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Labbé F, Lapointe M, Dubé E, Fletcher C. Perceptions of COVID-19 vaccination and factors influencing COVID-19 vaccine acceptance among indigenous peoples in Quebec, Canada: Insights from a facebook posts and comments analysis. Hum Vaccin Immunother 2024; 20:2397868. [PMID: 39279294 PMCID: PMC11407413 DOI: 10.1080/21645515.2024.2397868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024] Open
Abstract
Vaccination rates in Canada tend to be lower among Indigenous peoples than the rest of the population. The COVID-19 pandemic provided an unprecedented opportunity to better understand Indigenous perceptions about vaccination. The aim of this study was to explore perceptions of COVID-19 vaccine and other factors influencing COVID-19 vaccine acceptance as evidenced by public posts and comments on Facebook by Indigenous peoples in Quebec, Canada. We collected data on 95 Facebook pages or groups used by Indigenous peoples in Quebec between November 1, 2020, to June 15, 2021. To identify posts relating to COVID-19 vaccination, a keyword search ("vaccination," "vaccine," "shot," "does," "Moderna," "Pfizer") was carried out in English and French in the search bar of each Facebook page/group. Results show that First Nations peoples and Inuit in Quebec had important concerns about the usefulness, safety and effectiveness of COVID-19 vaccine. They also expressed fear of being used as test subjects for the rest of the population. Motivations mentioned by First Nations peoples and Inuit to get vaccinated against COVID-19 included to travel again and return to normal life with their loved ones, and the desire to protect the most vulnerable in their communities, especially Elders. Results show that Indigenous health care professionals were considered as reliable and trustful source of information regarding COVID-19, and that seeing role models being vaccinated build confidence and foster acceptance of the vaccine. Culturally adapted messages and vaccination campaigns by and for Indigenous peoples appear to be key to building trust toward COVID-19 vaccination.
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Affiliation(s)
- Fabienne Labbé
- Centre de recherche du CHU de Québec - Université Laval, Axe Santé des populations et pratiques optimales en santé, Hôpital du Saint-Sacrement, Québec, QC, Canada
| | - Mathilde Lapointe
- Centre de recherche du CHU de Québec - Université Laval, Axe Santé des populations et pratiques optimales en santé, Hôpital du Saint-Sacrement, Québec, QC, Canada
| | - Eve Dubé
- Centre de recherche du CHU de Québec - Université Laval, Axe Maladies infectieuses et immunitaires, avenue d'Estimauville, 3e étage, Québec, QC, Canada
- Département d'anthropologie, Pavillon Charles-De Koninck, local, Université Laval, avenue des Sciences-Humaines, Québec, QC, Canada
- Institut national de santé publique du Québec, Québec, QC, Canada
| | - Christopher Fletcher
- Centre de recherche du CHU de Québec - Université Laval, Axe Santé des populations et pratiques optimales en santé, Hôpital du Saint-Sacrement, Québec, QC, Canada
- Département de médecine sociale et préventive, Faculté de médecine, Pavillon Ferdinand-Vandry, local Université Laval, avenue de la Médecine, Québec, QC, Canada
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Dubé E, Renaud MP, Lyonnais MC, Pelletier C, Fletcher C. "The needle is already ready to go": communities' and health care professionals' perceptions of routine vaccination in Nunavik, Canada. Int J Circumpolar Health 2024; 83:2295042. [PMID: 38105644 PMCID: PMC10732179 DOI: 10.1080/22423982.2023.2295042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023] Open
Abstract
Inuit living in the northern region of Nunavik continue to experience significant health inequalities, which are rooted in colonialism that still have repercussions on their health-related perceptions and practices, including vaccination. This study aimed to explore the perceptions and determinants of routine vaccination among the Inuit of Nunavik by describing factors influencing vaccination decisions from the perspective of community members and health professionals. Semi-structured interviews focusing on the perception of vaccination and experience with vaccination and health services were conducted with 18 Inuit and 11 non-Inuit health professionals. Using the socio-ecological model, factors acting at the community and public policy (e.g. rumours and misinformation about vaccination, language barrier), organisational (e.g. complexity of the vaccination process, staff turnover, lack of specialised vaccination workers and interpreters), and intrapersonal and interpersonal (e.g. past experiences with vaccination, vaccine attitudes, social norms) levels were identified as having an impact on vaccination decisions. Improving vaccination coverage in Nunavik requires a more global reflection on how to improve and culturally adapt the health care and services offered to the Inuit population.
