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Fisher KA, Singh S, Stone RT, Nguyen N, Crawford S, Mazor KM. Primary care providers' views of discussing COVID-19 vaccination with vaccine hesitant patients: A qualitative study. PATIENT EDUCATION AND COUNSELING 2024; 127:108369. [PMID: 38996575 DOI: 10.1016/j.pec.2024.108369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 06/19/2024] [Accepted: 06/29/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVE To describe primary care providers' (PCPs) perspectives on discussing COVID-19 vaccination with their patients. METHODS All PCPs from 11 primary care clinics at 3 health systems were invited to participate. Focus groups were conducted between December 2021-January 2022, and were recorded and transcribed. Participants were asked about their experience communicating about the COVID-19 vaccine. Themes and subthemes were inductively identified using thematic analysis. RESULTS 40 PCPs participated. All PCPs viewed discussing COVID-19 vaccination as high priority. Strategies for promoting COVID-19 vaccination included influencing what people think and feel, building trust and leveraging their relationship with patients, and practical strategies such as on-site vaccination. Most strategies aimed at influencing what people think and feel and leveraging relationships were viewed as generally ineffective. On-site vaccine availability was identified as the most influential factor. PCPs expressed frustration by their interactions with vaccine hesitant patients, leading them to truncate their communication with these patients. CONCLUSIONS Despite using a broad range of strategies, most PCPs were unable to change the strongly held beliefs among the most vaccine hesitant patients that were often informed by misinformation and mistrust. PRACTICE IMPLICATIONS Promising strategies for promoting vaccination include social/relational (expressing empathy) and practical (on-site COVID-19 vaccine availability).
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Affiliation(s)
- Kimberly A Fisher
- Division of Health Systems Science, Department of Medicine, UMass Chan Medical School, Worcester, MA 01655, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, UMass Chan Medical School, Worcester, MA 01655, USA.
| | - Sonal Singh
- Division of Health Systems Science, Department of Medicine, UMass Chan Medical School, Worcester, MA 01655, USA; Department of Family and Community Medicine, UMass Chan Medical School, Worcester, MA 01655, USA.
| | | | - Ngoc Nguyen
- Meyers Health Care Institute, A Joint Endeavor of the UMass Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA 01605, USA.
| | - Sybil Crawford
- Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, MA 01655, USA.
| | - Kathleen M Mazor
- Division of Health Systems Science, Department of Medicine, UMass Chan Medical School, Worcester, MA 01655, USA.
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Kyakuwa N, Abaasa A, Mpooya S, Kalutte H, Atuhairwe C, Perez L, Kikaire B. Non-uptake of COVID-19 vaccines and reasons for non-uptake among healthcare workers in Uganda: a cross-sectional study. BMC Health Serv Res 2024; 24:663. [PMID: 38796411 PMCID: PMC11128104 DOI: 10.1186/s12913-024-11137-2] [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: 03/28/2024] [Accepted: 05/22/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND Vaccines play a crucial role in eradicating and containing disease outbreaks. Therefore, understanding the reasons behind vaccine refusal and associated factors is essential for improving vaccine acceptance rates. Our objective was to examine the determinants of COVID-19 vaccine non-uptake and explore the reasons for non-uptake among healthcare workers (HCWs) in Uganda. METHODS Between July and August 2021, we conducted a cross-sectional study among healthcare workers in primary healthcare facilities (private and government) in Entebbe Municipality, Uganda. Participants were recruited using convenience sampling, and consenting individuals received credentials to access an electronic database and complete a structured questionnaire. There were no established HCWs contact registers in the municipality, and the study was conducted during a national lock down, therefore, the HCWs who were on duty at the time of the study were approached. The survey questions were based on the '3Cs' model of vaccine hesitancy and focused on confidence, convenience, and complacency factors. Non-uptake of vaccines was defined as not having received any of the available vaccines in the country. We employed counts, percentages, and simple logit models to summarize the reasons for non-uptake of COVID-19 vaccines and to identify associated factors. RESULTS The study recruited 360 HCWs, 61.7% of whom were female, with an average age of 31 years (SD = 7.9). Among them, 124 (34.4%) healthcare workers did not receive any COVID-19 vaccine. Non-uptake of COVID-19 vaccines was independently associated with several factors, including age [35 + years adjusted odds ratio (aOR) = 0.30, 95% CI: 0.13-0.66 compared with 18-24 years], facility ownership [government, aOR = 0.22 (0.10-0.49) compared with private not-for-profit], previous testing for coronavirus [yes, aOR = 0.35 (0.19-0.65)], and previous involvement in COVID-19 vaccine activities [yes, aOR = 0.17 (0.10-0.29)]. The primary reasons cited for non-uptake of COVID-19 vaccines were related to a lack of confidence in the vaccines, such as concerns about side effects (79.8%) and the need for more time to understand the vaccines (89.5%), as well as the importance of weighing benefits and risks (84.7%) before being vaccinated. A smaller proportion, approximately 23%, cited reasons related to complacency and lack of convenience in accessing vaccination services. CONCLUSION The high proportion of non-uptake of COVID-19 vaccines among this population primarily stems from a lack of confidence and trust in the vaccines, coupled with insufficient time allowed for users to make informed decisions. This underscores the urgent need for ongoing monitoring and trend analysis of vaccine non-uptake to guide the development and implementation of strategies aimed at building and sustaining vaccine confidence. Adequate time should be allowed to explain benefits of vaccination to the population to allay fears that might exist before actual vaccination is rolled out.
