students at an urban public university at the mid-south region of the U.S. between October 2022 and April 2023. Study A assessed changes in HPV vaccination outcomes including knowledge, beliefs/attitudes, vaccine hesitancy, and intentions. Study B measured college students' primary reasons for HPV vaccine hesitancy and preferred strategies for the vaccination promotion including VR-based education. We conducted paired t-test and Wilcoxon signed ranks test for quantitative data and framework analysis for qualitative data. Results Participants reported significant improvements in knowledge [t(43) = 6.68, p < 0.001] regarding HPV vaccination between before and after reading the HPV VIS. No change was observed in beliefs/attitudes, vaccine hesitancy, and intentions. The framework analysis revealed college students' reasons for HPV vaccine hesitancy, needed information, and preferred strategies along with the potential of VR technology for future HPV vaccination education. Conclusion The findings provided essential information on designing HPV vaccination information focused on vaccine hesitancy among college students. Future research should consider these findings in developing interventions including VR to increasing HPV vaccine acceptance among college students.
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Affiliation(s)
- Sangchul Yoon
- Department of Medical Humanities and Social Sciences, College of Medicine, Yonsei University, Seoul, Republic of Korea
- Center for Global Development, Yonsei lnstituite for Global Health, Yonsei University Health System, Seoul, Republic of Korea
| | - Heeyeon Kim
- Center for Global Development, Yonsei lnstituite for Global Health, Yonsei University Health System, Seoul, Republic of Korea
| | - Juhyeong An
- Center for Global Development, Yonsei lnstituite for Global Health, Yonsei University Health System, Seoul, Republic of Korea
| | - Seok Won Jin
- School of Social Work, The University of Memphis, Memphis, TN, United States
- Institute of Media Arts, Yonsei University, Seoul, Republic of Korea
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29
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Morillon GF, Poder TG. Which factors drive the choice of the French-speaking Quebec population towards a COVID-19 vaccination programme: A discrete-choice experiment. Health Expect 2024; 27:e13963. [PMID: 39102733 PMCID: PMC10767688 DOI: 10.1111/hex.13963] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 08/07/2024] Open
Abstract
OBJECTIVES The aims of this study were to elicit preferences about the coronavirus disease 2019 (COVID-19) vaccine campaign in the general French-speaking adult Quebec population and to highlight the characteristics of the vaccine campaign that were of major importance. METHODS A discrete-choice experiment (DCE) was conducted between April and June 2021, in Quebec, Canada. A quota sampling method by age, gender and educational level was used to achieve a representative sample of the French-speaking adult population. The choice-based exercise was described by seven attributes within a vaccine campaign scenario. A mixed logit (MXL) model and a latent class logit (LCL) model were used to derive utility values. Age, gender, educational level, income and fear of COVID-19 were included as independent variables in the LCL. RESULTS A total of 1883 respondents were included for analysis, yielding 22,586 choices. From these choices, 3425 (15.16%) were refusals. In addition, 1159 (61.55%) individuals always accepted any of the vaccination campaigns, while 92 individuals (4.89%) always refused vaccine alternatives. According to the MXL, relative weight importance of attributes was effectiveness (32.50%), risk of side effects (24.76%), level of scientific evidence (22.51%), number of shots (15.73%), priority population (3.60%), type of vaccine (0.61%), and vaccination location (0.28%). Four classes were derived from the LCL model and attributes were more or less important according to them. Class 1 (19.8%) was more concerned about the effectiveness (27.99%), safety (24.22%) and the number of shots (21.82%), class 2 (55.3%) wanted a highly effective vaccine (40.16%) and class 3 (17.6%) gave high value to the scientific evidence (42.00%). Class 4 preferences (7.4%) were more balanced, with each attribute having a relative weight ranging from 1.84% (type of vaccine) to 21.32% (risk of side effects). Membership posterior probabilities to latent classes were found to be predicted by individual factors such as gender, annual income or fear of COVID-19. CONCLUSIONS Vaccination acceptance relies on multiple factors. This study allowed assessment of vaccination-specific issues through a choice-based exercise and description of factors influencing this choice by segmenting the sample and drawing profiles of individuals. Moreover, besides effectiveness and safety, a major point of this study was to show the importance given by the general population to the level of scientific evidence surrounding vaccines. PATIENT OR PUBLIC CONTRIBUTION A small group of citizens was involved in the conception, design and interpretation of data. Participants of the DCE were all from the general population.
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Affiliation(s)
- Gabin F. Morillon
- Montpellier Recherche en ÉconomieUniversity of MontpellierAvenue Raymond DugrandMontpellierFrance
| | - Thomas G. Poder
- Department of Management, Evaluation and Health Policy, School of Public HealthUniversity of MontrealMontrealQuebecCanada
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Dooley CE, Saif NT, Hodorowicz MT, Doyle ML, Gucer PW, Edwards LA, Cloeren M. Occupational Health Providers' Perceptions of Employee Vaccine Hesitancy. J Occup Environ Med 2024; 66:e42-e47. [PMID: 37871581 DOI: 10.1097/jom.0000000000003006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
OBJECTIVE This study examined the perspectives of occupational health providers (OHPs) on the most frequently encountered clinically relevant reasons for employee vaccine hesitancy. METHODS We conducted an anonymous, online, cross-sectional survey of US OHPs ( N = 217). The survey asked OHPs about the major reasons that employees cite for being unwilling to receive the following three categories of vaccines: COVID-19, annual influenza, and others relevant to the workplace. RESULTS Concern about adverse effects was the most frequently reported reason for employee vaccine hesitancy for each vaccine category. Mistrust was reported more frequently for COVID-19 than for the influenza vaccine or other vaccines (χ 2P < 0.05). Targets of employee mistrust included government and researchers or scientists, but mistrust of healthcare providers was uncommon. CONCLUSIONS These results can be used to inform interventions to address vaccine hesitancy in the occupational health setting.
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Affiliation(s)
- Cara E Dooley
- From the University of Maryland School of Medicine, Baltimore, Maryland (C.D., N.T.S., P.W.G., M.C.); University of Maryland School of Social Work, Baltimore, Maryland (M.T.H.); Johns Hopkins Education and Research Center for Occupational Safety and Health, Baltimore, Maryland (M.L.D.); and University of Maryland School of Nursing, Baltimore, Maryland (L.A.E.)