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Affiliation(s)
- Eve Dubé
- Direction des risques biologiques, Institut national de santé publique du Québec, Québec, Canada
- Département d’anthropologie, Université Laval, Québec, Canada
| | - Marie-Pierre Renaud
- École d’études autochtones, Université du Québec en Abitibi-Témiscamingue, Québec, Canada
| | | | - Catherine Pelletier
- Axe Maladies infectieuses et immunitaires, Centrre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Christopher Fletcher
- Département de médecine sociale et préventive, Université Laval, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
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Maar M, Bourdon C, Berti J, Bisaillon E, Boesch L, Boston A, Chapdelaine J, Humphrey A, Kumar S, Maar-Jackson B, Martell R, Naokwegijig B, Preet Kaur D, Rice S, Rickaby B, Sutherland M, Reade M. Creating a Culturally Safe Online Data Collection Instrument to Measure Vaccine Confidence Among Indigenous Youth: Indigenous Consensus Method. JMIR Form Res 2024; 8:e52884. [PMID: 39133917 PMCID: PMC11347907 DOI: 10.2196/52884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/19/2024] [Accepted: 05/10/2024] [Indexed: 08/30/2024] Open
Abstract
BACKGROUND Participating in surveys can shape the perception of participants related to the study topic. Administering a vaccine hesitancy questionnaire can have negative impacts on participants' vaccine confidence. This is particularly true for online and cross-cultural data collection because culturally safe health education to correct misinformation is typically not provided after the administration of an electronic survey. OBJECTIVE To create a culturally safe, online, COVID-19 vaccine confidence survey for Indigenous youth designed to collect authentic, culturally relevant data of their vaccine experiences, with a low risk of contributing to further vaccine confusion among participants. METHODS Using the Aboriginal Telehealth Knowledge Circle consensus method, a team of academics, health care providers, policy makers, and community partners reviewed COVID-19 vaccine hesitancy surveys used in public health research, analyzed potential risks, and created a framework for electronic Indigenous vaccine confidence surveys as well as survey items. RESULTS The framework for safer online survey items is based on 2 principles, a first do-no-harm approach and applying a strengths-based lens. Relevant survey domains identified in the process include sociodemographic information, participants' connection to their community, preferred sources for health information, vaccination uptake among family members and peers, as well as personal attitudes toward vaccines. A total of 44 survey items were developed, including 5 open-ended items to improve the authenticity of the data and the analysis of the experiences of Indigenous youth. CONCLUSIONS Using an Indigenous consensus method, we have developed an online COVID-19 vaccine confidence survey with culturally relevant domains and reduced the risk of amplifying misinformation and negative impacts on vaccine confidence among Indigenous participants. Our approach can be adapted to other online survey development in collaboration with Indigenous communities.
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Affiliation(s)
- Marion Maar
- Human Sciences Division, Northern Ontario School of Medicine (NOSM) University, Sudbury, ON, Canada
| | - Caleigh Bourdon
- Undergraduate Medical Education, Northern Ontario School of Medicine (NOSM) University, Sudbury, ON, Canada
| | - Joahnna Berti
- Debajehmujig Storytellers, Debajehmujig Theatre Group, Manitowaning, ON, Canada
| | - Emma Bisaillon
- Interdisciplinary Health, Laurentian University, Sudbury, ON, Canada
| | - Lisa Boesch
- Human Sciences Division, Northern Ontario School of Medicine (NOSM) University, Sudbury, ON, Canada
| | - Alicia Boston
- Public Health Sudbury & Districts, Sudbury, ON, Canada
| | | | | | - Sandeep Kumar
- Postgraduate Medical Education, Northern Ontario School of Medicine (NOSM) University, Thunder Bay, ON, Canada
| | | | - Robert Martell
- Interdisciplinary Health, Laurentian University, Sudbury, ON, Canada
| | - Bruce Naokwegijig
- Debajehmujig Storytellers, Debajehmujig Theatre Group, Manitowaning, ON, Canada
| | - Davinder Preet Kaur
- Postgraduate Medical Education, Northern Ontario School of Medicine (NOSM) University, Thunder Bay, ON, Canada
| | - Sarah Rice
- Public Health Sudbury & Districts, Sudbury, ON, Canada
| | - Barbara Rickaby
- School of Rural and Northern Health, Laurentian University, Sudbury, ON, Canada
| | | | - Maurianne Reade