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Affiliation(s)
| | - Andrew Abaasa
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Simon Mpooya
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | | | - Laurent Perez
- Department of Medicine, Service of Immunology and Allergy, Centre for Human Immunology Lausanne, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bernard Kikaire
- Makerere University College of Health Sciences, Kampala, Uganda
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Newman PA, Dinh DA, Nyoni T, Allan K, Fantus S, Williams CC, Tepjan S, Reid L, Guta A. Covid-19 Vaccine Hesitancy and Under-Vaccination among Marginalized Populations in the United States and Canada: A Scoping Review. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01882-1. [PMID: 38117443 DOI: 10.1007/s40615-023-01882-1] [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: 09/15/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Amid persistent disparities in Covid-19 vaccination and burgeoning research on vaccine hesitancy (VH), we conducted a scoping review to identify multilevel determinants of Covid-19 VH and under-vaccination among marginalized populations in the U.S. and Canada. METHODS Using the scoping review methodology developed by the Joanna Briggs Institute, we designed a search string and explored 7 databases to identify peer-reviewed articles published from January 1, 2020-October 25, 2022. We combine frequency analysis and narrative synthesis to describe factors influencing Covid-19 VH and under-vaccination among marginalized populations. RESULTS The search captured 11,374 non-duplicated records, scoped to 103 peer-reviewed articles. Among 14 marginalized populations identified, African American/Black, Latinx, LGBTQ+, American Indian/Indigenous, people with disabilities, and justice-involved people were the predominant focus. Thirty-two factors emerged as influencing Covid-19 VH, with structural racism/stigma and institutional mistrust (structural)(n = 71) most prevalent, followed by vaccine safety (vaccine-specific)(n = 62), side effects (vaccine-specific)(n = 50), trust in individual healthcare provider (social/community)(n = 38), and perceived risk of infection (individual)(n = 33). Structural factors predominated across populations, including structural racism/stigma and institutional mistrust, barriers to Covid-19 vaccine access due to limited supply/availability, distance/lack of transportation, no/low paid sick days, low internet/digital technology access, and lack of culturally- and linguistically-appropriate information. DISCUSSION We identified multilevel and complex drivers of Covid-19 under-vaccination among marginalized populations. Distinguishing vaccine-specific, individual, and social/community factors that may fuel decisional ambivalence, more appropriately defined as VH, from structural racism/structural stigma and systemic/institutional barriers to vaccination access may better support evidence-informed interventions to promote equity in access to vaccines and informed decision-making among marginalized populations.
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Affiliation(s)
- Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
| | - Duy A Dinh
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Thabani Nyoni
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Kate Allan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Sophia Fantus
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Charmaine C Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | - Luke Reid
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, ON, Canada
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Rabin Y, Kohler RE. COVID-19 Vaccination Messengers, Communication Channels, and Messages Trusted Among Black Communities in the USA: a Review. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01858-1. [PMID: 37947953 DOI: 10.1007/s40615-023-01858-1] [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: 08/16/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
Black and African American adults exhibited higher levels of mistrust and vaccine hesitancy and lower levels of vaccination throughout the COVID-19 pandemic. Vaccination and booster uptake remains disproportionately low among Black adults. We conducted a systematic review of empirical research published between February 2021 and July 2022 from five electronic databases and the grey literature. We screened studies that assessed COVID-19 vaccination information needs and preferences as well as communication strategies among Black adults in the USA. We extracted data, then analyzed and synthesized results narratively. Twenty-two articles were included: 2 interventions, 3 experimental surveys, 7 observational surveys, 8 qualitative inquiries, and 2 mixed methods studies. Studies reported credible and preferred COVID-19 vaccination information sources/messengers, channels, and content. Commonly trusted messengers included personal health care providers, social network connections, and church/faith leaders. Electronic outreach (e.g., email, text messages), community events (e.g., forums, canvassing), and social media were popular. Black communities wanted hopeful, fact-based messages that address racism and mistrust; persuasive messages using collective appeals about protecting others may be more influential in changing behavior. Future communication strategies aiming to increase vaccine confidence and encourage COVID-19 booster vaccination among Black communities should be developed in partnership with community leaders and local health care providers to disseminate trauma-informed messages with transparent facts and collective action appeals across multiple in-person and electronic channels.