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Ulmido ML, Reñosa MDC, Wachinger J, Endoma V, Landicho-Guevarra J, Landicho J, Bravo TA, Aligato M, McMahon SA. Conflicting and complementary notions of responsibility in caregiver's and health care workers' vaccination narratives in the Philippines. J Glob Health 2024; 14:04016. [PMID: 38206315 PMCID: PMC10783206 DOI: 10.7189/jogh.14.04016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Background Vaccine hesitancy (VH) continues to pose a public health threat globally. Understanding the attitudes and perceptions about vaccination of key stakeholders in vaccine decision-making (such as health care workers (HCWs) and caregivers) about vaccination can pave the way toward novel approaches to bolster vaccine confidence. In this study, we explored the role of notions of responsibilities among HCWs and caregivers in shaping vaccination interactions and decision-making in the Philippines. Methods We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) with 44 vaccine-hesitant caregivers, seven HCWs, and 20 community health workers (barangay health workers) in the Philippines between August 2020 and March 2021. The interviews and focus groups were conducted online, transcribed verbatim, and analysed through the reflexive thematic analysis approach. Results Caregivers highlighted responsibility in terms of being a good caregiver, managing risk to one's own child, and seeking and validating information. Meanwhile, HCWs highlighted responsibility as: being a good HCW, managing risk to children and to the community, and providing and transforming information. Our findings suggest that responsibility manifests differently in HCWs' and caregivers' narratives, and that these notions can be both conflicting and complementary, shaping the interaction between stakeholders and, ultimately, their vaccine decision-making. We also found that fostering a good relationship between HCWs and caregivers through communication techniques such as motivational interviewing could help bridge the gap created by mistrust in vaccinations. HCWs sharing their own experiences as parents who vaccinate their own children also resonate with caregivers. Conclusions Notions of responsibility can underpin collaborative and divisive interactions between HCWs and caregivers. Public health messaging and interventions related to vaccination must consider strategies that align with these notions to address VH.
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Affiliation(s)
- Ma Leslie Ulmido
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Mark Donald C Reñosa
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Baden-Württemberg, Germany
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Jonas Wachinger
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Vivienne Endoma
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Jhoys Landicho-Guevarra
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Jeniffer Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Thea Andrea Bravo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Mila Aligato
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Baden-Württemberg, Germany
- International Health Department, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
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Caplan AL, Ferguson K, Williamson A. Ethical Challenges of Advances in Vaccine Delivery Technologies. Hastings Cent Rep 2024; 54:13-15. [PMID: 38390678 DOI: 10.1002/hast.1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Strategies to address misinformation and hesitancy about vaccines, including the fear of needles, and to overcome obstacles to access, such as the refrigeration that some vaccines demand, strongly suggest the need to develop new vaccine delivery technologies. But, given widespread distrust surrounding vaccination, these new technologies must be introduced to the public with the utmost transparency, care, and community involvement. Two emerging technologies, one a skin-patch vaccine and the other a companion dye and detector, provide excellent examples of greatly improved delivery technologies for which such a careful approach should be developed in order to increase vaccine uptake. Defusing fears and conspiracy mongering must be a key part of their rollout.
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Hirani JC, Wüst M. Reminder design and childhood vaccination coverage. JOURNAL OF HEALTH ECONOMICS 2024; 93:102832. [PMID: 37976788 DOI: 10.1016/j.jhealeco.2023.102832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
A major policy concern across public vaccination programs is non-compliance. Exploiting Danish population data and three national reforms in regression discontinuity designs, we document the effects of reminders for childhood vaccination coverage. Retrospective reminders are primarily effective for families with small children and when sent out close to the recommended vaccination age. Digital and postal reminders are equally effective. Prospective reminders increase timely vaccinations in later childhood and help reaching high coverage for new vaccines in increasingly complex vaccination programs. While reminders prompt additional preventive care for focal children, we find no spillovers to other health behaviors or relatives.
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Affiliation(s)
| | - Miriam Wüst
- The Danish Center for Social Science Research - VIVE, Denmark; University of Copenhagen, Denmark; CEBI, Denmark.
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Alsuwaidi AR, Hammad HAAK, Elbarazi I, Sheek-Hussein M. Vaccine hesitancy within the Muslim community: Islamic faith and public health perspectives. Hum Vaccin Immunother 2023; 19:2190716. [PMID: 36914409 PMCID: PMC10038058 DOI: 10.1080/21645515.2023.2190716] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Vaccine hesitancy is a growing public health concern that has fueled the resurgence of vaccine-preventable diseases in several Muslim-majority countries. Although multiple factors are associated with vaccine hesitancy, certain religious deliberations are significant in determining individuals' vaccine-related decisions and attitudes. In this review article, we summarize the literature on religious factors linked to vaccine hesitancy among Muslims, thoroughly discuss the Islamic law (sharia) viewpoint on vaccination and offer recommendations to address vaccine hesitancy in Muslim communities. Halal content/labeling and the influence of religious leaders were identified as major determinants of vaccination choices among Muslims. The core concepts of sharia, such as "preservation of life," "necessities permit prohibitions," and "empowering social responsibility for the greater public benefit" promote vaccination. Engaging religious leaders in immunization programs is crucial to enhance the uptake of vaccines among Muslims.
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Affiliation(s)
- Ahmed R Alsuwaidi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | | | - Iffat Elbarazi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Mohamud Sheek-Hussein
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Brosset E, Fressard L, Cogordan C, Bocquier A, Annequin M, Bourrelly M, Constance J, Michels D, Mora M, Morel S, Oliveri C, Maradan G, Berenger C, Spire B, Verger P. Gradient of vaccine hesitancy among French men having sex with men: An electronic cross-sectional survey in 2022. Hum Vaccin Immunother 2023; 19:2293489. [PMID: 38093684 PMCID: PMC10730215 DOI: 10.1080/21645515.2023.2293489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/07/2023] [Indexed: 12/18/2023] Open
Abstract
In developed countries, vaccinations against hepatitis B (HBV), hepatitis A (HAV), and human papillomavirus (HPV) are often recommended to men who have sex with men (MSM) because of the risky sexual practices in which some engage. Vaccine coverage against these diseases is not optimal in France, probably due in part to vaccine hesitancy (VH). The overall aim of this survey among MSM was to estimate the prevalence of different grades of VH for these vaccines as well as of general VH (toward any vaccine). The specific objectives were to study the sociodemographic correlates of MSM specific and general VH and its association with vaccine uptake. A cross-sectional electronic survey (February-August 2022) collected information from 3,730 French MSM about their perceptions of HBV, HAV, and HPV and their related vaccines, to construct "specific VH" variables. Information about their past vaccination behaviors for any vaccine was used to construct a "general VH" variable, based on the World Health Organization definition. Almost 90% of MSM showed moderate or high specific VH for HBV, HAV, and/or HPV, and 54% general VH. A higher education level and comfortable financial situation were associated with lower grades of specific and general VH. Younger age was associated with less frequent specific VH and more frequent general VH. Specific VH, versus general, was more strongly associated with frequent self-reported non-vaccination against these three disease. Addressing their concerns about vaccines, improving their knowledge of vaccine-preventable sexually transmitted infections, and motivating them to get vaccinated are public health priorities.
