Race, ethnicity and COVID-19 vaccination: a qualitative study of UK healthcare staff

"If that would have lessened my symptoms, that would have been great...": a qualitative study about the acceptability of tecovirimat as treatment for mpox

BACKGROUND

Tecovirimat, an antiviral treatment for smallpox, was approved as a treatment for mpox by the European Medicines Agency in January 2022. Approval was granted under "exceptional circumstances" based on effectiveness found in pre-clinical challenge studies in animals and safety studies in humans showing minimal side effects. As clinical efficacy studies are still ongoing, there is currently limited information with regard to the acceptability of tecovirimat to treat mpox. The aim of this study is to understand prospective acceptability of use of tecovirimat as treatment for mpox.

METHODS

A co-produced, qualitative, focus group study design was conducted with a theoretically informed sample of people from communities at higher risk and with experience of mpox illness. Thirteen participants took part: all self-identified as cisgender male, 1 self-identified as Black British, 1 as British Asian, 5 as White, 3 as White British, 3 as White Other. Inclusion criteria were as follows: experience of mpox illness; age 18 and over; living in the United Kingdom (UK); living in the UK during 2022 mpox outbreak. Focus groups were recorded, transcribed and thematically analysed using a combination inductive and deductive coding informed by the Treatment Acceptability Framework.

RESULTS

Very few participants were aware of tecovirimat as a treatment option and none were offered it during their mpox illness. Key factors influencing acceptability found in this study were as follows: levels of trust in medicine; level of information; provider communication approach; quality of experience of mpox care. Marginalised communities at highest risk of mpox may have prior experience of structural discrimination which can greatly influence treatment acceptability.

CONCLUSIONS

This exploratory study suggest that offering tecovirimat (or comparable emergency-licensed treatments) to people with mpox is acceptable, although uptake will depend on knowledge of mpox treatment options, trust in medicine and medical professionals and provision of relevant information and choice. To increase acceptability of such treatments, clinicians should ensure patients are aware of mpox symptom management options, including pain relief; acknowledge and address patient concerns upfront and within the context of non-stigmatising care; and communicate offers in a consistent and supportive manner in line with locally approved eligibility criteria and protocols at the time.

Vaccine hesitancy: a structured review from a behavioral perspective (2015-2022)

Vaccine hesitancy, a complex behavioral phenomenon, poses a significant global health threat and has gained renewed attention amidst the COVID-19 pandemic. This paper scrutinized peer-reviewed literature on vaccine hesitancy published from 2015 to 2022, with a specific focus on behavioral perspectives, utilizing a Theories-Constructs-Variables-Contexts-Methods (TCVCM) framework. The study highlighted prominent theoretical approaches, abstract concepts, research variables, global contexts and academic techniques employed across a selected sample of 138 studies. The result is a consolidated overview of research and schematization of the factors influencing vaccine hesitancy and vaccination behaviors. These include individual-level, contextual, vaccine-specific, organizational, and public-policy-related dynamics. The findings corroborated the complexity of vaccine hesitancy and emphasized the difficulties of pursuing vaccine advocacy. The analysis also identified several directions for future research, and the need to conduct more contextual studies in low- and middle-income nations to bring out the cross-cultural nuances of vaccine hesitancy.

From Hesitancy to Acceptance: An Interpretative Approach to Unravel the Vaccination Motivation Among the Rural Population

Our study focuses on vaccination decisions within a collectivistic framework, prioritizing social and behavioral factors over individualistic views amidst COVID-19. Integrating behavioral biases and social ties, we inform targeted public health communication strategies. Examining vaccine uptake in rural India, we use Interpretative Phenomenological Analysis (IPA) to interpret deviations, capturing personal experiences and biases. Through the COM-B model and 25 interviews, we uncover motivations influenced by individual, family, and community factors. Synthesizing findings, we propose tailored public health communication grounded in behavioral psychology. Rather than disregarding biases, we explore their implications for effective interventions. This research advances health communication, particularly benefiting lower-middle-income countries with non-pharmacological approaches.

Contextualizing the racial gradient in covid-19 outcomes: Narratives from HBCU students

COVID-19 spread across the nation with Black Americans experiencing twice of the prevalence of deaths than White Americans. Black American college students are facing a unique set of biopsychosocial costs including less retention and poorer mental health. Therefore, the purpose of this study was to examine how Historically Black College or University (HBCU) students contextualize COVID-19. Interviews were conducted with 19 participants and lasted 40-60 minutes. They discussed topics including: their COVID-19 knowledge, precautionary measures, and barriers and promoters of school success were covered. Data were coded through semi-open coding and discussed among the research team. Responses were summarized by eight themes: emotional responses, colorblind rhetoric, lack of healthcare, essential work, distrust for the medical field, barriers to precautions like supply shortages and environmental factors, and poor baseline health. These findings may be used to develop interventions that moderate the impact of COVID-19 and future pandemics on mental health.

Is resistance to Covid-19 vaccination a "problem"? A critical policy inquiry of vaccine mandates for healthcare workers

As the COVID-19 global vaccination campaign was launched in December of 2020, vaccination became mandatory for many healthcare workers (HCWs) worldwide. Large minorities resisted the policy, and the responses of authorities to this resistance led to damaged professional reputations, job losses, and suspension or termination of practice licenses. The joint effect of dismissals, early retirements, career changes, and vaccine injuries disabling some compliant HCWs from adequate performance has exacerbated existing crises within health systems. Nevertheless, leading health authorities have maintained that the benefits of a fully vaccinated healthcare labor force-believed to be protecting health systems, vulnerable patient populations, and even HCWs themselves-achieved through mandates, if necessary, outweigh its potential harms. Informed by critical policy and discourse traditions, we examine the expert literature on vaccine mandates for HCWs. We find that this literature neglects evidence that contradicts official claims about the safety and effectiveness of COVID-19 vaccines, dismisses the science supporting the contextual nature of microbial virulence, miscalculates patient and system-level harms of vaccination policies, and ignores or legitimizes the coercive elements built into their design. We discuss the implications of our findings for the sustainability of health systems, for patient care, and for the well-being of HCWs, and suggest directions for ethical clinical and policy practice.