- Clinical Sciences Divison, Northern Ontario School of Medicine (NOSM) University, Sudbury, ON, Canada
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Peter E, Mohammed S, Variath C. Compassionate nursing in challenging contexts: The importance of judgments. Nurs Ethics 2024:9697330241272892. [PMID: 39122245 DOI: 10.1177/09697330241272892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
BACKGROUND Nurses' demonstration of compassion is an ethical and often regulatory expectation. While research has been conducted to examine the barriers and facilitators of compassion in nurses, little is known about how nurses develop and express compassion for patients who may be blamed for their health condition. Unvaccinated COVID-19 patients are an example of such patients. RESEARCH QUESTIONS How do nurses provide compassionate care for unvaccinated adults infected with COVID-19? How did the context of COVID-19 vaccination in Canada shape nurses' relationships with unvaccinated patients? RESEARCH DESIGN A generic qualitative approach using interviews to gather data was used. Martha Nussbaum's conceptualization of compassion and its cognitive requirements was employed to add depth to the analysis. PARTICIPANTS AND RESEARCH CONTEXT Seventeen Registered Nurses, from a range of practice settings, who had cared for unvaccinated patients with COVID-19 participated. ETHICAL CONSIDERATIONS Ethics approval was received, and signed informed consent was obtained. Participants who were the current students of the researchers were excluded. FINDINGS Three themes were identified:1) Encountering Extreme Workplace Impediments to Compassion.2) Managing Emotions to Provide "Nonjudgmental Care."3) Practicing Narrative Imagination. DISCUSSION The difficult working conditions during the pandemic impeded nurses' capacity to be compassionate. Yet, none judged their patients' suffering as trivial, and all provided necessary nursing care. Some initially blamed these patients for the severity of their illness and suppressed their emotions to provide what they called "nonjudgmental care." Upon reflection, participants recognized that these patients' life circumstances may have been barriers to vaccination which, in the end, facilitated the development of compassion. CONCLUSION This research has implications that go beyond that of caring for patients with COVID-19. The ideal of "nonjudgmental care" requires critical re-examination because judgments and emotions are required for compassion.
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Driedger SM, Maier R, Capurro G, Jardine C, Tustin J, Chartrand F, Sanguins J, Kloss O. "There's a little bit of mistrust": Red River Métis experiences of the H1N1 and COVID-19 pandemics. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2024; 44:1770-1787. [PMID: 38286593 DOI: 10.1111/risa.14274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/24/2023] [Accepted: 12/28/2023] [Indexed: 01/31/2024]
Abstract
We examined the perspectives of the Red River Métis citizens in Manitoba, Canada, during the H1N1 and COVID-19 pandemics and how they interpreted the communication of government/health authorities' risk management decisions. For Indigenous populations, pandemic response strategies play out within the context of ongoing colonial relationships with government institutions characterized by significant distrust. A crucial difference between the two pandemics was that the Métis in Manitoba were prioritized for early vaccine access during H1N1 but not for COVID-19. Data collection involved 17 focus groups with Métis citizens following the H1N1 outbreak and 17 focus groups during the COVID-19 pandemic. Métis prioritization during H1N1 was met with some apprehension and fear that Indigenous Peoples were vaccine-safety test subjects before population-wide distribution occurred. By contrast, as one of Canada's three recognized Indigenous nations, the non-prioritization of the Métis during COVID-19 was viewed as an egregious sign of disrespect and indifference. Our research demonstrates that both reactions were situated within claims that the government does not care about the Métis, referencing past and ongoing colonial motivations. Government and health institutions must anticipate this overarching colonial context when making and communicating risk management decisions with Indigenous Peoples. In this vein, government authorities must work toward a praxis of decolonization in these relationships, including, for example, working in partnership with Indigenous nations to engage in collaborative risk mitigation and communication that meets the unique needs of Indigenous populations and limits the potential for less benign-though understandable-interpretations.