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Affiliation(s)
- Emeline Brosset
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Lisa Fressard
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Chloé Cogordan
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Aurélie Bocquier
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- Université de Lorraine, APEMAC , Nancy, France
| | - Margot Annequin
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- INSERM, IRD, SESSTIM, ISSPAM, Aix Marseille University, Marseille, France
| | - Michel Bourrelly
- INSERM, IRD, SESSTIM, ISSPAM, Aix Marseille University, Marseille, France
| | - Jean Constance
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - David Michels
- AIDES, Pantin, France
- Laboratoire de recherche communautaire, Coalition PLUS, Pantin, France
| | - Marion Mora
- INSERM, IRD, SESSTIM, ISSPAM, Aix Marseille University, Marseille, France
| | | | - Camilla Oliveri
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
- INSERM, IRD, SESSTIM, ISSPAM, Aix Marseille University, Marseille, France
| | - Gwenaëlle Maradan
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Cyril Berenger
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Bruno Spire
- INSERM, IRD, SESSTIM, ISSPAM, Aix Marseille University, Marseille, France
| | - Pierre Verger
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
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Li L, Yang L, Wang Q, Wood CE, Kostkova P. Comparing factors influencing seasonal influenza vaccine acceptance and intentions among Chinese university students residing in China and UK: A cross-sectional study. Hum Vaccin Immunother 2023; 19:2290798. [PMID: 38111087 PMCID: PMC10760351 DOI: 10.1080/21645515.2023.2290798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/30/2023] [Indexed: 12/20/2023] Open
Abstract
University students, who face an elevated risk of influenza due to close living quarters and frequent social interactions, often exhibit low vaccine uptake rates. This issue is particularly pronounced among Chinese students, who encounter unique barriers related to awareness and access, emphasizing the need for heightened attention to this problem within this demographic. This cross-sectional study conducted in May-June 2022 involved 1,006 participants (404 in the UK, 602 in Mainland China) and aimed to explore and compare the factors influencing influenza vaccine acceptance and intentions between Chinese university students residing in the UK (C-UK) and Mainland China (C-M). The study employed a self-administered questionnaire based on the Theoretical Domains Framework and Capability Opportunity Motivation-Behavior model. Results revealed that approximately 46.8% of C-UK students received the influenza vaccine in the past year, compared to 32.9% of C-M students. More than half in both groups (C-UK: 54.5%, C-M: 58.1%) had no plans for vaccination in the upcoming year. Knowledge, belief about consequences, and reinforcement significantly influenced previous vaccine acceptance and intention in both student groups. Barriers to vaccination behavior included insufficient knowledge about the influenza vaccine and its accessibility and the distance to the vaccine center. Enablers included the vaccination behavior of individuals within their social circles, motivation to protect others, and concerns regarding difficulties in accessing medical resources during the COVID-19 pandemic. The findings of this study offer valuable insights for evidence-based intervention design, providing evidence for healthcare professionals, policymakers, and educators working to enhance vaccination rates within this specific demographic.
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Affiliation(s)
- Lan Li
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London (UCL), London, UK
| | - Liuqing Yang
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London (UCL), London, UK
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China
| | - Qiang Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China
- Department of Infectious Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, UK
| | - Caroline E Wood
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London (UCL), London, UK
| | - Patty Kostkova
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London (UCL), London, UK
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Condran B, Kervin M, Burton C, Blydt-Hansen TD, Morris SK, Sadarangani M, Otley A, Yong E, Mitchell H, Bettinger JA, Top KA. Parent and healthcare provider views of live varicella vaccination of pediatric solid organ transplant recipients. Pediatr Transplant 2023; 27:e14609. [PMID: 37746885 DOI: 10.1111/petr.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/28/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Live attenuated varicella vaccine (LAVV) has historically been contraindicated in children who are immunocompromised due to solid organ transplant (SOT) because of safety concerns. Recently, clinical guidelines were developed that support post-transplant varicella vaccination in selected SOT recipients based on emerging evidence of LAVV safety. This qualitative study sought to explore barriers and facilitators to implementing the new guidelines, as well as acceptability of LAVV among healthcare providers (HCPs) and parents. METHODS HCPs and parents of transplant recipients were recruited from four sites using purposive sampling. Data from semi-structured interviews were analyzed using an Interpretive Description approach that incorporated data from the interviews, academic knowledge and clinical experience, and drew from Grounded Theory and Thematic Analysis. The theoretical framework used was Adaptive Leadership. RESULTS Thirty-four participants (16 HCPs and 18 parents) were included in the analysis. Parents developed skills in adaptive leadership that included strategies to protect their child against infectious diseases. Foundational information that live vaccines were absolutely contraindicated post-transplant "stuck" with parents and led them to develop strategies other than vaccination to keep their child safe. Some parents struggled to understand that information previously presented as a certainty (contraindication of LAVV) could change. Their approach to adaptive leadership informed their appraisal of the new vaccination guidelines and willingness to accept vaccination. CONCLUSIONS HCPs should adopt a family-centered approach to communicating changing guidelines that considers parents' approach to adaptive leadership and discusses the changing nature of medical evidence. Trust between HCPs and parents can facilitate these conversations.
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Affiliation(s)
- Brian Condran
- Canadian Center for Vaccinology, IWK Health, Halifax, Nova Scotia, Canada
| | - Melissa Kervin
- Canadian Center for Vaccinology, IWK Health, Halifax, Nova Scotia, Canada
| | - Catherine Burton
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Tom D Blydt-Hansen
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shaun K Morris
- Clinical Public Health and Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases and Child Health Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Manish Sadarangani
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Anthony Otley
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Hana Mitchell
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Julie A Bettinger
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Karina A Top
- Canadian Center for Vaccinology, IWK Health, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
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Al-Aghbari AA, Naanyu V, Luchters S, Irungu E, Baalawy K, Bärnighausen T, Mauti J. Reducing Barriers to COVID-19 Vaccination Uptake: Community Ideas from Urban and Rural Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7093. [PMID: 38063523 PMCID: PMC10705992 DOI: 10.3390/ijerph20237093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/13/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023]
Abstract
Following the rapid development of COVID-19 vaccines, addressing vaccine hesitancy and optimizing uptake have emerged as critical challenges, emphasizing the importance of reducing barriers toward COVID-19 vaccination. This study investigates ideas on ways to reduce barriers to COVID-19 vaccination uptake. It explores methods that can overcome COVID-19 vaccination barriers through qualitative research: interviews and group discussions involving healthcare providers, administration personnel, teachers, and individuals with chronic conditions across urban (Mombasa) and rural (Kilifi) Kenya. Audio-recorded discussions were transcribed and thematically analyzed across locations. Five themes emerged in our results regarding the reduction in barriers to COVID-19 vaccination in the context of Kenya, including awareness campaigns, engaging diverse stakeholders, using various communication techniques, capacity building to increase vaccination centers and trained staff, and lastly, revising relevant government health policies and guidelines. These results indicate the importance of adopting multiple approaches, as no single strategy can boost vaccine acceptance. Moreover, this study provides recommendations for conceiving actionable interventions to potentially boost vaccine demand and maintain routine immunization in Kenya.