Ethico-racial positioning in campaigns for COVID-19 research and vaccination featuring public figures

This article analyses a set of videos which featured public figures encouraging racially minoritised people in the UK to take the COVID-19 vaccine or get involved in related research. As racially targeted health communication has both potentially beneficial and problematic consequences, it is important to examine this uniquely high-profile case. Using a purposive sample of 10 videos, our thematic content analysis aimed to reveal how racially minoritised people were represented and the types of concerns about the vaccine that were expressed. We found representations of racialised difference that centred on 'community' and invoked shared social experiences. The expressed concerns centred on whether ethnic difference was accounted for in the vaccine's design and development, plus the overarching issue of trust. Our analysis adopts and develops the concept of 'racialisation'; we explore how 'mutuality' underpinned normative calls to action ('ethico-racial imperatives') and how the videos 'responsibilised' racially minoritised people. We discuss two points of tension in this case: the limitations for addressing the causes of mistrust and the risks of reductivism that accompanied the ambiguous notion of community. Our analysis develops scholarship on racialisation in health contexts and provides public health practitioners with insights into the socio-political considerations of racially targeted communications.

Marginalisation and distrust in the context of the COVID-19 vaccination programme: experiences of communities in a northern UK city region

BACKGROUND

There are clear inequalities in COVID - 19 vaccination rates amongst marginalised groups, with lower rates for some minoritised ethnic and religious groups, younger people, those living in more deprived areas, and with lower socio-economic status. Existing research focuses on psychological and socio-economic factors that influence vaccine uptake and does not explore broader social and historical contexts. Understanding inequalities in COVID-19 vaccine uptake requires a critical examination of the drivers of, and barriers to, vaccination.

METHODS

We present findings from a co-designed qualitative research study undertaken during the COVID-19 pandemic. Focus groups and interviews were used to examine the context underpinning responses to the COVID-19 vaccination in Greater Manchester, particularly focussing on experiences of marginalisation. Thematic framework analysis was used to analyse the data.

RESULTS

We found that the public's responses to the COVID-19 vaccination programme are intertwined with a longstanding history of institutional distrust and disenfranchisement, resulting from experiences of marginalisation and social inequalities. This was exacerbated further by the disproportionate impacts of the COVID-19 pandemic on minoritised ethnic groups, younger people, and those with existing health conditions.

CONCLUSIONS

Histories of structural inequalities experienced by minoritised groups invoked feelings of suspicion and scepticism at the motivations of the agencies behind the vaccination rollout. This highlights the need for a contextualised analysis of attitudes to vaccines, considering pre-existing inequalities, which may be especially relevant for conceptualising public responses to the vaccination programme. Finally, our study shows the important ways in which public (dis)trust can impact public health policies. We recommend this should be incorporated into responses to future public health crises.

Marital conflict of a nurse family following COVID-19 vaccinations: A case studying

Vaccination is one of the best strategies to control a pandemic. Although there is much research evidence of its effectiveness, a small percentage of people would not incubate the vaccine. After starting vaccination of healthcare workers as the first group in Iran, there were many debates and concerns regarding the effectiveness of the COVID-19 vaccine and its long-term side effects among them. In this investigation, the impact of these disagreements on the relationship of a nurse couple has been presented. The wife believed that people should incubate the COVID-19 vaccine as soon as possible and the man was anti-vaxxer and he believed that COVID-19 vaccines are not safe and it should be refused. After that, the wife got the COVID-19 vaccine, and their difference in views led to marital conflicts and disturbance in the function of the family. This case study was approved by the Research Council and Ethics Committee of Semnan University of Medical Science. Vaccine refusing could have complicated effects on a community and family. There should be a plan to assess families' function and apply it in the case of disturbance in families' function. Moreover, several strategies should be implemented to persuade anti-vaxxers.

Intern nursing students' experiences in the COVID-19 vaccination unit and views on the COVID-19 vaccine: A phenomenological qualitative study

BACKGROUND

Improving acceptance of the COVID-19 vaccine among nursing students is an important strategy for both preventing infection and building public confidence in the vaccine.

OBJECTIVE

The aim of this study was to describe the views of intern nursing students on the COVID-19 vaccine and to evaluate their experiences in the COVID-19 vaccination unit.

METHODS

This was a phenomenological qualitative study with a descriptive design. The 46 intern nursing students included in this study were all trained in the COVID-19 vaccination unit. The data was collected at focus group interviews conducted during June 2021 and October 2021.

RESULTS

The mean age of intern nursing students was 22.78±0.91. From the focus group interviews, two themes were identified regarding the views of intern nursing students on the COVID-19 vaccine and their experiences in the COVID-19 vaccination unit: Theme 1. Positive views; Theme 2. Negative views. Intern nursing students described that they trust the COVID-19 vaccine and believe in its protection. Intern nursing students who performed their clinical practices in COVID-19 vaccination unit stated that they realized their responsibilities toward patients and the community.

CONCLUSIONS

From the INSs' point of view, confidence in the vaccine, responsibility towards patients, their families and the community, and VU practice experience, the health risk associated with COVID-19 positively affected their decision to be vaccinated against COVID-19. The participation of intern nursing students in clinical practice during the pandemic influenced both intern nursing students and population in terms of the uptake of COVID-19 vaccines.

An online RCT on behavioural expectations effects of COVID-19 certification policies in England

Objective

The aim of this study was to compare the effects of different types of COVID-19 certification policy on subsequent behavioural expectations.

Design

4 × 2 between-subjects pre-registered randomised controlled trial.

Method

In August 2022, participants (n = 2726) in England were presented with a scenario describing a rise in COVID-19 infections and the introduction of new protective measures. The protective measures described varied with regards to the setting (healthcare vs. recreational) and the type of policy (no certification vs. vaccination vs. vaccination or free Lateral Flow test vs. vaccination or Lateral Flow test at personal cost). Participants then answered questions on their expectations to receive another dose of the COVID-19 vaccine, to receive the seasonal influenza vaccine and to adhere to other protective behaviours following the announcement, as well as questions based on Self-Determination Theory, COVID-19 vaccine hesitancy and broader vaccine hesitancy.

