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Mckee S, Sheikhan NY, Patenaude S, Henderson J, Knight R, Kidd SA, Barbic S, O'Reilly A, Hawke LD. 'Is It Safe? Is it not?' A Youth-Led Photovoice Study of Youth Perspectives of COVID-19 Vaccine Confidence. Health Expect 2024; 27:e70051. [PMID: 39369276 PMCID: PMC11456145 DOI: 10.1111/hex.70051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 07/17/2024] [Accepted: 09/17/2024] [Indexed: 10/07/2024] Open
Abstract
BACKGROUND Youth have been uniquely affected by the COVID-19 pandemic. Despite high rates of COVID-19 infection, youth had one of the lowest vaccine uptake rates. Certain characteristics can affect vaccine uptake, such as mental health and substance use, but it is important to understand uptake for an effective response to pandemics. OBJECTIVE This study examined the perspectives of youth with mental health or substance use concerns on COVID-19 vaccine confidence, hesitancy and overall COVID-19 vaccine perspectives. METHODS Using photovoice, a community-based participatory research method, a sample of 27 youth aged 14-24 years participated in a series of photography workshops and focus groups. Participants submitted final photographs for discussion. Focus groups were recorded, transcribed and thematically analysed. RESULTS Four themes were generated: (1) Youth deciphered the vaccine discourse in a changing information landscape; (2) mixed perspectives of families, friends and loved ones influenced the vaccine journey; (3) complex societal influences affected views and decisions around the COVID-19 vaccine; and (4) youth navigated their vaccine journeys through first- and second-hand experiences. The four themes and subthemes highlight the evolution of youth's journeys with the COVID-19 vaccine over the course of the pandemic and into the late-pandemic period. CONCLUSIONS Youth with mental health or substance use challenges navigated a complex environment during the COVID-19 pandemic. The wide variety of factors influencing vaccine perspectives should be taken into account in public health messaging and future research on youth vaccine uptake. Youth-led and youth-engaged research can help solicit rich and meaningful perspectives of young people on important public health issues. PATIENT OR PUBLIC CONTRIBUTION This was a youth-led study. A youth research analyst conducted the study activities together with the support of a youth advisory group, an adult photographer with lived experience, and a scientific team.
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Affiliation(s)
- Shelby Mckee
- Centre for Addiction and Mental HealthTorontoOntarioCanada
| | - Natasha Y. Sheikhan
- Centre for Addiction and Mental HealthTorontoOntarioCanada
- University of TorontoTorontoOntarioCanada
| | - Sean Patenaude
- Centre for Addiction and Mental HealthTorontoOntarioCanada
| | - Jo Henderson
- Centre for Addiction and Mental HealthTorontoOntarioCanada
- University of TorontoTorontoOntarioCanada
| | | | - Sean A. Kidd
- Centre for Addiction and Mental HealthTorontoOntarioCanada
- University of TorontoTorontoOntarioCanada
| | - Skye Barbic
- University of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Lisa D. Hawke
- Centre for Addiction and Mental HealthTorontoOntarioCanada
- University of TorontoTorontoOntarioCanada
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Nascimento LG, Dubé È, Burns KE, Brown P, Calnan M, Ward PR, Filice E, Herati H, Ike NAU, Rotolo B, Meyer SB. Informing efforts beyond tailored promotional campaigns by understanding contextual factors shaping vaccine hesitancy among equity-deserving populations in Canada: an exploratory qualitative study. Int J Equity Health 2023; 22:209. [PMID: 37805472 PMCID: PMC10559625 DOI: 10.1186/s12939-023-02025-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Vaccine hesitancy exists on a continuum ranging between complete adherence and complete refusal due to doubts or concerns within a heterogeneous group of individuals. Despite widespread acknowledgement of the contextual factors influencing attitudes and beliefs shaping COVID-19 vaccine hesitancy, qualitative research with equity-deserving groups, accounting for unique lived experiences, remains a gap in the literature. We aim to identify and begin to understand and document the unique contextual factors shaping hesitancy by equity-deserving groups as it relates to relationships with government and health authorities. METHODS Participants were recruited and interviewed between Aug-Dec 2021. Semi-structured interviews using a convergent interviewing technique were conducted with individuals from the general population, as well as individuals who identify as First Nations, Métis, or Inuit, members of the LGBT2SQ + community, low-income Canadians, Black Canadians, and newcomers. Interviews were audio recorded and transcribed by a team of researchers. Memos were written following interviews and used to complement the thematic analysis of the interview data. Themes are presented in the results section. RESULTS The rationale for hesitancy among equity-deserving groups is consistent with literature documenting hesitancy in the general population. Contextual factors surrounding equity-deserving groups' attitudes and beliefs, however, are unique and relate to a history of oppression, discrimination, and genocide. We identified factors unique to subgroups; for example, religious or fatalistic beliefs among participant who identify as FNMI, fear associated with lack of testing and speed of vaccines' production among participants who identify as FNMI, Black, and LGBT2SQ + , distrust of the healthcare system for LGBT2SQ + and Black Canadians, and distrust of the government and opposition to vaccine mandates for participating who identify as LGBT2SQ + , low-income, FNMI, or Black Canadian. Newcomers stood out as very trusting of the government and accepting of COVID-19 vaccination. CONCLUSIONS While our data on vaccine hesitancy largely mirror concerns reported in the vast body of literature citing rationale for COVID-19 hesitancy in high-income countries, the contextual factors identified in our work point to the need for wider systemic change. Our results may be used to support efforts, beyond tailored promotion campaigns, to support the confident acceptance of vaccines for COVID-19 and the acceptance of novel vaccines as future infectious diseases emerge.