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Affiliation(s)
- Ahmed Asa’ad Al-Aghbari
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (T.B.); (J.M.)
| | - Violet Naanyu
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya;
| | - Stanley Luchters
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR), Harare 0002, Zimbabwe;
- Department of International Public Health, Liverpool School of Tropical Medicine (LSTM), Liverpool L3 5QA, UK
- Department of Public Health and Preventive Medicine, Ghent University, 9000 Ghent, Belgium
| | - Eunice Irungu
- The Aga Khan Hospital Mombasa, Mumbasa, Kenya; (E.I.); (K.B.)
| | - Kawthar Baalawy
- The Aga Khan Hospital Mombasa, Mumbasa, Kenya; (E.I.); (K.B.)
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (T.B.); (J.M.)
| | - Joy Mauti
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (T.B.); (J.M.)
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Limaye RJ, Schulz G, Michel AE, Collins ME, Johnson SB. Leveraging a Peer-to-Peer Approach to Mitigate Vaccine Misinformation and Improve Vaccine Communication During a Pandemic: Experiences From the Development of a Massive Open Online Course. Health Secur 2023; 21:467-472. [PMID: 38084962 DOI: 10.1089/hs.2023.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
The COVID-19 pandemic has not only led to massive global mortality and morbidity, but it has also fueled an infodemic of false and misleading information about COVID-19 and vaccines. The spread of misinformation and disinformation on vaccine safety and efficacy has contributed to vaccine hesitancy and distrust of public health institutions and has undermined the public health response to the COVID-19 pandemic. Because communication plays a monumental role in pandemic preparedness, a promising approach to countering the COVID-19 infodemic is empowering peers to serve as trusted messengers to provide accurate information using evidence-based communication approaches. With this in mind, we developed a massive open online course (MOOC) to provide the general public with the knowledge, skills, and resources to effectively navigate potentially contentious vaccine conversations with their peers, with a specific focus on parents. Within the first year of the course launch, 29,000 people had enrolled. Learners appreciated the information related to vaccine development, communication tips and techniques, and identifying and responding to vaccine misinformation. Over 1,000 learners who completed the course participated in an online evaluation survey. To address public distrust in healthcare providers, government, and science, our survey results indicate that peer-to-peer approaches to addressing vaccine hesitancy can empower community members to educate others and promote vaccine acceptance at scale.
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Affiliation(s)
- Rupali Jayant Limaye
- Rupali Jayant Limaye, PhD, is an Associate Professor, Global Disease Epidemiology and Control, in the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Gretchen Schulz
- Gretchen Schulz, MSPH, is a Research Assistant, in the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Alexandra E Michel
- Alexandra E. Michel, MPH, is a Research Associate, International Vaccine Access Center, in the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Megan E Collins
- Megan E. Collins, MD, is an Associate Professor, Department of Ophthalmology, at the Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sara B Johnson
- Sara B. Johnson, MD, is a Professor, Department of Pediatrics, at the Johns Hopkins University School of Medicine, Baltimore, MD
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Kokabisaghi F, Akhtar F, Taghipour A, Javan-Noughabi J, Moghri J, Tabatabaee SS. Why healthcare providers are not vaccinated? A qualitative study during the COVID-19 pandemic in Iran. BMC PRIMARY CARE 2023; 24:208. [PMID: 37828425 PMCID: PMC10571274 DOI: 10.1186/s12875-023-02166-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Vaccination has been effective in controlling contagious diseases, especially among high-risk groups such as medical staff. Their unwillingness to be vaccinated might adversely affect individual and public health. This study aimed to explore the factors related to the refusal of COVID-19 vaccines among health service providers. METHODS A qualitative study was conducted on 28 healthcare providers in Mashhad, Northeast of Iran from March to June 2022. The method of data collection was face-to-face interviews. The purposive method was used for sampling. Data collection continued until the saturation was reached. To analyze the data, the content analysis method was applied, and Maxqda (version 10) software was used. RESULTS By analyzing interview transcripts, six themes and ten sub-themes were extracted. Factors that explained employees' reluctance to be vaccinated against COVID-19 were the opinion of peers, lack of trust in vaccines, fear of vaccination, mistrust to the government and health authorities, low perceived risk of coronavirus disease, and the contradictions of traditional and modern medicine in their approach to controlling the disease. CONCLUSIONS Among healthcare workers, concerns about the side effects of vaccines were the most influential factors in refusing vaccination. Providing reliable information about vaccines and their safety is key to increasing the trust of health workers in vaccination and facilitating its acceptance.
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Affiliation(s)
- Fatemeh Kokabisaghi
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Akhtar
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Taghipour
- Department of Epidemiology & Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Javan-Noughabi
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Moghri
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Saeed Tabatabaee
- Department of Health Economics and Management Sciences, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
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Nascimento LG, Dubé È, Burns KE, Brown P, Calnan M, Ward PR, Filice E, Herati H, Ike NAU, Rotolo B, Meyer SB. Informing efforts beyond tailored promotional campaigns by understanding contextual factors shaping vaccine hesitancy among equity-deserving populations in Canada: an exploratory qualitative study. Int J Equity Health 2023; 22:209. [PMID: 37805472 PMCID: PMC10559625 DOI: 10.1186/s12939-023-02025-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Vaccine hesitancy exists on a continuum ranging between complete adherence and complete refusal due to doubts or concerns within a heterogeneous group of individuals. Despite widespread acknowledgement of the contextual factors influencing attitudes and beliefs shaping COVID-19 vaccine hesitancy, qualitative research with equity-deserving groups, accounting for unique lived experiences, remains a gap in the literature. We aim to identify and begin to understand and document the unique contextual factors shaping hesitancy by equity-deserving groups as it relates to relationships with government and health authorities. METHODS Participants were recruited and interviewed between Aug-Dec 2021. Semi-structured interviews using a convergent interviewing technique were conducted with individuals from the general population, as well as individuals who identify as First Nations, Métis, or Inuit, members of the LGBT2SQ + community, low-income Canadians, Black Canadians, and newcomers. Interviews were audio recorded and transcribed by a team of researchers. Memos were written following interviews and used to complement the thematic analysis of the interview data. Themes are presented in the results section. RESULTS The rationale for hesitancy among equity-deserving groups is consistent with literature documenting hesitancy in the general population. Contextual factors surrounding equity-deserving groups' attitudes and beliefs, however, are unique and relate to a history of oppression, discrimination, and genocide. We identified factors unique to subgroups; for example, religious or fatalistic beliefs among participant who identify as FNMI, fear associated with lack of testing and speed of vaccines' production among participants who identify as FNMI, Black, and LGBT2SQ + , distrust of the healthcare system for LGBT2SQ + and Black Canadians, and distrust of the government and opposition to vaccine mandates for participating who identify as LGBT2SQ + , low-income, FNMI, or Black Canadian. Newcomers stood out as very trusting of the government and accepting of COVID-19 vaccination. CONCLUSIONS While our data on vaccine hesitancy largely mirror concerns reported in the vast body of literature citing rationale for COVID-19 hesitancy in high-income countries, the contextual factors identified in our work point to the need for wider systemic change. Our results may be used to support efforts, beyond tailored promotion campaigns, to support the confident acceptance of vaccines for COVID-19 and the acceptance of novel vaccines as future infectious diseases emerge.