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Affiliation(s)
- Yael Rabin
- Department of Health Behavior Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Racquel E Kohler
- Department of Health Behavior Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA.
- Center for Cancer Health Equity, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
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Schrimpf A, Jentzsch A, Geier AK, Bleckwenn M. Comparison of SARS-CoV-2 Vaccination Skepticism, Reasons, and Concerns Between Mass Vaccination Centers and General Practices in Germany 2021. Patient Prefer Adherence 2023; 17:2855-2870. [PMID: 37953979 PMCID: PMC10638907 DOI: 10.2147/ppa.s433331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/24/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction The reluctance to be vaccinated against COVID-19 has significantly curbed vaccine uptake. Unlike mass vaccination centers, general practitioners (GPs) might be able to address some of the patients' concerns through their long-term doctor-patient relationship. This study compared vaccination reasons, concerns and skepticism about vaccination, and perceived importance of the vaccine and its hypothetical value between vaccination centers and GP practices. Methods A survey was distributed (07/2021-10/2021) among newly vaccinated individuals in ten GP practices (n = 364) and two vaccine centers (n = 474). Results Participants in vaccine centers stated more prosocial and benefit-oriented reasons for vaccination, whereas participants in GP practices more often stated the GP's recommendation as the reason. Perceived importance of the vaccine in combating the pandemic was rated higher among individuals at vaccine centers and with higher health awareness and self-efficacy. Participants at both types of sites who preferred a GP for vaccination expressed more vaccination skepticism, which was also related to older age, more health risk concerns related to COVID-19 vaccines, and lower perceived importance of the vaccine. Conclusion Our results indicate opportunities for framing future vaccination campaigns that include vaccination centers. Additionally, a rapid GP involvement in future mass vaccinations might be crucial for overcoming attitudinal barriers and achieving higher vaccine uptake.
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Affiliation(s)
- Anne Schrimpf
- Institute for General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Anne Jentzsch
- Institute for General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Anne-Kathrin Geier
- Institute for General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Markus Bleckwenn
- Institute for General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
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Madran B, Kayı İ, Beşer A, Ergönül Ö. Uptake of COVID-19 vaccines among healthcare workers and the effect of nudging interventions: A mixed methods study. Vaccine 2023:S0264-410X(23)00688-6. [PMID: 37336661 PMCID: PMC10250152 DOI: 10.1016/j.vaccine.2023.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/29/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND During the coronavirus disease (COVID-19) pandemic, vaccination of healthcare workers (HCWs) has a critical role because of their high-risk exposure and being a role model. Therefore, we aimed to investigate vaccine hesitancy and the role of mandatory polymerase chain reaction (PCR) testing and education for vaccine uptake. METHODS We conducted an explanatory sequential designed observational mixed-methods study, including quantitative and qualitative sections consecutively in two different pandemic hospitals between 15 September 2021 and 1 April 2022. The characteristics of vaccinated and unvaccinated HCWs were compared. The vaccine hesitancy scales were applied, and the effect of nudging, such as mandatory PCR and education, were evaluated. In-depth interviews were performed to investigate the COVID-19 vaccine hesitancy among HCWs according to Health Belief Model. RESULTS In total, 3940 HCWs were included. Vaccine hesitancy was more common among males than females, the ancillary workers than other health professions, and nonmedical departments than other departments. After the mandatory weekly PCR request nudge, 83.33 % (130/156) vaccine-hesitant HCWs were vaccinated, and 8.3 % (13/156) after the small group seminars and mandatory PCR every two days. The rate of COVID-19 vaccination was raised from 95.5 % to 99.67 % (3927/3940). At the end of in-depth interviews (n = 13), the vaccine hesitancy determinants were distrust, fear of uncertainty, immune confidence and spirituality, the media effect, social pressure, and obstinacy. CONCLUSIONS The nudging interventions such as mandatory PCR testing and small group seminars helped raise the rate of COVID-19 vaccination; the most effective one is mandatory PCR.