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Affiliation(s)
| | - Ève Dubé
- Institut National de Santé Publique du Québec, Québec City, Canada
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McKinnon B, Abalovi K, Fortin G, Parvez M, Dalal S, Bouabid R, Jasmin D, Zéphrin M, Gupta N, Hasan AT, Andog-Naba Sebastien A, Taheem B, Dubé È, Tuong Nguyen C, Quach C, Vandermorris A, Zinszer K. Perspectives on COVID-19 Vaccination and Vaccine Passports in a Diverse Urban Adolescent Population: A Youth Participatory Mixed Methods Study. J Adolesc Health 2023; 73:527-535. [PMID: 37294252 PMCID: PMC10150197 DOI: 10.1016/j.jadohealth.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/02/2023] [Accepted: 04/11/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Disparities in youth COVID-19 vaccine acceptance and uptake have been documented in several countries, yet few studies have explored the attitudes and perceptions underlying vaccine-related decision-making among adolescent populations with unique sociocultural, environmental, and/or structural contexts that may influence vaccine uptake. METHODS This study used data from surveys and semistructured interviews collected between January and March 2022 as part of an ongoing community-based research project in two ethnoculturally diverse, lower income neighborhoods of Montreal, Canada. Youth researchers designed and conducted interviews with unvaccinated adolescents, and thematic analysis was employed to explore attitudes and perceptions underlying vaccine-related decisions and opinions about vaccine passports. Survey data were used to describe sociodemographic and psychological determinants of COVID-19 vaccination. RESULTS Among 315 survey participants aged 14-17 years, most (74%) were fully vaccinated against COVID-19. Prevalence ranged from 57% among Black adolescents to 91% among South and/or Southeast Asian adolescents (34% difference, 95% confidence interval: 20-49). Qualitative and quantitative findings highlighted several misconceptions about the safety, effectiveness, and necessity of COVID-19 vaccines and adolescents' desire for trusted sources of information to address their concerns. Vaccine passports likely increased uptake, yet adolescents were strongly resistant to the policy, and for some, it may have fueled distrust of government and scientific institutions. DISCUSSION Strategies that increase the trustworthiness of institutions and foster genuine partnership with underserved youth may improve vaccine confidence and help ensure an effective, proequity recovery from COVID-19.