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Affiliation(s)
- S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ryan Maier
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gabriela Capurro
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cindy Jardine
- Faculty of Health Sciences, University of the Fraser Valley, Chilliwack, British Columbia, Canada
| | - Jordan Tustin
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Frances Chartrand
- Health & Wellness Department, Manitoba Métis Federation, Winnipeg, Manitoba, Canada
| | - Julianne Sanguins
- Health & Wellness Department, Manitoba Métis Federation, Winnipeg, Manitoba, Canada
| | - Olena Kloss
- Health & Wellness Department, Manitoba Métis Federation, Winnipeg, Manitoba, Canada
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Cénat JM, Moshirian Farahi SMM, Dalexis RD, Caulley L, Xu Y, Beogo I, Pongou R. COVID-19 vaccine mistrust, health literacy, conspiracy theories, and racial discrimination among a representative ethnically diverse sample in Canada: The vulnerability of Arab, Asian, Black, and Indigenous peoples. J Med Virol 2024; 96:e29795. [PMID: 39007429 DOI: 10.1002/jmv.29795] [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: 04/28/2024] [Revised: 06/19/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024]
Abstract
Despite increased risk of severe acute respiratory syndrome coronavirus 2 infections and higher rates of COVID-19-related complications, racialized and Indigenous communities in Canada have lower immunization uptake compared to White individuals. However, there is woeful lack of data on predictors of COVID-19 vaccine mistrust (VM) that accounts for diverse social and cultural contexts within specific racialized and Indigenous communities. Therefore, we sought to characterize COVID-19 VM among Arab, Asian, Black, and Indigenous communities in Canada. An online survey was administered to a nationally representative, ethnically diverse panel of participants in October 2023. Arabic, Asian, Indigenous, and Black respondents were enriched in the sampling panel. Data were collected on demographics, COVID-19 VM, experience of racial discrimination, health literacy, and conspiracy beliefs. We used descriptive and regression analyses to determine the extent and predictors of COVID-19 VM among racialized and Indigenous individuals. All racialized respondents had higher VM score compared to White participants. Among 4220 respondents, we observed highest VM among Black individuals (12.18; ±4.24), followed by Arabic (12.12; ±4.60), Indigenous (11.84; ±5.18), Asian (10.61; ±4.28), and White (9.58; ±5.00) participants. In the hierarchical linear regression analyses, Black participants, women, everyday racial discrimination, and major experience of discrimination were positively associated with COVID-19 VM. Effects of racial discrimination were mediated by addition of conspiracy beliefs to the model. Racialized and Indigenous communities experience varying levels of COVID-19 VM and carry specific predictors and mediators to development of VM. This underscores the intricate interaction between race, gender, discrimination, and VM that need to be considered in future vaccination campaigns.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ontario, Ottawa, Canada
- Interdisciplinary Centre for Black Health, University of Ottawa, Ontario, Ottawa, Canada
- University of Ottawa Research Chair on Black Health, Ontario, Ottawa, Canada
| | | | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ontario, Ontario, Canada
| | - Lisa Caulley
- Interdisciplinary Centre for Black Health, University of Ottawa, Ontario, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ontario, Ottawa, Canada
| | - Yan Xu
- Faculty of Medicine, University of Ottawa, Ontario, Ottawa, Canada
| | - Idrissa Beogo
- Interdisciplinary Centre for Black Health, University of Ottawa, Ontario, Ottawa, Canada
- School of Nursing, University of Ottawa, Ontario, Ottawa, Canada
| | - Roland Pongou
- Interdisciplinary Centre for Black Health, University of Ottawa, Ontario, Ottawa, Canada
- Department of Economics, University of Ottawa, Ontario, Ottawa, Canada
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Souleymanov R, Still M, Christianson T, Morris M, Favel A, Wahpoosewyan D, McLeod A, Gervais L, King A, Piyesis MK, Jackson R, Payne M, Ringaert L, Larcombe L, Restall G, Montpetit D. The Gigii-Bapiimin Study: resilience and the impacts of COVID-19 on health and wellbeing of Indigenous people living with HIV in Manitoba and Saskatchewan. AIDS Care 2024; 36:899-907. [PMID: 38843558 DOI: 10.1080/09540121.2024.2361827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/24/2024] [Indexed: 07/25/2024]
Abstract
The Gigii-Bapiimin study explored the impacts of the COVID-19 pandemic on the health and wellbeing of First Nations, Inuit, and Métis people living with HIV in Manitoba and Saskatchewan, two provinces in Canada with alarmingly high rates of HIV infections. Participants (n = 28 in Manitoba and n = 23 in Saskatchewan) were recruited using various methods, including flyers, community organizations, peers, and social media. The qualitative interviews focused on the pandemic's impact on health, access to services, and ceremonies. The data were analyzed using inductive thematic analysis. The study identified three key themes: (a) resilience and coping; (b) negative impacts on health and substance use; (c) decreased access to health services, HIV care and harm reduction. The participants shared their experiences of social isolation and the loss of community support, which had deleterious effects on their mental health and substance use. The impacts on access to HIV care were exacerbated by poverty, homelessness, and distress over inadvertent disclosure of HIV status. Participants mitigated these impacts by relying on Indigenous knowledges, ceremonies, and resilience within their communities. Service providers must address the impacts of the COVID-19 pandemic on Indigenous people living with HIV and their access to HIV services and ceremonies.