Results

We found no main effects of setting or type of certification on expectation to receive the next dose of the COVID-19 vaccine, to receive the seasonal influenza vaccine, or to adhere to other protective measures, when controlling for baseline expectations.

Conclusions

These findings suggest that it is unlikely that the concept of certification, however it is framed, alters inclinations in the English population towards COVID-19 and seasonal flu vaccination or inclinations towards adhering to other protective behaviours within settings to which certification would apply. These findings are based on a hypothetical scenario and should be interpreted with caution.

Calculation, knowledge, and identity: Dimensions of trust when making COVID-19 vaccination choices in China

Vaccine hesitancy threatens the response to the COVID-19 pandemic and to other infectious disease outbreaks globally. Fostering trust has been highlighted as a critical factor in addressing vaccine hesitancy and expanding vaccine coverage, but qualitative exploration of trust in the context of vaccination remains limited. We contribute to filling this gap by providing a comprehensive qualitative analysis of trust in the context of COVID-19 vaccination in China. We conducted 40 in-depth interviews with Chinese adults in December 2020. During data collection, trust emerged as a highly salient topic. Interviews were audio-recorded, transcribed verbatim, translated into English, and analyzed with a combination of inductive and deductive coding. Following established trust literature, we differentiate between three types of trust - calculation-based trust, knowledge-based trust, and identity-based trust - which we grouped across components of the health system, as informed by the WHO's building blocks. Our results highlight how participants attributed their level of trust in COVID-19 vaccines to their trust in the medical technology itself (based on assessing risks and benefits or previous vaccination experiences), the service delivery and health workforce (informed by past experiences with health providers and their role throughout the pandemic), and leadership and governance (drawing on notions of government performance and patriotism). Reducing negative impact from past vaccine controversies, increasing the credibility of pharmaceutical companies, and fostering clear communication are identified as important channels for facilitating trust. Our findings emphasize a strong need for comprehensive information on COVID-19 vaccines and increased promotion of vaccination by credible figures.

Beyond Information Provision: Analysis of the Roles of Structure and Agency in COVID-19 Vaccine Confidence in Ethnic Minority Communities

People from Black and Asian backgrounds are more likely to die from COVID-19 but less likely to be vaccinated, threatening to exacerbate health inequalities already experienced by ethnic minority groups. The literature suggests that mistrust rooted in structural inequality (including socioeconomic position and experience of racism) may be a key barrier to COVID-19 vaccine uptake. Understanding and addressing structural inequality is likely to lead to longer-term impacts than information alone. The aim of this study is to draw on health and sociological theories of structure and agency to inform our understanding of how structural factors influence vaccine confidence. We conducted qualitative interviews and focus groups with 22 people from London and the surrounding areas from December 2021 to March 2022. Fourteen participants were members of the public from ethnic minority backgrounds, and seven were professionals working with the public to address concerns and encourage vaccine uptake. Our findings suggest that people from ethnic minority backgrounds make decisions regarding COVID-19 vaccination based on a combination of how they experience external social structures (including lack of credibility and clarity from political authority, neglect by health services, and structural racism) and internal processes (weighing up COVID-19 vaccine harms and benefits and concerns about vaccine development and deployment). We may be able to support knowledge accumulation through the provision of reliable and accessible information, particularly through primary and community care, but we recommend a number of changes to research, policy and practice that address structural inequalities. These include working with communities to improve ethnicity data collection, increasing funding allocation to health conditions where ethnic minority communities experience poorer outcomes, greater transparency and public engagement in the vaccine development process, and culturally adapted research recruitment processes.

Physical Activity Message Framing and Ethnicity Before and During COVID-19

People of Black ethnicities are well known to be disproportionately burdened by coronavirus and have poorer health outcomes. Public health messages encouraged physical activity during the pandemic as it is evidenced to positively affect the immune system, however people of Black ethnicities are often reported as failing to achieve the recommended daily amount. Health message framing during COVID-19 specifically in relation to ethnicity and physical activity motivation has yet to be investigated. Two studies examined message frame effect on physical activity motivation prior to and at the onset of the pandemic and how this differed by ethnicity. Gain framed messages were found to positively affect physical activity motivation pre-COVID-19 and during the pandemic fear framed messages were found to positively affect physical activity motivation. Neither of these effects differed by ethnicity. Implications for future physical activity health message framing are discussed.

Migrant healthcare workers during COVID-19: bringing an intersectional health system-related approach into pandemic protection. A German case study

Introduction

Migrant healthcare workers played an important role during the COVID-19 pandemic, but data are lacking especially for high-resourced European healthcare systems. This study aims to research migrant healthcare workers through an intersectional health system-related approach, using Germany as a case study.

Methods

An intersectional research framework was created and a rapid scoping study performed. Secondary analysis of selected items taken from two COVID-19 surveys was undertaken to compare perceptions of national and foreign-born healthcare workers, using descriptive statistics.

Results

Available research is focused on worst-case pandemic scenarios of Brazil and the United Kingdom, highlighting racialised discrimination and higher risks of migrant healthcare workers. The German data did not reveal significant differences between national-born and foreign-born healthcare workers for items related to health status including SARS-CoV-2 infection and vaccination, and perception of infection risk, protective workplace measures, and government measures, but items related to social participation and work conditions with higher infection risk indicate a higher burden of migrant healthcare workers.

Conclusions

COVID-19 pandemic policy must include migrant healthcare workers, but simply adding the migration status is not enough. We introduce an intersectional health systems-related approach to understand how pandemic policies create social inequalities and how the protection of migrant healthcare workers may be improved.

COVID-19 vaccine perceptions among South Asian communities in the UK: An application of the theory of planned behavior

Based on the Theory of Planned Behavior, this paper explores the perceptions of the COVID-19 vaccine among South Asian communities residing in the UK. Thirty-eight semi-structured interviews were conducted using a qualitative approach and analyzed using thematic analysis. Participants represented Indian, Pakistani, Bangladeshi, Sri Lankan, Afghani, and Nepali backgrounds. The participants revealed that family and community influence their perceptions of the COVID-19 vaccine. The results suggest that normalizing vaccine acceptance, addressing unknown side effects, and popularizing vaccine efficacy data will increase vaccine uptake within the South Asian community in the UK.