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Affiliation(s)
- Bahar Madran
- Koç University, School of Nursing, Public Health Nursing, Istanbul, Turkey.
| | - İlker Kayı
- Koç University, School of Medicine, Department of Public Health, Istanbul, Turkey; Koç University İşbank Center for Infectious Diseases (KUISCID), Istanbul, Turkey.
| | - Ayşe Beşer
- Koç University, School of Nursing, Public Health Nursing, Istanbul, Turkey.
| | - Önder Ergönül
- Koç University İşbank Center for Infectious Diseases (KUISCID), Istanbul, Turkey; Koç University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
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Msunyaro E, Rangi J, Haonga T, Kileo N, Mlembwa J, Nyawade S, Machekanyanga Z, Kalinga A, John W, Bukuku MA, Kusena P, Isack I, Mathenge V, Saguti G, Akyoo E, Yoti Z. Contribution of community champions to accelerate the uptake of COVID-19 vaccination in Rukwa region, Tanzania, February - October 2022. Pan Afr Med J 2023; 45:5. [PMID: 37538368 PMCID: PMC10395113 DOI: 10.11604/pamj.supp.2023.45.1.39705] [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: 03/17/2023] [Accepted: 06/01/2023] [Indexed: 08/05/2023] Open
Abstract
Introduction Tanzania is among the African countries which started COVID-19 vaccination late (August 2021) compared to other countries in the African continent. By mid-March 2022, overall vaccine uptake was 13% of the targeted population, which was very low compared to other countries. We describe the contribution of champions in the Rukwa region that led to an increase in vaccine coverage rate in Tanzania. Methods a community-based campaign was conducted using community champions from July 15th to August 31st, 2022. A baseline assessment was conducted focusing on the key drivers, barriers, and enablers for COVID-19 vaccine uptake in the region. A working session to develop IEC materials and messages tailored to addressing the issues raised in the community to be used in the campaign in the region was conducted, followed by the campaign's launch. Community engagement and sensitizations, which contributed to the rise of vaccinated people, were based on house-to-house visits, village meetings, and visiting community gatherings such as marketplaces, places of worship, and sports areas, which were done by champions alongside vaccinators. Results the campaign contributed to the increase of vaccination coverage because, before the start of the campaign, the vaccination coverage was 10% as of July 14th, 2022. After the campaign, which started on July 15th to August 31st, 2022, the coverage increased by 12%. During the post-evaluation exercise after the campaign, the coverage keeps increased and reached 94% by October 2022. The coverage kept increasing even after the intervention's end due to the campaign's positive effect. Conclusion the community still needs correct information to avoid misinformation and hesitancy, especially when introducing new disease response mechanisms such as vaccines. The community champions who are based in the community play a critical role in addressing community concerns and contribute to the effectiveness of the implementation; hence sustainability is crucial.
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Affiliation(s)
- Erick Msunyaro
- Health Promotion Section, Ministry of Health, Dodoma, Tanzania
| | | | - Tumaini Haonga
- Health Promotion Section, Ministry of Health, Dodoma, Tanzania
| | - Neema Kileo
- World Health Organization, Dar es Salaam, Tanzania
| | | | - Susan Nyawade
- World Health Organization, The Office of Regional Office, Brazzaville, Congo
| | | | - Akili Kalinga
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | - Winfrida John
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | | | | | - Ibrahim Isack
- The Office of Regional Commissioner, Rukwa, Tanzania
| | | | - Grace Saguti
- World Health Organization, Dar es Salaam, Tanzania
| | | | - Zabulon Yoti
- World Health Organization, Dar es Salaam, Tanzania
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Fisher KA, Nguyen N, Fouayzi H, Crawford S, Singh S, Dong M, Wittenberg R, Mazor KM. From COVID-19 Vaccine Hesitancy to Vaccine Acceptance: Results of a Longitudinal Survey. Public Health Rep 2023:333549231176006. [PMID: 37243439 DOI: 10.1177/00333549231176006] [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: 05/28/2023] Open
Abstract
OBJECTIVES COVID-19 vaccines are widely available, but uptake is suboptimal. To develop strategies to increase vaccination rates, we sought to (1) characterize adults initially hesitant to be vaccinated for COVID-19 who later received the vaccine and (2) identify factors associated with their vaccination decision. METHODS In January 2021, we conducted an online survey of US adults via Prolific that assessed vaccination intent, COVID-19-related knowledge and attitudes, and demographic characteristics. In May 2021, we recontacted respondents to assess vaccination status and factors influencing their vaccination decision. We used χ2 statistics and t tests to examine associations between respondents' vaccination status and their characteristics, knowledge, and attitudes. We analyzed reasons for vaccination using thematic analysis. RESULTS Of 756 initially vaccine-hesitant respondents, 529 (70.0%) completed the follow-up survey. Nearly half of those initially not sure about vaccination (47.3%, 112 of 237) were vaccinated at follow-up, while 21.2% (62 of 292) of those initially planning not to be vaccinated were vaccinated at follow-up. Of those initially not sure, higher educational attainment, greater knowledge of COVID-19, and a doctor's recommendation were associated with vaccination. Of those initially intending not to be vaccinated, male sex, Democratic political affiliation, receipt of an influenza shot within 5 years, being more worried about COVID-19, and having greater COVID-19 knowledge were associated with increased likelihood of being vaccinated. Of 167 respondents who gave reasons for vaccination, protecting oneself and others (59.9%), practical issues (29.9%), social influences (17.4%), and vaccine safety (13.8%) were the main reasons. CONCLUSION Providing information on the protective value of vaccination, implementing rules that make remaining unvaccinated burdensome, making vaccination easy, and providing social support may influence vaccine-hesitant adults to accept vaccination.