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Affiliation(s)
- Rusty Souleymanov
- Faculty of Social Work, University of Manitoba, Winnipeg, Canada
- Manitoba HIV-STBBI Collective Impact Network, Winnipeg, Canada
| | - Marni Still
- Faculty of Social Work, University of Manitoba, Winnipeg, Canada
| | | | - Melissa Morris
- Faculty of Social Work, University of Manitoba, Winnipeg, Canada
| | - Ann Favel
- Faculty of Social Work, University of Manitoba, Winnipeg, Canada
| | | | - Albert McLeod
- Manitoba HIV-STBBI Collective Impact Network, Winnipeg, Canada
- Two-Spirit Consultants Inc., Winnipeg, Canada
| | | | - Alexandra King
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | | | - Randy Jackson
- School of Social Work, McMaster University, Hamilton, Canada
| | - Mike Payne
- Manitoba HIV-STBBI Collective Impact Network, Winnipeg, Canada
- Nine Circles Community Health Centre, Winnipeg, Canada
| | - Laurie Ringaert
- Manitoba HIV-STBBI Collective Impact Network, Winnipeg, Canada
| | - Linda Larcombe
- Faculty of Social Work, University of Manitoba, Winnipeg, Canada
- Manitoba HIV-STBBI Collective Impact Network, Winnipeg, Canada
| | - Gayle Restall
- Faculty of Social Work, University of Manitoba, Winnipeg, Canada
- Manitoba HIV-STBBI Collective Impact Network, Winnipeg, Canada
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Gonzalez-Jaramillo N, Abbühl D, Roa-Díaz ZM, Kobler-Betancourt C, Frahsa A. COVID-19 vaccine acceptance in the general population and under-resourced communities from high-income countries: realist review. BMJ Open 2024; 14:e084560. [PMID: 38631831 PMCID: PMC11029206 DOI: 10.1136/bmjopen-2024-084560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE To compare vaccination willingness before rollout and 1 year post-rollout uptake among the general population and under-resourced communities in high-income countries. DESIGN A realist review. DATA SOURCES Embase, PubMed, Dimensions ai and Google Scholar. SETTING High-income countries. DEFINITIONS We defined vaccination willingness as the proportion of participants willing or intending to receive vaccines prior to availability. We defined vaccine uptake as the real proportion of the population with complete vaccination as reported by each country until November 2021. RESULTS We included data from 62 studies and 18 high-income countries. For studies conducted among general populations, the proportion of vaccination willingness was 67% (95% CI 62% to 72%). In real-world settings, the overall proportion of vaccine uptake among those countries was 73% (95% CI 69% to 76%). 17 studies reported pre-rollout willingness for under-resourced communities. The summary proportion of vaccination willingness from studies reporting results among people from under-resourced communities was 52% (95% CI 0.46% to 0.57%). Real-world evidence about vaccine uptake after rollout among under-resourced communities was limited. CONCLUSION Our review emphasises the importance of realist reviews for assessing vaccine acceptance. Limited real-world evidence about vaccine uptake among under-resourced communities in high-income countries is a call to context-specific actions and reporting.