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Affiliation(s)
| | - Ève Dubé
- Institut National de Santé Publique du Québec, Québec City, Canada
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Zelaya CM, Francis DB, Williams LB. Understanding COVID-19 Vaccine Knowledge, Beliefs, and Trusted Information Sources Among Black Women in Kentucky: Implications for Vaccine Uptake. JOURNAL OF HEALTH COMMUNICATION 2023; 28:680-688. [PMID: 37667624 PMCID: PMC10592059 DOI: 10.1080/10810730.2023.2252367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
To optimize COVID-19 vaccination rates among Black women in the United States, it is crucial to understand their vaccine beliefs and determine the most effective communication sources and messages to encourage vaccination. Consequently, we conducted seven focus groups with 20 Black women from Kentucky (aged 18-37 years) between October and November 2020. We identified five themes reflecting the participants' level of awareness, knowledge of the vaccine and vaccine development process; their uncertainty about vaccine safety and clinical trials; their willingness to get vaccinated, and their preferences for trusted sources and persuasive messages to motivate vaccine uptake. Despite the participants' high level of awareness about the vaccine's development, significant concerns were identified regarding the speed of the vaccine's development and clinical trials, known medical injustices against Black people, political influence, vaccine efficacy, and potential side effects that fed their unwillingness to vaccinate. Based on our findings, we recommend vaccination campaigns targeting Black women should prioritize messaging highlighting the benefits and limitations of the vaccine while emphasizing its protective benefits for self, family, and community. Campaigns should also include Black healthcare providers as sources of messages. The findings have additional implications for encouraging continued confidence in the vaccine and improving uptake.
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Nalubega P, Namugumya R, Zalwango F, Ssali A, Mboizi R, Hookham L, Seeley J, Le Doare K. COVID-19 disease and vaccination in pregnancy: understanding knowledge, perceptions and experiences among pregnant women and community leaders in Uganda. Trans R Soc Trop Med Hyg 2023; 117:697-704. [PMID: 37132467 PMCID: PMC10546905 DOI: 10.1093/trstmh/trad028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/13/2023] [Accepted: 04/18/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND We investigated pregnant women and community leaders' knowledge, perceptions and experiences of the coronavirus disease 2019 (COVID-19) vaccination program during pregnancy in Uganda and how this changed over the course of the pandemic. METHODS We conducted 20 in-depth interviews (IDIs) and two group discussions (GDs) with pregnant women and four GDs with community leaders in Kawempe division of Kampala, Uganda. The first round of IDIs/GDs were carried out in March 2021. In July 2021, telephone IDIs were conducted with 7 pregnant women and 10 community leaders randomly selected from first-round interview participants. Themes were analysed deductively drawing codes from the topic guides. RESULTS In the first round, the majority of participants thought COVID-19 was not real because of misconceptions around government messaging/motivation and beliefs that Africans would not be affected. In the second round, participants recognised COVID-19 disease, because of rising case numbers and fatalities. There was increased awareness of the benefits of the vaccine. However, pregnant women remained unsure of vaccine safety and quality, citing side effects like fevers and general body weakness. Role models and coherent public health messaging and healthcare workers were key enablers of vaccine uptake. CONCLUSIONS Targeted and sustained COVID-19 communication and engagement strategies are needed, especially for pregnant women and others in their communities, to improve vaccine confidence during outbreaks.
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Affiliation(s)
- Phiona Nalubega
- Medical Research Council/Uganda Virus Research Institute, and London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Ritah Namugumya
- Medical Research Council/Uganda Virus Research Institute, and London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Flavia Zalwango
- Medical Research Council/Uganda Virus Research Institute, and London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Agnes Ssali
- Medical Research Council/Uganda Virus Research Institute, and London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Robert Mboizi
- Makerere University–Johns Hopkins University Research Collaboration, P.O. Box 23491, Kampala, Uganda
| | - Lauren Hookham
- St. George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute, and London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
| | - Kirsty Le Doare
- Medical Research Council/Uganda Virus Research Institute, and London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
- St. George's, University of London, Cranmer Terrace, London SW17 0RE, UK
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Bocquier A, Bruel S, Michel M, Le Duc‐Banaszuk A, Bonnay S, Branchereau M, Chevreul K, Chyderiotis S, Gauchet A, Giraudeau B, Hagiu D, Mueller JE, Gagneux‐Brunon A, Thilly N. Co-development of a school-based and primary care-based multicomponent intervention to improve HPV vaccine coverage amongst French adolescents (the PrevHPV Study). Health Expect 2023; 26:1843-1853. [PMID: 37312280 PMCID: PMC10485335 DOI: 10.1111/hex.13778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 05/01/2023] [Accepted: 05/09/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Despite various efforts to improve human papillomavirus (HPV) vaccine coverage in France, it has always been lower than in most other high-income countries. The health authorities launched in 2018 the national PrevHPV research programme to (1) co-develop with stakeholders and (2) evaluate the impact of a multicomponent complex intervention aimed at improving HPV vaccine coverage amongst French adolescents. OBJECTIVE To describe the development process of the PrevHPV intervention using the GUIDance for rEporting of intervention Development framework as a guide. METHODS To develop the intervention, we used findings from (1) published evidence on effective strategies to improve vaccination uptake and on theoretical frameworks of health behaviour change; (2) primary data on target populations' knowledge, beliefs, attitudes, preferences, behaviours and practices as well as the facilitators and barriers to HPV vaccination collected as part of the PrevHPV Programme and (3) the advice of working groups involving stakeholders in a participatory approach. We paid attention to developing an intervention that would maximise reach, adoption, implementation and maintenance in real-world contexts. RESULTS We co-developed three components: (1) adolescents' and parents' education and motivation using eHealth tools (web conferences, videos, and a serious video game) and participatory learning at school; (2) general practitioners' e-learning training on HPV using motivational interviewing techniques and provision of a decision aid tool and (3) easier access to vaccination through vaccination days organised on participating middle schools' premises to propose free of charge initiation of the HPV vaccination. CONCLUSION We co-developed a multicomponent intervention that addresses a range of barriers and enablers of HPV vaccination. The next step is to build on the results of its evaluation to refine it before scaling it up if proven efficient. If so, it will add to the small number of multicomponent interventions aimed at improving HPV vaccination worldwide. PATIENT OR PUBLIC CONTRIBUTION The public (adolescents, their parents, school staff and health professionals) participated in the needs assessment using a mixed methods approach. The public was also involved in the components' development process to generate ideas about potential activities/tools, critically revise the successive versions of the tools and provide advice about the intervention practicalities, feasibility and maintenance.