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Affiliation(s)
- Kimberly A Fisher
- Meyers Health Care Institute, a joint endeavor of the UMass Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA
- Department of Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Ngoc Nguyen
- Meyers Health Care Institute, a joint endeavor of the UMass Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA
| | - Hassan Fouayzi
- Meyers Health Care Institute, a joint endeavor of the UMass Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA
| | - Sybil Crawford
- Meyers Health Care Institute, a joint endeavor of the UMass Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA
- Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, MA, USA
| | - Sonal Singh
- Meyers Health Care Institute, a joint endeavor of the UMass Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA
- Department of Family and Community Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - May Dong
- T.H. Chan School of Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Ruth Wittenberg
- Meyers Health Care Institute, a joint endeavor of the UMass Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA
| | - Kathleen M Mazor
- Meyers Health Care Institute, a joint endeavor of the UMass Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA
- Department of Medicine, UMass Chan Medical School, Worcester, MA, USA
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Kalra S, Kalra D, Grafova I, Rubin JS, Monheit A, Cantor J, Duberstein P, Bhuyan SS. Association of death or illness from COVID-19 among family and friends on vaccine uptake within four months of the Emergency Use Authorization. Findings from a national survey in the United States. Vaccine 2023; 41:1911-1915. [PMID: 36682984 PMCID: PMC9837229 DOI: 10.1016/j.vaccine.2023.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 01/03/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To examine the relationship between knowing that a friend or family member became ill with, or died from, COVID-19 and receiving a vaccine dose within four months of the FDA's Emergency Use Authorization. METHODS A national sample of 1,517 respondents were surveyed from April 7 to April 12, 2021, 1,193 of whom were eligible for the vaccine when the data were collected. RESULTS Respondents who knew someone who became ill with COVID-19 (AOR = 2.32, 95 % CI 1.74-3.09) or knew someone who died (AOR = 2.29, 95 % CI 1.32-3.99) from COVID-19 were more likely to receive at least a single COVID-19 vaccine dose. CONCLUSION Encouraging people to share their COVID-19 illness and bereavement experiences with their local network such as friends, families, social-networks and via social media might help increase vaccine uptake.
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Affiliation(s)
- Saurabh Kalra
- Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA.
| | - Deepak Kalra
- Department of Neurology, Penn State College of Medicine, Pennsylvania State University, Hershey, PA, USA.
| | - Irina Grafova
- Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA.
| | - Julia Sass Rubin
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA.
| | - Alan Monheit
- Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA.
| | - Joel Cantor
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA.
| | - Paul Duberstein
- Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA.
| | - Soumitra S Bhuyan
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA.
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Fisher KA, Nguyen N, Fouayzi H, Singh S, Crawford S, Mazor KM. Impact of a physician recommendation on COVID-19 vaccination intent among vaccine hesitant individuals. PATIENT EDUCATION AND COUNSELING 2023; 106:107-112. [PMID: 36244947 PMCID: PMC9523946 DOI: 10.1016/j.pec.2022.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/09/2022] [Accepted: 09/26/2022] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To test the impact of varied physician recommendations on COVID-19 vaccine hesitancy. METHODS We conducted a vignette-based experimental survey on Prolific, an online research platform. COVID-19 vaccine hesitant, adult panel members were assigned to one of five messages that varied by recommendation style (participatory vs explicit) and strategy (acknowledgement of concerns; comparison to the flu shot; statement that millions of people have already received it; emphasis on protecting others). Vaccine hesitancy was re-assessed with the question, "Would you get vaccinated at this visit?". RESULTS Of the 752 participants, 60.1% were female, 43.4% Black, 23.6% Latino, and 33.0% White; mean age was 35.6 years. Overall, 33.1% of the initially "not sure" and 13.1% of the initially "no" participants became less hesitant following any recommendation. Among the "not sure" participants, 20.3% of those who received a participatory recommendation became less hesitant compared with 34.3%- 39.5% for the explicit recommendations. The "protect others" message was most effective among initially "no" participants; 19.8% become less hesitant, compared to 8.7% for the participatory recommendation. CONCLUSION A physician recommendation may reduce COVID-19 vaccine hesitancy. PRACTICE IMPLICATIONS An explicit recommendation and "protect others" message appear to be important elements of a physician recommendation for COVID-19 vaccination.