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Affiliation(s)
| | - Dominik Abbühl
- ISPM, University of Bern, Bern, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Zayne Milena Roa-Díaz
- ISPM, University of Bern, Bern, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
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Tsui N, Edwards SA, Simms AJ, King KD, Mecredy G. COVID-19 vaccination intention and vaccine hesitancy among citizens of the Métis Nation of Ontario. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:209-219. [PMID: 38189860 PMCID: PMC11006635 DOI: 10.17269/s41997-023-00836-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 11/06/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE The study objective is to measure the influence of psychological antecedents of vaccination on COVID-19 vaccine intention among citizens of the Métis Nation of Ontario (MNO). METHODS A population-based online survey was implemented by the MNO when COVID-19 vaccines were approved in Canada. Questions included vaccine intention, the short version of the "5C" psychological antecedents of vaccination scale (confidence, complacency, constraint, calculation, collective responsibility), and socio-demographics. Census sampling via the MNO Registry was used achieving a 39% response rate. Descriptive statistics, bivariate analyses, and multinomial logistic regression models (adjusted for sociodemographic variables) were used to analyze the survey data. RESULTS The majority of MNO citizens (70.2%) planned to be vaccinated. As compared with vaccine-hesitant individuals, respondents with vaccine intention were more confident in the safety of COVID-19 vaccines, believed that COVID-19 is severe, were willing to protect others from getting COVID-19, and would research the vaccines (Confident OR = 19.4, 95% CI 15.5-24.2; Complacency OR = 6.21, 95% CI 5.38-7.18; Collective responsibility OR = 9.83, 95% CI 8.24-11.72; Calculation OR = 1.43, 95% CI 1.28-1.59). Finally, respondents with vaccine intention were less likely to let everyday stress prevent them from getting COVID-19 vaccines (OR = 0.47, 95% CI 0.42-0.53) compared to vaccine-hesitant individuals. CONCLUSION This research contributes to the knowledge base for Métis health and supported the MNO's information sharing and educational activities during the COVID-19 vaccines rollout. Future research will examine the relationship between the 5Cs and actual uptake of COVID-19 vaccines among MNO citizens.
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Affiliation(s)
- Noel Tsui
- Métis Nation of Ontario, Ottawa, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- ICES Central, Toronto, ON, Canada.
| | - Sarah A Edwards
- Métis Nation of Ontario, Ottawa, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- ICES Central, Toronto, ON, Canada
| | - Abigail J Simms
- Métis Nation of Ontario, Ottawa, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- ICES Central, Toronto, ON, Canada
| | - Keith D King
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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10
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Mundo Ortiz A, Nasri B. Socio-demographic determinants of COVID-19 vaccine uptake in Ontario: Exploring differences across the Health Region model. Vaccine 2024; 42:2106-2114. [PMID: 38413281 DOI: 10.1016/j.vaccine.2024.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 02/29/2024]
Abstract
The COVID-19 pandemic continues to be a worldwide public health concern. Although vaccines against this disease were rapidly developed, vaccination uptake has not been equal across all the segments of the population, particularly in the case of underrepresented groups. However, there are also differences in vaccination across geographical areas, which might be important to consider in the development of future public health vaccination policies. In this study, we examined the relationship between vaccination status (having received the first dose of a COVID-19 vaccine), socio-economic strata, and the Health Regions for individuals in Ontario, Canada. Our results show that between October of 2021 and January of 2022, individuals from underrepresented communities were three times less likely to be vaccinated than White/Caucasian individuals across the province of Ontario, and that in some cases, within these groups, individuals in low-income brackets had significantly higher odds of vaccination when compared to their peers in high income brackets. Finally, we identified significantly lower odds of vaccination in the Central, East and West Health Regions of Ontario within certain underrepresented groups. This study shows that there is an ongoing need to better understand and address differences in vaccination uptake across diverse segments of the population of Ontario that the pandemic has largely impacted.