Reasons for COVID-19 vaccine hesitancy in ethnic minority groups: A systematic review and thematic synthesis of initial attitudes in qualitative research

Despite being disproportionately affected by the COVID-19 pandemic, ethnic and racial minority groups show widespread vaccine hesitancy. Adherence to ongoing booster vaccine campaigns is required to contain future spread of the virus and protect health systems. This review aims to appraise and synthesise qualitative studies published from December 2021 to February 2022 addressing the issue for an in-depth exploration of initial COVID-19 vaccine hesitancy in minorities, including refugee, asylum seeker and migrant populations. A systematic literature search of five databases identified 15 eligible studies. Thematic synthesis identified three main themes of "institutional mistrust", "lack of confidence in vaccine and vaccine development process", and "lack of reliable information or messengers". Two minor themes included "complacency/perceived lack of need" and "structural barriers to vaccine access". "Institutional mistrust" permeated several other themes, demonstrating the need for culturally sensitive approaches. Applying our findings to the World Health Organisation's Three C Model of vaccine hesitancy, the "confidence" dimension appears to represent a disproportionately large barrier to vaccine uptake in ethnic minority groups. Indeed, nuanced adaptations of the model may be necessary to explain vaccine hesitancy in those groups. Further research is required to explore factors facilitating vaccine uptake to monitor changes in hesitancy over time.

Qualitative evaluation of reasons for healthcare professionals being unvaccinated against COVID-19

Background and Aim

The importance of immunization has increased even more during the pandemic. This study aimed to evaluate the reasons for healthcare professionals not being vaccinated against COVID-19 and to develop solutions for the causes.

Subject and Methods

This qualitative study was carried out with in-depth interviews between July 2021 and October 2021, with 32 healthcare professionals and five key people who had never been vaccinated against COVID-19.

Results

The most common reasons that healthcare professionals were not vaccinated against COVID-19 were concerns about vaccine side effects, believing that the vaccine is not effective, distrust of the vaccine content and COVID-19 treatment methods, the rapid production of the vaccine, the fact that the vaccine is produced with a new technology, thinking that the vaccine is not the definitive solution, seeing themselves as healthy and young, and the belief that they would have a mild case of the disease and recover. The main themes were COVID-19 vaccine-related reasons, individual reasons/group effects, contextual reasons, and vaccination-related general issues. The main sub-themes were vaccine production, distrust, risk perception, policies and infodemic.

Conclusion

It has been seen that the uncertainty, infodemic, and insecurity that emerged especially during the pandemic period are related to each other. As knowledge and awareness about the disease increase, there is an increase in risk perception. For this reason, social information studies should be increased and physicians should be enabled to use media tools more effectively.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01822-7.

Black People Narrate Inequalities in Healthcare Systems that Hinder COVID-19 Vaccination: Evidence from the USA and the UK

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented global health emergency. As a novel condition, there is no known definitive treatment for the condition, except for the use of vaccines as a control measure. In the literature, the issue of inequalities in healthcare systems has been documented as a hindrance to COVID-19 vaccination; however, the specific inequalities in healthcare systems that hinder COVID-19 vaccination are poorly understood. Guided by the fundamental cause theory (FCT), this study aims to address this gap among Black people, a minority group vulnerable to inequalities in healthcare systems. Thirty-five Black people (age range = 21-58 years) residing in either the United States of America (USA) or the United Kingdom (UK) participated in this study. Qualitative data were collected and analyzed using thematic analysis. Most USA participants and a few UK participants narrated that no inequalities in healthcare systems hinder them from receiving COVID-19 vaccines. Contrarily, most UK participants and a few USA participants narrated inequalities in healthcare systems that hinder them from receiving COVID-19 vaccines. These are mistrust of the healthcare system, health policies regarding COVID-19 vaccination, historical factors (such as historical abuse of Black bodies by health professionals), residential location, and dissatisfaction with health services. In terms of what governments must do to correct these inequalities, participants recommended the need for acknowledgment and community engagement. This is the first international collaboration to examine this problem. Important implications for theory, healthcare systems, and COVID-19 vaccination program planning are highlighted. Finally, there are members of other minority groups and vulnerable communities who are not Black people. Such groups could face unique inequalities that hinder COVID-19 vaccination. Therefore, future studies should include such groups.

Motivators and barriers to COVID-19 vaccination of healthcare workers in Latvia

This study aims to identify motivators and barriers regarding Coronavirus disease 2019 (COVID-19) vaccination among Latvian healthcare workers (HCWs). Data were collected from March to May 2021 using an online survey. Overall, 1,444 participants took part in the study. From this pool of respondents, 528 indicated motivating factors in favor of the COVID-19 vaccination (86.5% were women; aged between 20 and 75 years), while 198 mentioned barriers against the COVID-19 vaccination (92.9% were women; aged between 19 and 68 years). The thematic analysis was conducted on two open-ended questions. The main motivators reported for COVID-19 vaccination were belief in the effectiveness of the vaccine, benefits of easing COVID-19 restrictions, responsibility, and restriction or pressure in case of non-vaccination. The main barriers reported regarding the COVID-19 vaccination were concerns about the effectiveness and safety of vaccines, perceived health risks of vaccination, risk perception toward COVID-19, misinformation about COVID-19 vaccines, belief that vaccination is being imposed, and belief in the conspiracy theories surrounding COVID-19. The results of this study help identify the existing motivating and hindering factors for COVID-19 vaccination among HCWs in Latvia. These results can be used to promote vaccination in HCW, develop information campaigns, and alleviate concerns of HCW.

Attitudes towards coronavirus (COVID-19) vaccine and sources of information across diverse ethnic groups in the UK: a qualitative study from June to October 2020

OBJECTIVES

Across diverse ethnic groups in the UK, explore attitudes and intentions towards COVID-19 vaccination and sources of COVID-19 information.