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Affiliation(s)
| | - Sébastien Bruel
- Department of General Practice, Jacques Lisfranc Faculty of MedicineSaint‐Etienne‐Lyon UniversitySaint‐EtienneFrance
- Health, Systemic, Process UR 4129 Research Unit, University Claude BernardUniversity of LyonLyonFrance
| | - Morgane Michel
- ECEVE UMR 1123, Université de Paris CitéParisFrance
- Assistance Publique‐Hôpitaux de Paris, Hôtel Dieu, URC Eco Ile‐de‐France/Hôpital Robert DebréUnité d'épidémiologie cliniqueParisFrance
| | | | | | - Marion Branchereau
- Centre Régional de Coordination des Dépistages des cancers‐Pays de la LoireAngersFrance
| | - Karine Chevreul
- ECEVE UMR 1123, Université de Paris CitéParisFrance
- Assistance Publique‐Hôpitaux de Paris, Hôtel Dieu, URC Eco Ile‐de‐France/Hôpital Robert DebréUnité d'épidémiologie cliniqueParisFrance
| | - Sandra Chyderiotis
- Emerging Disease Epidemiology Unit, Institut PasteurUniversité Paris CitéParisFrance
| | - Aurélie Gauchet
- LIP/PC2SUniversité Grenoble AlpesGrenobleFrance
- LIP/PC2SUniversité Savoie Mont BlancChambéryFrance
| | - Bruno Giraudeau
- SPHERE U1246, Université de Tours, Université de NantesINSERMToursFrance
- INSERM CIC 1415CHRU de ToursToursFrance
| | - Dragos‐Paul Hagiu
- Department of General Practice, Jacques Lisfranc Faculty of MedicineSaint‐Etienne‐Lyon UniversitySaint‐EtienneFrance
- CIC‐INSERM 1408, CHU deSaint‐EtienneFrance
| | - Judith E. Mueller
- Emerging Disease Epidemiology Unit, Institut PasteurUniversité Paris CitéParisFrance
- Univ. Rennes, EHESP, CNRS, Inserm, Arènes ‐ UMR 6051RSMS (Recherche sur les Services et Management en Santé) ‐ U 1309RennesFrance
| | - Amandine Gagneux‐Brunon
- Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, CIC INSERM 1408 VaccinologieCHU de Saint‐EtienneSaint‐EtienneFrance
| | - Nathalie Thilly
- APEMACUniversité de LorraineNancyFrance
- Département Méthodologie, Promotion, InvestigationUniversité de Lorraine, CHRU‐NancyNancyFrance
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Padmanabhanunni A, Pretorius TB, Isaacs SA. Validation of the vaccination attitudes examination scale in a South African context in relation to the COVID-19 vaccine: quantifying dimensionality with bifactor indices. BMC Public Health 2023; 23:1872. [PMID: 37759186 PMCID: PMC10537843 DOI: 10.1186/s12889-023-16803-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 09/21/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic represented a global public health emergency. Existing studies support the view that vaccination and mass immunization are among the most effective means of containing the outbreak and promoting health. However, negative attitudes toward vaccination and the related vaccine hesitancy among many groups have created a significant barrier to effectively managing the health crisis. Having a valid and reliable tool to assess attitudes toward vaccination remains imperative so that factors underlying vaccine refusal can be identified and public health interventions can be facilitated. The current study examined the psychometric properties of the Vaccination Attitudes Examination Scale (VAX) in South Africa. METHODS Participants (n = 322) completed the VAX. Confirmatory factor analysis and ancillary bifactor indices were used to examine the hypothesized factor structure (a total scale and four subscales) of the scale. Inter-item correlations, factor loadings, and average variance extracted were used to examine the validity of the scale. Predictive validity was examined by comparing those who had received the COVID-19 vaccine and those who had not. The reliability of the scale was examined in terms of both Cronbach's alpha and composite reliability. RESULTS Confirmatory factor analysis provided support for the conceptualization of the scale as consisting of a total scale and four subscales, and ancillary bifactor indices indicated that the subscales accounted for a sufficient amount of variance (44%) after the variance explained by the total scale was considered. Overall, the analysis indicated that the scale had satisfactory reliability (alpha and composite reliability = 0.70) and provided evidence for the construct, convergent, and predictive validity of the VAX. CONCLUSIONS The sound psychometric qualities of the scale, when used in a low- to middle-income country, have the potential to advance research and immunization policy within these settings and facilitate more targeted interventions to promote vaccine uptake.
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Affiliation(s)
- Anita Padmanabhanunni
- Department of Psychology, University of the Western Cape, Robert Sobukwe Road, Bellville, Cape Town, 7535, South Africa
| | - Tyrone Brian Pretorius
- Department of Psychology, University of the Western Cape, Robert Sobukwe Road, Bellville, Cape Town, 7535, South Africa.
| | - Serena Ann Isaacs
- Department of Psychology, University of the Western Cape, Robert Sobukwe Road, Bellville, Cape Town, 7535, South Africa
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Evans WD, Bingenheimer JB, Long M, Ndiaye K, Donati D, Rao NM, Akaba S, Nsofor I, Agha S. Outcomes of a social media campaign to promote COVID-19 vaccination in Nigeria. PLoS One 2023; 18:e0290757. [PMID: 37713381 PMCID: PMC10503765 DOI: 10.1371/journal.pone.0290757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/02/2023] [Indexed: 09/17/2023] Open
Abstract
The COVID-19 pandemic has been an historic challenge to public health and behavior change programs. In low -and middle-income countries (LMICs) such as Nigeria, there have been challenges in promoting vaccination. Vaccine hesitancy and social norms related to vaccination may be important factors in promoting or inhibiting not only COVID vaccination, but other routine vaccinations as well. The aim of this study was to conduct a national-level quasi-experimental evaluation of a social media based COVID-19 vaccination promotion campaign in Nigeria run in 2022. We followed a longitudinal cohort of Nigerians (at baseline) drawn from all 37 states in Nigeria over a 10-month period. This was done at 3 time points to evaluate psychosocial predictors of vaccination and vaccination outcomes following a theory of change based on Diffusion of Innovations, Social Norms Theory, and the Motivation, Opportunity, Ability (MOA) Framework. In a quasi-experimental design, participants in 6 Nigerian states where the social media campaign was run (treatment) were compared to participants from non-treatment states. This study highlights new social media-based data collection techniques. The study found that vaccination rates increased in treatment states compared to non-treatment states, and that these effects were strongest between baseline and first follow up (December 2021 to March 2022). We also found that more pro-vaccination social norms at one time point are associated with higher vaccination rates at a later time point. Social media campaigns are a promising approach to increasing vaccination at scale in LMICs, and social norms are an important factor in promoting vaccination, which is consistent with the Social Norms Theory. We describe implications for future vaccination campaigns and identify future research priorities in this area.