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Affiliation(s)
- Ariel Mundo Ortiz
- Centre de Recherches Mathématiques, Université de Montréal. 2920 Ch de la Tour, Montréal, QC H3T 1N8, Canada; Department of Social and Preventive Medicine, École de Santé Publique, Université de Montréal. 7101 Av du Parc, Montréal, QC H3N 1X9, Canada; Centre de recherche en santé publique, Université de Montréal. 7101 Av du Parc, Montréal, QC H3N 1X9, Canada
| | - Bouchra Nasri
- Centre de Recherches Mathématiques, Université de Montréal. 2920 Ch de la Tour, Montréal, QC H3T 1N8, Canada; Department of Social and Preventive Medicine, École de Santé Publique, Université de Montréal. 7101 Av du Parc, Montréal, QC H3N 1X9, Canada; Centre de recherche en santé publique, Université de Montréal. 7101 Av du Parc, Montréal, QC H3N 1X9, Canada.
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11
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Nickel NC, Phillips-Beck W, Enns JE, Ekuma O, Taylor C, Fileatreault S, Eze N, Star L, Lavoie J, Katz A, Brownell M, Mahar A, Urquia M, Chateau D, Lix L, Chartier M, Brownell E, Tso Deh M, Durksen A, Romanescu R. COVID-19 diagnostic testing and vaccinations among First Nations in Manitoba: A nations-based retrospective cohort study using linked administrative data, 2020-2021. PLoS Med 2024; 21:e1004348. [PMID: 38363739 PMCID: PMC10871479 DOI: 10.1371/journal.pmed.1004348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/15/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Differential access to healthcare has contributed to a higher burden of illness and mortality among First Nations compared to other people in Canada. Throughout the Coronavirus Disease 2019 (COVID-19) pandemic, First Nations organizations in Manitoba partnered with public health and Manitoba government officials to ensure First Nations had early, equitable and culturally safe access to COVID-19 diagnostic testing and vaccination. In this study, we examined whether prioritizing First Nations for vaccination was associated with faster uptake of COVID-19 vaccines among First Nations versus All Other Manitobans (AOM). METHODS AND FINDINGS In this retrospective cohort study, we used linked, whole-population administrative data from the Manitoba healthcare system (February 2020 to December 2021) to determine rates of COVID-19 diagnostic testing, infection, and vaccination, and used adjusted restricted mean survival time (RMST) models to test whether First Nations received their first and second vaccine doses more quickly than other Manitobans. The cohort comprised 114,816 First Nations (50.6% female) and 1,262,760 AOM (50.1% female). First Nations were younger (72.3% were age 0 to 39 years) compared to AOM (51% were age 0 to 39 years) and were overrepresented in the lowest 2 income quintiles (81.6% versus 35.6% for AOM). The 2 groups had a similar burden of comorbidities (65.8% of First Nations had none and 6.3% had 3 or more; 65.9% of AOM had none and 6.0% had 3 or more) and existing mental disorders (36.9% of First Nations were diagnosed with a mood/anxiety disorder, psychosis, personality disorder, or substance use disorder versus 35.2% of AOM). First Nations had crude infection rates of up to 17.20 (95% CI 17.15 to 17.24) COVID-19 infections/1,000 person-months compared with up to 6.24 (95% CI 6.16 to 6.32) infections/1,000 person-months among AOM. First Nations had crude diagnostic testing rates of up to 103.19 (95% CI 103.06 to 103.32) diagnostic COVID-19 tests/1,000 person-months compared with up to 61.52 (95% CI 61.47 to 61.57) tests/1,000 person-months among AOM. Prioritizing First Nations to receive vaccines was associated with faster vaccine uptake among First Nations versus other Manitobans. After adjusting for age, sex, income, region of residence, mental health conditions, and comorbidities, we found that First Nations residents received their first vaccine dose an average of 15.5 (95% CI 14.9 to 16.0) days sooner and their second dose 13.9 (95% CI 13.3 to 14.5) days sooner than other Manitobans in the same age group. The study was limited by the discontinuation of population-based COVID-19 testing and data collection in December 2021. As well, it would have been valuable to have contextual data on potential barriers to COVID-19 testing or vaccination, including, for example, information on social and structural barriers faced by Indigenous and other racialized people, or the distrust Indigenous people may have in governments due to historical harms. CONCLUSION In this study, we observed that the partnered COVID-19 response between First Nations and the Manitoba government, which oversaw creation and enactment of policies prioritizing First Nations for vaccines, was associated with vaccine acceptance and quick uptake among First Nations. This approach may serve as a useful framework for future public health efforts in Manitoba and other jurisdictions across Canada.