DESIGN

Remote qualitative interviews and focus groups (FGs) conducted June-October 2020 before UK COVID-19 vaccine approval. Data were transcribed and analysed through inductive thematic analysis and mapped to the Theoretical Domains Framework.

SETTING

England and Wales.

PARTICIPANTS

100 participants from 19 self-identified ethnic groups.

RESULTS

Mistrust and doubt were reported across ethnic groups. Many participants shared concerns about perceived lack of information about COVID-19 vaccine safety and efficacy. There were differences within each ethnic group, with factors such as occupation and perceived health status influencing intention to accept a vaccine once made available. Across ethnic groups, participants believed that public contact occupations, older adults and vulnerable groups should be prioritised for vaccination. Perceived risk, social influences, occupation, age, comorbidities and engagement with healthcare influenced participants' intentions to accept vaccination once available. All Jewish FG participants intended to accept, while all Traveller FG participants indicated they probably would not.Facilitators to COVID-19 vaccine uptake across ethnic groups included: desire to return to normality and protect health and well-being; perceived higher risk of infection; evidence of vaccine safety and efficacy; vaccine availability and accessibility.COVID-19 information sources were influenced by social factors and included: friends and family; media and news outlets; research literature; and culture and religion. Participants across most different ethnic groups were concerned about misinformation or had negative attitudes towards the media.

CONCLUSIONS

During vaccination rollout, including boosters, commissioners and providers should provide accurate information, authentic community outreach and use appropriate channels to disseminate information and counter misinformation. Adopting a context-specific approach to vaccine resources, interventions and policies and empowering communities has potential to increase trust in the programme.

Perceptions and Motivating Factors Regarding COVID-19 Vaccination in Latinx Older Adults in Chicago: A Local, Qualitative Perspective

Purpose

Historically marginalized communities disproportionately impacted by the pandemic are demonstrating lower uptake of COVID-19 vaccines. To facilitate the development of culturally tailored, language concordant educational materials promoting COVID-19 vaccination, we first explored older Latinx adults' awareness, attitudes, and beliefs about COVID-19 vaccines and factors involved in vaccination decisions within their communities.

Patients and Methods

Individual, semi-structured interviews were conducted with 15 participants who self-identified as Latinx/Hispanic, aged 50 and older, and living in Chicago. Eight interviews were conducted in English and seven in Spanish. Thematic analysis was used to analyze participants' responses.

Results

Participants revealed four key factors influencing vaccination decisions: 1. protecting oneself and loved ones (against COVID-19 (n=14), or from perceived dangers of the vaccine (n=9)); 2. trust in authorities (trusting information (n=9), or worrying the vaccine is being manipulated (n=5)); 3. access and availability (gratitude to live in a country where vaccines are available (n=5), or fear of going to vaccination sites due to immigration and insurance status (n=4)); and 4. Employment and semblance of normalcy (vaccination to create opportunities (n=6), or concern about missing out due to side effects (n=9)).

Conclusion

Our findings illuminate key factors influencing decisions for COVID-19 vaccination among Latinx older adults in Chicago. Vaccination information aiming to increase vaccination rates among this important population may benefit from leveraging collective pronouns and spirituality, language concordance, low-tech options, building trust, and addressing insurance and immigration doubts. Next steps include developing educational materials based on these themes, followed by dissemination and evaluation. Lessons learned may be of interest to public health experts responding to the ongoing pandemic and other public health crises experienced by historically marginalized communities.

UK ethnic minority healthcare workers' perspectives on COVID-19 vaccine hesitancy in the UK ethnic minority community: A qualitative study

Background

The experiences of UK ethnic minority (UKEM) healthcare workers are crucial to ameliorating the disproportionate COVID-19 infection rate and outcomes in the UKEM community. We conducted a qualitative study on UKEM healthcare workers' perspectives on COVID-19 vaccine hesitancy (CVH) in the UKEM community.

Methods

Participants were 15 UKEM healthcare workers (11 females; age range: 26-58 [43.3 ± 9.4] years). Data were collected using individual and joint interviews, and a focus group, and analyzed using thematic analysis.

Results

We generated three themes: heterogeneity (two subthemes), mistrust (six subthemes), and mitigating (six subthemes). Therein, participants distinguished CVH in the UKEM community in educational attainment and ethnicity. They pointed to the role of mistrust in CVH in the UKEM community. They opined that the mistrust underlying CVH in the UKEM community is rooted in history and religion, conspiracy theories, the speedy development and novelty of the vaccines, post-vaccination complications/side effects, false positive test results, and social media and social support/influence. Participants recommended that interventions targeted at mitigating CVH in the UKEM community need to, in a non-judgmental way, tackle dis/misinformation and provide education, and incorporate UKEM healthcare worker endorsement. They also suggested such interventions be community-oriented, enhance the convenience of vaccination centers and the possibility of vaccine choice, and appreciate that overcoming CVH and accepting vaccination is a gradual process involving personal assessment of risks and benefits.

Conclusion

CVH in the UKEM community is a multifaceted phenomenon requiring multicomponent interventions.

Exploring COVID-19 Vaccine Confidence with People from Black and Asian Backgrounds in England

Aims

Little research has examined factors underlying COVID-19 vaccine hesitancy or refusal in Black and Asian individuals in England, among whom hesitancy tends to be higher than in the general population. This qualitative study aimed to gain an understanding of factors affecting hesitancy in Black and Asian individuals in England, to help address concerns about having the vaccine.

Method

Ninety-five participants (51 women, 42 men, 2 other; 58% were aged between 30 and 49) recruited via a market recruitment agency, local Healthwatch networks, and using a snowballing method, participated in four activities on an online engagement platform, sharing their attitudes towards the COVID-19 vaccine roll-out, and factors shaping their beliefs and concerns, over 5 weeks from April to March 2021.

Results

Inductive thematic analysis revealed five themes: (1) a variety of views on the COVID-19 vaccine, (2) targeted messaging for Black and Asian people as counterproductive, (3) confusion over the purpose of the vaccine roll-out, (4) hesitancy to take the vaccine, and (5) local networks as a trusted source of information.