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Affiliation(s)
- W. Douglas Evans
- Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
| | - Jeffrey B. Bingenheimer
- Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
| | - Michael Long
- Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
| | - Khadidiatou Ndiaye
- Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
| | - Dante Donati
- School of Business, Columbia University, New York, New York, United States of America
| | - Nandan M. Rao
- Virtual Lab LLC, Corvallis, Oregon, United States of America
| | - Selinam Akaba
- Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
| | | | - Sohail Agha
- Global Health Visions, Seattle, Washington, United States of America
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Verger P, Cogordan C, Fressard L, Gosselin V, Donato X, Biferi M, Verlomme V, Sonnier P, Meur H, Malfait P, Berthiaume P, Ramalli L, Gagneur A. A postpartum intervention for vaccination promotion by midwives using motivational interviews reduces mothers' vaccine hesitancy, south-eastern France, 2021 to 2022: a randomised controlled trial. Euro Surveill 2023; 28:2200819. [PMID: 37733238 PMCID: PMC10515496 DOI: 10.2807/1560-7917.es.2023.28.38.2200819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/17/2023] [Indexed: 09/22/2023] Open
Abstract
BackgroundDespite childhood vaccine mandates imposed in 2018 in France, parental vaccine hesitancy (VH) remains frequent. Interventions in Quebec, Canada, applying motivational interviewing (MI) techniques have successfully reduced parents' VH for childhood immunisations.AimTo determine whether MI intervention for mothers in maternity wards in the days after birth in France could significantly reduce VH, increase intentions to vaccinate (VI) their child at 2 months and reduce VH social inequalities.MethodsWe conducted a parallel-arm multicentre randomised controlled trial from November 2021 to April 2022 to compare impacts of MI performed by MI-trained midwives (intervention) vs a vaccination leaflet (control). We included 733 mothers from two maternity hospitals in south-eastern France, randomly assigned either arm. The validated Parents Attitudes about Childhood Vaccines questionnaire was used before and after MI or leaflet to assess mothers' VH (13 items, 0-100 score) and VI (1 item, 1-10 score). Difference-in-difference (D-I-D) models were used to estimate net impact of MI vs leaflet for the entire sample and stratified by VH and education level.ResultsMotivational interview intervention reduced mothers' VH score by 33% (p < 0.0001) and increased VI by 8% (p < 0.0001); the effect was largest for the highest initial VH levels. D-I-D analyses estimated net VH decrease at 5.8/100 points (p = 0.007) and net VI increase at 0.6/10 points (p = 0.005). Net VH decrease was highest for high initial VH levels and low education levels.ConclusionsOur results show positive effects of MI intervention, and means of its implementation should be investigated in France.
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Affiliation(s)
- Pierre Verger
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Chloé Cogordan
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Lisa Fressard
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | | | - Xavier Donato
- Maternity ward, Saint-Joseph Hospital, Marseille, France
| | | | | | - Pierre Sonnier
- Comité Régional d'Education pour la Santé Provence-Alpes-Côte-D'Azur, Marseille, France
| | - Hervé Meur
- Agence Régionale de Santé Provence-Alpes-Côte-D'Azur, Marseille, France
| | - Philippe Malfait
- Santé publique France (French National Public Health Agency), Marseille, France
| | | | - Lauriane Ramalli
- Santé publique France (French National Public Health Agency), Marseille, France
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Anato JLF, Ma H, Hamilton MA, Xia Y, Harper S, Buckeridge D, Brisson M, Hillmer MP, Malikov K, Kerem A, Beall R, Wagner CE, Racine É, Baral S, Dubé È, Mishra S, Maheu-Giroux M. Impact of a vaccine passport on first-dose SARS-CoV-2 vaccine coverage by age and area-level social determinants of health in the Canadian provinces of Quebec and Ontario: an interrupted time series analysis. CMAJ Open 2023; 11:E995-E1005. [PMID: 37875315 PMCID: PMC10609911 DOI: 10.9778/cmajo.20220242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND In Canada, all provinces implemented vaccine passports in 2021 to reduce SARS-CoV-2 transmission in non-essential indoor spaces and increase vaccine uptake (policies active September 2021-March 2022 in Quebec and Ontario). We sought to evaluate the impact of vaccine passport policies on first-dose SARS-CoV-2 vaccination coverage by age, and area-level income and proportion of racialized residents. METHODS We performed interrupted time series analyses using data from Quebec's and Ontario's vaccine registries linked to census information (population of 20.5 million people aged ≥ 12 yr; unit of analysis: dissemination area). We fit negative binomial regressions to first-dose vaccinations, using natural splines adjusting for baseline vaccination coverage (start: July 2021; end: October 2021 for Quebec, November 2021 for Ontario). We obtained counterfactual vaccination rates and coverage, and estimated the absolute and relative impacts of vaccine passports. RESULTS In both provinces, first-dose vaccination coverage before the announcement of vaccine passports was 82% (age ≥ 12 yr). The announcement resulted in estimated increases in coverage of 0.9 percentage points (95% confidence interval [CI] 0.4-1.2) in Quebec and 0.7 percentage points (95% CI 0.5-0.8) in Ontario. This corresponds to 23% (95% CI 10%-36%) and 19% (95% CI 15%-22%) more vaccinations over 11 weeks. The impact was larger among people aged 12-39 years. Despite lower coverage in lower-income and more-racialized areas, there was little variability in the absolute impact by area-level income or proportion racialized in either province. INTERPRETATION In the context of high vaccine coverage across 2 provinces, the announcement of vaccine passports had a small impact on first-dose coverage, with little impact on reducing economic and racial inequities in vaccine coverage. Findings suggest that other policies are needed to improve vaccination coverage among lower-income and racialized neighbourhoods and communities.