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Affiliation(s)
- Britt McKinnon
- Centre for Public Health Research, University of Montreal, Montréal, Québec, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Krystelle Abalovi
- Centre for Public Health Research, University of Montreal, Montréal, Québec, Canada
| | - Geneviève Fortin
- Centre for Public Health Research, University of Montreal, Montréal, Québec, Canada; School of Public Health, University of Montreal, Montréal, Québec, Canada
| | - Maryam Parvez
- Centre for Public Health Research, University of Montreal, Montréal, Québec, Canada; School of Population and Global Health, McGill University, Montréal, Québec, Canada
| | - Sanya Dalal
- School of Population and Global Health, McGill University, Montréal, Québec, Canada
| | - Rania Bouabid
- Calixa-Lavallée Secondary School, Montréal-Nord, Québec, Canada
| | - Djunah Jasmin
- Henri-Bourassa Secondary School, Montréal-Nord, Québec, Canada
| | | | - Nandini Gupta
- Lucien-Pagé Secondary School, Montréal, Québec, Canada
| | | | | | - Binal Taheem
- Lucien-Pagé Secondary School, Montréal, Québec, Canada
| | - Ève Dubé
- Research Centre of the CHU of Québec, Laval University, Québec, Québec, Canada
| | - Cat Tuong Nguyen
- School of Public Health, University of Montreal, Montréal, Québec, Canada
| | - Caroline Quach
- Department of Microbiology, Infectiology and Immunology, University of Montreal, Montréal, Québec, Canada
| | - Ashley Vandermorris
- Division of Adolescent Medicine, Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Kate Zinszer
- Centre for Public Health Research, University of Montreal, Montréal, Québec, Canada; School of Public Health, University of Montreal, Montréal, Québec, Canada
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Hopkins KL, Underwood T, Iddrisu I, Woldemeskel H, Bon HB, Brouwers S, De Almeida S, Fol N, Malhotra A, Prasad S, Bharadwaj S, Bhatnagar A, Knobler S, Lihemo G. Community-Based Approaches to Increase COVID-19 Vaccine Uptake and Demand: Lessons Learned from Four UNICEF-Supported Interventions. Vaccines (Basel) 2023; 11:1180. [PMID: 37514996 PMCID: PMC10384848 DOI: 10.3390/vaccines11071180] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 07/30/2023] Open
Abstract
Vaccination is critical to minimize serious illness and death from COVID-19. Yet uptake of COVID-19 vaccines remains highly variable, particularly among marginalized communities. This article shares lessons learned from four UNICEF interventions that supported Governments to generate acceptance and demand for COVID-19 vaccines in Zambia, Iraq, Ghana, and India. In Zambia, community rapid assessment provided invaluable real-time insights around COVID-19 vaccination and allowed the identification of population segments that share beliefs and motivations regarding COVID-19 vaccination. Findings were subsequently used to develop recommendations tailored to the different personas. In Iraq, a new outreach approach (3iS: Intensification of Integrated Immunization) utilized direct community engagement to deliver health messages and encourage service uptake, resulting in over 4.4 million doses of COVID-19 and routine immunization vaccines delivered in just 8 months. In Ghana, a human-centered design initiative was applied to co-develop community-informed strategies to improve COVID-19 vaccination rates. In India, a risk communication and community engagement initiative reached half a million people over six months, translating into a 25% increase in vaccination rates. These shared approaches can be leveraged to improve COVID-19 vaccination coverage and close gaps in routine immunization across diverse and marginalized communities.
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Affiliation(s)
| | | | - Iddi Iddrisu
- UNICEF Ghana Country Office, Accra-North P.O. Box 5051, Ghana
| | | | - Helena Ballester Bon
- UNICEF Regional Office for East and Southern Africa, Nairobi P.O. Box 44145, Kenya
| | - Symen Brouwers
- UNICEF Regional Office for East and Southern Africa, Nairobi P.O. Box 44145, Kenya
| | - Sofia De Almeida
- UNICEF Regional Office for East and Southern Africa, Nairobi P.O. Box 44145, Kenya
| | - Natalie Fol
- UNICEF Regional Office for East and Southern Africa, Nairobi P.O. Box 44145, Kenya
| | - Alka Malhotra
- UNICEF India Country Office, New Delhi 110 003, India
| | | | - Sowmyaa Bharadwaj
- Praxis Institute for Participatory Practices, New Delhi 110 016, India
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Hu H, Gilliland F, Baezconde-Garbanati L. Communities, Mistrust, and Implementation: Addressing a Large Gap in the National Strategy for COVID-19 and Future Pandemics. Am J Public Health 2022; 112:1713-1715. [PMID: 36302214 PMCID: PMC9670215 DOI: 10.2105/ajph.2022.307115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 09/03/2023]
Affiliation(s)
- Howard Hu
- Howard Hu, Frank Gilliland, and Lourdes Baezconde-Garbanati are with the Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Frank Gilliland
- Howard Hu, Frank Gilliland, and Lourdes Baezconde-Garbanati are with the Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Lourdes Baezconde-Garbanati
- Howard Hu, Frank Gilliland, and Lourdes Baezconde-Garbanati are with the Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles
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