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Affiliation(s)
- Kimberly A Fisher
- Department of Medicine, Division of Health Systems Science, UMass Chan Medical School, Worcester, MA, USA.
| | - Ngoc Nguyen
- Department of Medicine, Division of Health Systems Science, UMass Chan Medical School, Worcester, MA, USA
| | - Hassan Fouayzi
- Department of Medicine, Division of Health Systems Science, UMass Chan Medical School, Worcester, MA, USA
| | - Sonal Singh
- Department of Medicine, Division of Health Systems Science, UMass Chan Medical School, Worcester, MA, USA; Department of Family and Community Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Sybil Crawford
- Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, MA, USA
| | - Kathleen M Mazor
- Department of Medicine, Division of Health Systems Science, UMass Chan Medical School, Worcester, MA, USA
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Bussink-Voorend D, Hautvast JLA, Vandeberg L, Visser O, Hulscher MEJL. A systematic literature review to clarify the concept of vaccine hesitancy. Nat Hum Behav 2022; 6:1634-1648. [PMID: 35995837 DOI: 10.1038/s41562-022-01431-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 07/13/2022] [Indexed: 11/25/2022]
Abstract
Vaccine hesitancy (VH) is considered a top-10 global health threat. The concept of VH has been described and applied inconsistently. This systematic review aims to clarify VH by analysing how it is operationalized. We searched PubMed, Embase and PsycINFO databases on 14 January 2022. We selected 422 studies containing operationalizations of VH for inclusion. One limitation is that studies of lower quality were not excluded. Our qualitative analysis reveals that VH is conceptualized as involving (1) cognitions or affect, (2) behaviour and (3) decision making. A wide variety of methods have been used to measure VH. Our findings indicate the varied and confusing use of the term VH, leading to an impracticable concept. We propose that VH should be defined as a state of indecisiveness regarding a vaccination decision.
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Affiliation(s)
- Daphne Bussink-Voorend
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands.
| | - Jeannine L A Hautvast
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands
| | - Lisa Vandeberg
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Olga Visser
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands
| | - Marlies E J L Hulscher
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
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Allen JD, Fu Q, Shrestha S, Nguyen KH, Stopka TJ, Cuevas A, Corlin L. Medical mistrust, discrimination, and COVID-19 vaccine behaviors among a national sample U.S. adults. SSM Popul Health 2022; 20:101278. [DOI: 10.1016/j.ssmph.2022.101278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/14/2022] Open
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Williams DP, Jones NM, Holman EA. Racial and ethnic differences in perseverative cognition at the onset of the COVID-19 pandemic. Soc Sci Med 2022; 306:115105. [PMID: 35724589 PMCID: PMC9161684 DOI: 10.1016/j.socscimed.2022.115105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 12/04/2022]
Abstract
Rationale Coronavirus (COVID-19) disproportionately affects people of color (e.g., Black and Latinx individuals) in the U.S., increasing their morbidity and mortality relative to White people. Despite this greater threat to their well-being, the mental health impact of COVID-19 on people of color remains poorly understood. Perseverative cognition (PC; i.e., excessive worry and/or rumination), is a common psychological response to such threats that independently associates with poor mental and physical health. Objective To examine patterns of PC across race/ethnicity when the COVID-19 pandemic began. Methods This study surveyed 6,514 respondents from the NORC AmeriSpeak panel, a probability-based representative national sample of U.S. adults between 3/18/20-4/18/20. We employed traditional statistical analyses and natural language processing of open-ended data to examine pandemic-related worries. Results Weighted regression analyses with relevant covariates revealed group differences across specific domains of COVID-related worry. Relative to White respondents, Hispanic/Latino respondents reported more worries about social disarray, meeting basic needs, experiencing economic impacts, obtaining healthcare, and contracting COVID-19. Black respondents reported more worry about economic impacts relative to Whites. Additional group differences in worry emerged in open-ended data: Black respondents perseverated about death from COVID-19, whereas Hispanic/Latino respondents reported concerns about COVID-19 spread, and people refusing to uphold mitigation mandates. In contrast, White respondents expressed worry over compromised immune systems and economic collapse. Conclusions Results identify significant group differences in COVID-19 related PC, suggesting that people of color faced greater threat to mental well-being at the onset of the pandemic, and may be at greater risk for downstream PC-related physical health consequences.