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Affiliation(s)
- Jorge Luis Flores Anato
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Huiting Ma
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Mackenzie A Hamilton
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Yiqing Xia
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Sam Harper
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - David Buckeridge
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Marc Brisson
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Michael P Hillmer
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Kamil Malikov
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Aidin Kerem
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Reed Beall
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Caroline E Wagner
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Étienne Racine
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Stefan Baral
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Ève Dubé
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Sharmistha Mishra
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics (Flores Anato, Xia, Harper, Buckeridge, Racine, Maheu-Giroux), School of Population and Global Health, McGill University, Montréal, Que.; MAP Centre for Urban Health Solutions (Ma, Hamilton, Mishra), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre de Recherche du CHU de Québec and Département de médecine sociale et préventive (Brisson), Université Laval, Québec, Que.; Ontario Ministry of Health (Hillmer, Malikov, Kerem); Institute of Health Policy, Management and Evaluation (Hillmer), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Beall), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Bioengineering (Wagner), McGill University, Montréal, Que.; Direction des risques biologiques (Racine, Dubé), Institut national de santé publique du Québec, Ville de Québec, Que.; Department of Epidemiology (Baral), Johns Hopkins School of Public Health, Baltimore, Md.; Département d'anthropologie (Dubé), Faculté des sciences sociales, Université Laval, Québec, Que.; Division of Infectious Diseases, Department of Medicine (Mishra), University of Toronto, Toronto, Ont.
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49
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Le-Morawa N, Kunkel A, Darragh J, Reede D, Chidavaenzi NZ, Lees Y, Hoffman D, Dia L, Kitcheyan T, White M, Belknap I, Agathis N, Began V, Balajee SA. Effectiveness of a COVID-19 Vaccine Rollout in a Highly Affected American Indian Community, San Carlos Apache Tribe, December 2020-February 2021. Public Health Rep 2023; 138:23S-29S. [PMID: 36017554 PMCID: PMC10515982 DOI: 10.1177/00333549221120238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
COVID-19 has disproportionately affected American Indian Tribes, including the San Carlos Apache Tribe, which resides on 1.8 million acres in Arizona and has 16 788 official members. High vaccination rates among American Indian/Alaska Native people in the United States have been reported, but information on how individual Tribes achieved these high rates is scarce. We describe the COVID-19 epidemiology and vaccine rollout in the San Carlos Apache Tribe using data extracted from electronic health records from the San Carlos Apache Healthcare Corporation (SCAHC). By mid-December 2020, 19% of the San Carlos Apache population had received a positive reverse transcription polymerase chain reaction test for SARS-CoV-2, the virus that causes COVID-19. The Tribe prioritized for vaccination population groups with the highest risk for severe COVID-19 outcomes (eg, those aged ≥65 years, who had a 46% risk of hospitalization if infected vs 13% overall). SCAHC achieved high early COVID-19 vaccination rates in the San Carlos community relative to the state of Arizona (47.6 vs 25.2 doses per 100 population by February 27, 2021). These vaccination rates reflected several strategies that were implemented to achieve high COVID-19 vaccine access and uptake, including advance planning, departmental vaccine education sessions within SCAHC, radio and Facebook postings featuring Tribal leaders in the Apache language, and pop-up community vaccine clinics. The San Carlos Apache Tribe's vaccine rollout strategy was an early success story and may provide a model for future vaccination campaigns in other Tribal nations and rural communities in the United States.
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Affiliation(s)
- Nam Le-Morawa
- San Carlos Apache Healthcare Corporation, San Carlos, AZ, USA
| | - Amber Kunkel
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James Darragh
- San Carlos Apache Healthcare Corporation, San Carlos, AZ, USA
| | - David Reede
- Department of Health and Human Services, San Carlos Apache Tribe, San Carlos, AZ, USA
| | | | - Yvonne Lees
- Department of Health and Human Services, San Carlos Apache Tribe, San Carlos, AZ, USA
| | - Dillene Hoffman
- San Carlos Apache Healthcare Corporation, San Carlos, AZ, USA
| | - Lapriel Dia
- San Carlos Apache Healthcare Corporation, San Carlos, AZ, USA
| | - Tara Kitcheyan
- San Carlos Apache Healthcare Corporation, San Carlos, AZ, USA
| | - Melinda White
- San Carlos Apache Healthcare Corporation, San Carlos, AZ, USA
| | - Isaiah Belknap
- San Carlos Apache Healthcare Corporation, San Carlos, AZ, USA
| | - Nickolas Agathis
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Victoria Began
- San Carlos Apache Healthcare Corporation, San Carlos, AZ, USA
| | - S Arunmozhi Balajee
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
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50
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Schuh HB, Rimal RN, Breiman RF, Orton PZ, Dudley MZ, Kao LS, Sargent RH, Laurie S, Weakland LF, Lavery JV, Orenstein WA, Brewer J, Jamison AM, Shaw J, Josiah Willock R, Gust DA, Salmon DA. Evaluation of online videos to engage viewers and support decision-making for COVID-19 vaccination: how narratives and race/ethnicity enhance viewer experiences. Front Public Health 2023; 11:1192676. [PMID: 37670826 PMCID: PMC10475941 DOI: 10.3389/fpubh.2023.1192676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/17/2023] [Indexed: 09/07/2023] Open
Abstract
Background Vaccine hesitancy has hampered the control of COVID-19 and other vaccine-preventable diseases. Methods We conducted a national internet-based, quasi-experimental study to evaluate COVID-19 vaccine informational videos. Participants received an informational animated video paired with the randomized assignment of (1) a credible source (differing race/ethnicity) and (2) sequencing of a personal narrative before or after the video addressing their primary vaccine concern. We examined viewing time and asked video evaluation questions to those who viewed the full video. Results Among 14,235 participants, 2,422 (17.0%) viewed the full video. Those who viewed a personal story first (concern video second) were 10 times more likely to view the full video (p < 0.01). Respondent-provider race/ethnicity congruence was associated with increased odds of viewing the full video (aOR: 1.89, p < 0.01). Most viewers rated the informational video(s) to be helpful, easy to understand, trustworthy, and likely to impact others' vaccine decisions, with differences by demographics and also vaccine intentions and concerns. Conclusion Using peer-delivered, personal narrative, and/or racially congruent credible sources to introduce and deliver vaccine safety information may improve the openness of vaccine message recipients to messages and engagement.
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Affiliation(s)
- Holly B. Schuh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Rajiv N. Rimal
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Robert F. Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | - Matthew Z. Dudley
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | | | | | - Leo F. Weakland
- Center for Global Health Innovation, Atlanta, GA, United States
| | - James V. Lavery
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Center for Ethics, Emory University, Atlanta, GA, United States
| | - Walter A. Orenstein
- Department of Medicine, Emory University, School of Medicine, Atlanta, GA, United States
| | - Janesse Brewer
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Amelia M. Jamison
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jana Shaw
- Division of Infectious Diseases, Department of Pediatrics, The State University of New York (SUNY) Upstate Medical University, Syracuse, NY, United States
| | - Robina Josiah Willock
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Deborah A. Gust
- Department of Psychology, Education Division, Gwinnett Technical College, Lawrenceville, GA, United States
| | - Daniel A. Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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