Conclusions

Our findings suggest that respecting individuals’ agency, transparency of information provided, and the independence of the bodies providing this information are important. Instead of targeted messaging, local networks should be used in campaigns to increase COVID-19 vaccine uptake among Black and Asian individuals.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40615-022-01372-w.

Facilitators and barriers to COVID-19 vaccination uptake among ethnic minorities: A qualitative study in primary care

Introduction

COVID-19 vaccination effectively reduces severe disease and death from COVID-19. However, both vaccine uptake and intention to vaccinate differ amongst population groups. Vaccine hesitancy is highest amongst specific ethnic minority groups. There is very limited understanding of the barriers and facilitators to COVID-19 vaccine uptake in Black and South Asian ethnicities. Therefore, we aimed to explore COVID-19 vaccination hesitancy in primary care patients from South Asian (Bangladeshi/Pakistani) and Black or Black British/African/Caribbean/Mixed ethnicities.

Methods

Patients from the above ethnicities were recruited using convenience sampling in four London general practices. Telephone interviews were conducted, using an interpreter if necessary, covering questions on the degree of vaccine hesitancy, barriers and potential facilitators, and decision-making. Interviews were transcribed verbatim and thematically analysed. Data collection and analysis occurred concurrently with the iterative development of the topic guide and coding framework. Key themes were conceptualised through discussion with the wider team.

Results

Of thirty-eight interviews, 55% (21) of these were in Black or Black British/African/Caribbean/Mixed ethnicities, 32% (12) in Asian / British Asian and 13% (5) in mixed Black and White ethnicities. Key themes included concerns about the speed of vaccine roll-out and potential impacts on health, mistrust of official information, and exposure to misinformation. In addition, exposure to negative messages linked to vaccination appears to outweigh positive messages received. Facilitators included the opportunity to discuss concerns with a healthcare professional, utilising social influences via communities and highlighting incentives.

Conclusion

COVID-19 has disproportionately impacted ethnic minority groups. Vaccination is an effective strategy for mitigating risk. We have demonstrated factors contributing to vaccine reluctance, hesitancy and refusal and highlighted levers for change.

Disparities in the offer of COVID-19 vaccination to migrants and non-migrants in Norway: a cross sectional survey study

Background

Vaccination is key to reducing the spread and impacts of COVID-19 and other infectious diseases. Migrants, compared to majority populations, tend to have lower vaccination rates, as well as higher infection disease burdens. Previous studies have tried to understand these disparities based on factors such as misinformation, vaccine hesitancy or medical mistrust. However, the necessary precondition of receiving, or recognizing receipt, of an offer to get a vaccine must also be considered.

Methods

We conducted a web-based survey in six parishes in Oslo that have a high proportion of migrant residents and were hard-hit during the COVID-19 pandemic. Logistic regression analyses were conducted to investigate differences in reporting being offered the COVID-19 vaccine based on migrant status. Different models controlling for vaccination prioritization variables (age, underlying health conditions, and health-related jobs), socioeconomic and demographic variables, and variables specific to migrant status (language spoken at home and years lived in Norway) were conducted.

Results

Responses from 5,442 participants (response rate of 9.1%) were included in analyses. The sample included 1,284 (23.6%) migrants. Fewer migrants than non-migrants reported receiving a vaccine offer (68.1% vs. 81.1%), and this difference was significant after controlling for prioritization variables (OR 0.65, 95% CI: 0.52–0.82). Subsequent models showed higher odds ratios for reporting having been offered the vaccine for females, and lower odds ratios for those with university education. There were few to no significant differences based on language spoken at home, or among birth countries compared to each other. Duration of residence emerged as an important explanatory variable, as migrants who had lived in Norway for fewer than 15 years were less likely to report offer of a vaccine.

Conclusion

Results were consistent with studies that show disparities between non-migrants and migrants in actual vaccine uptake. While differences in receiving an offer cannot fully explain disparities in vaccination rates, our analyses suggest that receiving, or recognizing and understanding, an offer does play a role. Issues related to duration of residence, such as inclusion in population and health registries and health and digital literacy, should be addressed by policymakers and health services organizers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13687-8.

COVID-19 health information needs of older adults from ethnic minority groups in the UK: a qualitative study

OBJECTIVE

This study aimed to identify the COVID-19 health information needs of older adults from ethnic minority groups in the UK.

STUDY DESIGN

A qualitative study using semistructured interviews.

SETTING AND PARTICIPANTS

Indian and Nepalese older adults (≥65 years), their families (≥18 years) and healthcare professionals (HCPs) (≥18 years) engaging with these communities. Participants were recruited between July and December 2020 from Kent, Surrey and Sussex through community organisations.

RESULTS

24 participants took part in the study; 13 older adults, 7 family members and 4 HCPs. Thirteen participants were female, and the majority (n=17) spoke a language other than English at home. Older participants mostly lived in multigenerational households, and family and community were key for providing support and communicating about healthcare needs. Participants' knowledge of COVID-19 varied widely; some spoke confidently about the subject, while others had limited information. Language and illiteracy were key barriers to accessing health information. Participants highlighted the need for information in multiple formats and languages, and discussed the importance of culturally appropriate avenues, such as community centres and religious sites, for information dissemination.

CONCLUSION

This study, undertaken during the COVID-19 pandemic, provides insight into how health information can be optimised for ethnic minority older adults in terms of content, format and cultural relevance. The study highlights that health information interventions should recognise the intersection between multigenerational living, family structure, and the health and well-being of older adults, and should promote intergenerational discussion.