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Affiliation(s)
- DeWayne P Williams
- Department of Psychological Science, University of California, Irvine, USA
| | - Nickolas M Jones
- Department of Psychological Science, University of California, Irvine, USA
| | - E Alison Holman
- Department of Psychological Science, University of California, Irvine, USA; Sue & Bill Gross School of Nursing, University of California, Irvine, USA.
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14
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Bernstein HH, McNally VV, Orenstein WA. Is It Time for Coronavirus Disease-2019 Vaccine Mandates? J Pediatr 2022; 242:235-237. [PMID: 34788680 PMCID: PMC8590634 DOI: 10.1016/j.jpeds.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/06/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Henry H. Bernstein
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY,Reprint requests: Henry H. Bernstein, DO, MHCM, FAAP, 410 Lakeville Rd, Suite 311, New Hyde Park, NY 11042
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15
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Thomas CM, Searle K, Galván A, Liebman AK, Mann EM, Kirsch JD, Stauffer WM. Healthcare Worker Perspectives on COVID-19 Vaccines: Implications for Increasing Vaccine Acceptance among Healthcare Workers and Patients. Vaccine 2022; 40:2612-2618. [PMID: 35315322 PMCID: PMC8904141 DOI: 10.1016/j.vaccine.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 11/30/2022]
Abstract
Objective To understand COVID-19 vaccine perspectives among healthcare workers serving diverse communities. Methods A dual English/Spanish survey was distributed to healthcare workers in the United States from 3/12/2021–4/22/2021 by the Migrant Clinicians Network, Society of Refugee Healthcare Providers, a Federally Qualified Healthcare Center, and social media advertisement to general primary care workers. Results 517 responses were at least 50% complete and included in the analysis. Among these, 88% (457/517) indicated vaccine acceptance. Factors associated with acceptance included not reporting any vaccine concerns, identifying as male, ≥65 years of age, being a physician or advanced practice provider, and interacting directly with patients from refugee, immigrant, and migrant (RIM) communities. Participants identified educational information as most helpful for themselves when making a vaccine decision, but a healthcare provider’s recommendation as most helpful for their patients. Conclusion Healthcare workers, especially those serving RIM communities, are vaccine accepting. Tailoring vaccine-related information to healthcare workers may improve vaccine confidence for both themselves and patients who rely on them for information.
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Affiliation(s)
- Christine M Thomas
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, United States; National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States.
| | - Kelly Searle
- School of Public Health, University of Minnesota, Minneapolis, MN, United States; National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States
| | - Alma Galván
- Migrant Clinicians Network, Austin, TX, United States; National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States
| | - Amy K Liebman
- Migrant Clinicians Network, Austin, TX, United States; National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States
| | - Erin M Mann
- National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States
| | - Jonathan D Kirsch
- National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States; Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, United States
| | - William M Stauffer
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, United States; National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States; Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, MN, United States
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16
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Understanding COVID-19 vaccination willingness among youth: A survey study in the Netherlands. Vaccine 2022; 40:833-836. [PMID: 35042646 PMCID: PMC8730787 DOI: 10.1016/j.vaccine.2021.12.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 02/08/2023]
Abstract
Vaccination of youth could be key to preventing future outbreaks of SARS-CoV-2. Given the limited direct health benefit for young people, it is important to understand how youth themselves perceive obtaining a vaccination. This survey study in a representative sample of Dutch youth aged 12-18 showed that 73% were willing to get vaccinated against COVID-19. In regression analyses, vaccination willingness was strongly related to age, perceived personal (protect own health) and societal benefits (to get rid of restrictive policies), and their peers' and parents' vaccination uptake. Negative associations with vaccination willingness were perceived side-effects and potential unknown long term consequences. On-going and transparent communication with up-to-date information about safety and risks, delivered by independent and trusted experts (as perceived by the recipients) seems important for addressing questions and concerns. Local information sessions for youth and parents where a vaccination can be obtained without appointment could have merit in addition to mass media communication.
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Davis TP, Yimam AK, Kalam MA, Tolossa AD, Kanwagi R, Bauler S, Kulathungam L, Larson H. Behavioural Determinants of COVID-19-Vaccine Acceptance in Rural Areas of Six Lower- and Middle-Income Countries. Vaccines (Basel) 2022; 10:vaccines10020214. [PMID: 35214672 PMCID: PMC8875839 DOI: 10.3390/vaccines10020214] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
Delayed acceptance or refusal of COVID-19 vaccines may increase and prolong the threat to global public health and the economy. Identifying behavioural determinants is considered a critical step in explaining and addressing the barriers of vaccine refusal. This study aimed to identify the behavioural determinants of COVID-19-vaccine acceptance and provide recommendations to design actionable interventions to increase uptake of the COVID-19 vaccine in six lower- and middle-income countries. Taking into consideration the health belief model and the theory of reasoned action, a barrier analysis approach was employed to examine twelve potential behavioural determinants of vaccine acceptance in Bangladesh, India, Myanmar, Kenya, the Democratic Republic of the Congo (DRC), and Tanzania. In all six countries, at least 45 interviews with those who intended to get the vaccine (“Acceptors”) and another 45 or more interviews with those who did not (“Non-acceptors”) were conducted, totalling 542 interviews. Data analysis was performed to find statistically significant (p < 0.05) differences between Acceptors and Non-acceptors of COVID-19 vaccines and to identify which beliefs were most highly associated with acceptance and non-acceptance of vaccination based on the estimated relative risk. The analysis showed that perceived social norms, perceived positive and negative consequences, perceived risk, perceived severity, trust, perceived safety, and expected access to COVID-19 vaccines had the highest associations with COVID-19-vaccine acceptance in Bangladesh, Kenya, Tanzania, and the DRC. Additional behavioural determinants found to be significant in Myanmar and India were perceived self-efficacy, trust in COVID-19 information provided by leaders, perceived divine will, and perceived action efficacy of the COVID-19 vaccines. Many of the determinants were found to be significant, and their level of significance varied from country to country. National and local plans should include messages and activities that address the behavioural determinants found in this study to significantly increase the uptake of COVID-19 vaccines across these countries.
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Affiliation(s)
- Thomas P. Davis
- World Vision International, 1202 Geneva, Switzerland; (A.K.Y.); (R.K.); (S.B.); (L.K.)
- Correspondence: ; Tel.: +41-79-692-4053
| | - Adugna Kebede Yimam
- World Vision International, 1202 Geneva, Switzerland; (A.K.Y.); (R.K.); (S.B.); (L.K.)
| | - Md Abul Kalam
- Bangladesh Country Office, Helen Keller International, Dhaka 1212, Bangladesh;
| | | | - Robert Kanwagi
- World Vision International, 1202 Geneva, Switzerland; (A.K.Y.); (R.K.); (S.B.); (L.K.)
| | - Sarah Bauler
- World Vision International, 1202 Geneva, Switzerland; (A.K.Y.); (R.K.); (S.B.); (L.K.)
| | - Loria Kulathungam
- World Vision International, 1202 Geneva, Switzerland; (A.K.Y.); (R.K.); (S.B.); (L.K.)
| | - Heidi Larson
- Vaccine Confidence Project, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
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Lin YC, Chen TCT. An intelligent system for assisting personalized COVID-19 vaccination location selection: Taiwan as an example. Digit Health 2022. [DOI: 10.1177/20552076221109062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
In many regions of the world, with the gradual increase in the supply of COVID-19 vaccines, COVID-19 vaccination has changed from centralized government control to personalized selection. When choosing a location for COVID-19 vaccination, in addition to subjective preferences, objective information (such as the expected waiting time at a COVID-19 vaccination location and the crowdedness and reliability of the vaccination location) also need to be considered. However, it is not convenient for an individual to collect and compare such information. To address this issue, this research applies web content mining to extract the conditions of COVID-19 vaccination locations. Then, a novel asymmetric calibrated fuzzy inverse of column sum and fuzzy Vise Kriterijumska Optimizacija I Kompromisno Resenje recommendation mechanism is proposed. Finally, an intelligent system is developed to assist a user in selecting a personalized COVID-19 vaccination location. In a regional experiment conducted in Taichung City, Taiwan, the developed intelligent system was applied to assist 20 users in choosing personalized COVID-19 vaccination locations. The successful recommendation rate was 95%.
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Affiliation(s)
- Yu-Cheng Lin
- Department of Computer-Aided Industrial Design, Overseas Chinese University, Taichung
| | - Tin-Chih Toly Chen
- Department of Industrial Engineering and Management, National Yang Ming Chiao Tung University, Hsinchu City
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