Leaving No One Behind: Interventions and Outcomes of the COVID-19 Vaccine Maximising Uptake Programme

The devastating impact of COVID-19 on individuals and communities has accelerated the development of vaccines and the deployment of ambitious vaccination programmes to reduce the risks of infection, infection transmission and symptom severity. However, many people delay or refuse to get vaccinated against COVID-19, for many complex reasons. Vaccination programmes that are tailored to address individual and communities' COVID-19 concerns can improve vaccine uptake rates and help achieve the required herd-immunity threshold. The Maximising Uptake Programme has led to the vaccination of 7979 people from February-August 2021 in the South West of England, UK, who are at high risk of severe illness from COVID-19 and/or may not access the COVID-19 vaccines through mass vaccination centres and general practices. These include: people experiencing homelessness; non-English-speaking people; people from minority ethnic groups; refugees and asylum seekers; Gypsy, Roma, Travelers and boat people; and those who are less able to access vaccination centres, such as people with learning difficulties, serious mental illness, drug and alcohol dependence, people with physical and sensory impairment, and people with dementia. Outreach work coupled with a targeted communication and engagement campaign, co-designed with community leaders and influencers, have led to significant engagement and COVID-19 vaccine uptake among the target populations.

COVID-19 vaccination readiness among multiple racial and ethnic groups in the San Francisco Bay Area: A qualitative analysis

BACKGROUND

COVID-19 vaccination rates are lower among historically marginalized populations, including Black/African American and Latinx populations, threatening to contribute to already high COVID-19 morbidity and mortality disparities for these groups. We conducted a community-based participatory research study using qualitative methods to explore knowledge and beliefs about COVID-19 vaccination among Black/African American, Latinx, and Chinese American residents of the San Francisco Bay Area and assess their views on vaccination outreach and delivery strategies.

METHODS AND FINDINGS

Data were collected from January 14, 2021, to February 24, 2021, with adult residents (N = 109 [Female: N = 76; 70%]) in San Francisco. Focus groups (N = 10) and in-depth interviews (N = 25) were conducted among Black/African Americans (N = 35), Latinx (N = 40), and Chinese Americans (n = 34) in English, Spanish, Cantonese, or Mandarin. Themes were identified using grounded field theory, and included misinformation, mistrust of government and health institutions, and linguistic and other barriers to vaccine access. All three racial/ethnic groups had experiences with vaccine misinformation and information overload. Many African American and Latinx participants cited structural and interpersonal racism, and anti-immigrant discrimination, as factors reducing their trust in government and public health disseminated information and their willingness to be vaccinated. Participants expressed trust in community-based organizations, including faith-based organizations and community-run clinics. Participants often experienced barriers to vaccine access, such as transportation to drive-in sites, with Latinx and Chinese American groups also frequently citing language barriers.

CONCLUSIONS

Vaccine outreach strategies must acknowledge how longstanding systemic, institutional, and structural racism contributes to mistrust in government and health institutions and engage with and support trusted messengers from the community to eliminate cultural, linguistic, and other barriers to vaccine access.

'A disease like any other' traditional, complementary and alternative medicine use and perspectives in the context of COVID-19 among the Congolese community in Belgium

BACKGROUND

As a hard-hit area during the COVID-19 pandemic, Belgium knew the highest mortality among people from sub-Saharan African descent, compared to any other group living in the country. After migration, people often maintain traditional perceptions and habits regarding health and healthcare, resulting in a high prevalence of traditional, complementary and alternative medicine use among different migrant communities in northern urban settings. Despite being the largest community of sub-Saharan African descent in Belgium, little is known on ethnobotanical practices of the Belgian Congolese community. We therefore conducted an exploratory study on the use of medicinal plants in the context of COVID-19 and perceptions on this new disease among members of the Congolese community in Belgium.

METHODS

We conducted 16 in-depth semi-structured interviews with people of Congolese descent currently living in Belgium. Participants were selected using purposive sampling. Medicinal plant use in the context of COVID-19 was recorded through free-listing. Data on narratives, ideas and perceptions on the origin, cause/aetiology and overall measures against COVID-19 (including vaccination) were collected. Interview transcripts were analysed using thematic analysis.

RESULTS

Four overarching themes emerged from our data. Firstly, participants perceived the representation of the severity of COVID-19 by the Belgian media and government-and by extend by all governmental agencies in the global north-as exaggerated. As a result, traditional and complementary treatments were seen as feasible options to treat symptoms of the disease. Fifteen forms of traditional, complementary and alternative medicine were documented, of which thirteen were plants. Participants seem to fold back on their Congolese identity and traditional knowledge in seeking coping strategies to deal with the COVID-19 pandemic. Finally, institutional postcolonial distrust did not only seem to lead to distrust in official messages on the COVID-19 pandemic but also to feelings of vaccination hesitancy.

CONCLUSION

In the context of the COVID-19 pandemic, participants in our study retreated to, reshaped and adapted traditional and culture-bound knowledge. This study suggests that the fragile and sensitive relationship between sub-Saharan African migrant groups and other social/ethnic groups in Belgium might play a role in their sensitivity to health-threatening situations, such as the COVID-19 pandemic.

Overcoming COVID-19 vaccine hesitancy among ethnic minorities: A systematic review of UK studies

Ethnic minority communities in the UK have been disproportionately affected by the pandemic, with increased risks of infection, severe disease, and death. Hesitancy around the COVID-19 vaccine may be contributing to disparities in vaccine delivery to ethnic minority communities. This systematic review aims to strengthen understanding of COVID-19 vaccine concerns among ethnic minorities in the UK. Five databases were searched in February 2022, yielding 24 peer-reviewed studies reporting on vaccine hesitancy or acceptance in ethnic minority groups. Data were extracted using a standardised form, and quality assessment was carried out using the Standard Quality Criteria. There were three key themes: (1). Prevalence of vaccine hesitancy; (2). Reasons for vaccine hesitancy and acceptance; and (3). Recommendations to address vaccine concerns. Vaccine hesitancy, which was more common among some ethnic minority groups, is a complex phenomenon, driven by misinformation, mistrust, concerns about safety and efficacy, and structural and systemic inequities. Community engagement and tailored communication may help to address vaccine concerns. Robust data disaggregated by ethnicities are needed to better understand barriers and facilitators for COVID-19 vaccine delivery in ethnic minority communities. Strategies to address structural disadvantage need to be inclusive, comprehensive, and behaviorally informed and foster confidence in healthcare systems and governments. Community leaders and health care practitioners may prove to be the most important agents in creating an environment of trust within ethnic minority groups.

Interventions to Mitigate Vaping Misinformation: A Meta-Analysis

The impact of misinformation about vapes' relative harms compared with smoking may lead to increased tobacco-related burden of disease and youth vaping. Unfortunately, vaping misinformation has proliferated. Despite growing attempts to mitigate vaping misinformation, there is still considerable ambiguity regarding the ability to effectively curb the negative impact of misinformation. To address this gap, we use a meta-analysis to evaluate the relative impact of interventions designed to mitigate vaping-related misinformation. We searched (from January 2020 till August 2021) various databases and gray literature. Only English language, original studies that employed experimental designs where participants were randomly assigned either to receive mitigating information or to a no-mitigation condition (either misinformation-only or neutral control) were included. Meta-analysis was conducted for the four eligible studies. The mean effect size of attempts to mitigate vaping misinformation was positive but not statistically significant (d = 0.383, 95% CI [-0.029, 0.796], p = .061, k = 5) with lack of evidence for publication bias. Given limited studies included, we were unable to determine factors affecting the efficacy of interventions. The limited focus on non-US studies and youth populations is concerning given the popularity of vaping in low- to middle-income countries (LMICs) and among youth. The findings of this meta-analysis describe the current state of the literature and prescribe specific recommendations to better address the proliferation of vaping misinformation, providing insights helpful in limiting the tobacco mortality burden and curtailing youth vaping.

Staying "One Step Ahead of a Racist": Expanding Understandings of the Experiences of the Covid-19 Pandemic Among People From Minoritized Ethnic Groups Living in Britain

Covid-19 has had a disproportionate impact on those in minoritized ethnic groups. Considerable attention has been given to evidence of ethnic inequalities in rates of infection, hospitalisation, and death. But other ways in which the pandemic experience has been affected by ethnicity have received less consideration. This paper explores the lived experiences of people in different minoritized ethnic groups living in South West England, during the United Kingdom's first pandemic lockdown, using qualitative data collected from interviews and comments provided on a survey. Perceived positive opportunities for growth were offset by anxiety and stress, which were themselves compounded by an awareness of the additional risks they experienced as members of racialised groups, and a sense that this was being ignored-or intentionally exacerbated-by the British authorities. Frustration with an incompetent and corrupt national Government was intensified by concerns regarding their racist motives. Racism in wider society undermined confidence in key public institutions, such as the NHS and the police, while also producing barriers to informal local-community pandemic responses. Only through recognition of the particular ways in which the pandemic affected those in minoritized ethnic groups, including the multiple and compounding effects of current and historical racism, will it be possible to identify avenues for transformative systemic policy change and opportunities to rebuild trust and a better post-pandemic society for all.

Levers and Barriers to Vaccinate against COVID-19 in the Multicultural Context of French Guiana: A Qualitative Cross-Sectional Survey among Health Care Workers

In French Guiana, a French overseas territory in South America facing a fourth wave of COVID-19, vaccination coverage is very low, both in the population and among health care workers (HCWs). Vaccine hesitancy concerned 35.7% of the latter in early 2021. The objective of this complementary study is to understand barriers and levers and to adapt messages to increase vaccination coverage among HCWs. We conducted a regional cross-sectional survey of HCWs with a questionnaire containing open-ended questions exploring factors associated with vaccine hesitancy and the needs to adapt the vaccination campaign in French Guiana. The discourses were analyzed using a qualitative approach based on grounded theory, with open coding of data by themes and construction of abstract categories. The analysis of the 357 responses collected from January to March 2021 reveals several trends. The ethical aspect of the HCWs' role emphasizes the importance of getting vaccinated themselves (to protect patients, to set an example...) and of vaccinating as many people as possible, including the most geographically or socially distant, such as undocumented migrants. However, some HCWs remain suspicious of the vaccine with concerns over the efficacy and side effects, of health institutions, and of the pharmaceutical industry. The role of fake news circulating on social networks has been widely discussed. Efforts to explain and convince HCWs must be continued in French Guiana using the identified levers to improve the acceptability of vaccination.

Attitudes towards the COVID-19 Vaccine and Willingness to Get Vaccinated among Healthcare Workers in French Guiana: The Influence of Geographical Origin

Background: In the context of the global COVID-19 pandemic and the expansion of the more transmissible 20J/501Y.V3 (Gamma) variant of concern (VOC), mRNA vaccines have been made available in French Guiana, an overseas French territory in South America, from mid-January 2021. This study aimed to estimate the willingness to be vaccinated and the socio-demographic and motivational correlates among Health Care Workers (HCWs) in French Guiana. Methods: A cross-sectional survey was conducted from January 22 to March 26, 2021 among a sample of HCWs in French Guiana. They were asked about their willingness to get vaccinated against COVID-19 and vaccine hesitancy, vaccine uptake and vaccines attitudes. Factors associated with willingness to get vaccinated have been analyzed with ordinal logistic regression, using Stata software. Results: A total of 579 HCWs were interviewed, including 220 physicians and 200 nurses most often working in hospital (54%) or in the liberal sector (22%). Overall, 65.6% of respondents reported that they were willing or had already been vaccinated against COVID-19, while 24.3% of respondents reported that they did not want to get vaccinated against COVID-19 and 11.2% were unsure. HCWs were more willing to get vaccine if they were older, were worried about COVID-19 and were confident in the management of epidemic. Conversely, participants were less likely to have been vaccinated or willing to if they were nurses or of another non-medical profession, born in French Guiana, feared adverse effects, or if they did not trust pharmaceutical companies and management of the epidemic by authorities. Conclusion: Negative attitudes towards vaccines are a major public health concern among HCWs in French Guiana when considering the current active epidemic with Gamma VOC. General vaccine hesitancy and concerns about future side effects in particular represent important barriers. Low confidence in government and science are significant in COVID-19 vaccine refusal among non-medical staffs. Public health messaging with information on vaccine safety should be tailored to address these concerns. The specific challenges of HCWs from French Guiana must be taken into account.