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Affiliation(s)
- Nathan C. Nickel
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Jennifer E. Enns
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Carole Taylor
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sarah Fileatreault
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nkiru Eze
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Leona Star
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada
| | - Josée Lavoie
- Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Dept of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alyson Mahar
- School of Nursing, Faculty of Health Sciences, Queen’s University, Kingston, Canada
| | - Marcelo Urquia
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Dan Chateau
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australia National University, Canberra, Australia
| | - Lisa Lix
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Emily Brownell
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Miyosha Tso Deh
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Anita Durksen
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Razvan Romanescu
- Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
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12
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Soares GH, Hedges J, Poirier B, Sethi S, Jamieson L. Deadly places: The role of geography in Aboriginal and Torres Strait Islander COVID-19 vaccination. Aust N Z J Public Health 2024; 48:100130. [PMID: 38354624 DOI: 10.1016/j.anzjph.2024.100130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 10/30/2023] [Accepted: 12/29/2023] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE The objective of this study was to investigate the geospatial distribution of COVID-19 vaccination rates for Aboriginal and Torres Strait Islander Peoples across Local Government Areas in Australia. METHODS We described the patterns of COVID-19 vaccination across jurisdictions, identified clusters with different levels of vaccination uptake, and assessed the relationship between contextual factors and vaccination (spatial error model, spatial lag model, and geographic weighted regression). RESULTS The proportion of the Aboriginal and Torres Strait Islander population that received at least two doses of a COVID-19 vaccine by the last week of June 2022 ranged from 62.9% to 97.5% across Local Government Areas. The proportion of the overall population who is Aboriginal or Torres Strait Islander (β = 0.280, standard deviation [SD] = 1.92), proportion of the total labour force employed (β =0.286, SD = 0.98), and proportion of individuals who speak an Aboriginal or Torres Strait Islander language (β =0.215, SD = 0.15) had, on average, the strongest effects on COVID-19 vaccination rates. CONCLUSION Findings underscore the extent to which area-level demographic influence the COVID-19 vaccination for Aboriginal and Torres Strait Islander Australians. IMPLICATIONS FOR PUBLIC HEALTH Findings can inform vaccination strategies that prioritise geographic areas with higher vulnerability to promote equity for Aboriginal and Torres Strait Islander Peoples.
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Affiliation(s)
- Gustavo Hermes Soares
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia.
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia
| | - Brianna Poirier
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia. https://twitter.com/@briannapoirier
| | - Sneha Sethi
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia. https://twitter.com/@drsnehasethi
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia
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13
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Eichelberger L, Hansen A, Cochran P, Hahn M, Fried R. COVID-19 vaccine decision-making in remote Alaska between November 2020 and November 2021. Int J Circumpolar Health 2023; 82:2242582. [PMID: 37535846 PMCID: PMC10402834 DOI: 10.1080/22423982.2023.2242582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023] Open
Abstract
Vaccine hesitancy is an ongoing barrier to achieve sufficient COVID-19 vaccination coverage. Although there are many studies globally of vaccine hesitancy based on large survey samples, there are fewer in-depth qualitative studies that explore vaccine hesitancy and acceptance as a spectrum of decision-making. In this paper, we begin to describe vaccination decision-making among 58 adults living in remote Alaska based on three waves of online surveys and follow-up semi-structured interviews conducted between November 2020 and November 2021. The survey question of intention was not a predictor of adoption for about one third of the interviewees who were unvaccinated when they took the survey (n=12, 35%). Over half of all interviewees (n=37, 64%) had vaccine-related concerns, including 25 vaccinated individuals (representing 57% of vaccinated interviewees). Most interviewees reported that they learned about COVID-19 vaccines through interpersonal interactions (n=30, 52%) and/or a variety of media sources (n=29, 50%). The major facilitators of acceptance were trust in the information source (n=20, 48% of the 42 who responded), and learning from the experiences of family, friends, and the broader community (n=12, 29%). Further, trust and having a sense of agency appears to be important to interviewee decision-making, regardless of vaccination status and intention.
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Affiliation(s)
- Laura Eichelberger
- Tribal Water Center, Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Amanda Hansen
- Tribal Water Center, Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | | | - Micah Hahn
- Institute for Circumpolar Health Studies, University of Alaska Anchorage, Anchorage, AK, USA
| | - Ruby Fried
- Institute for Circumpolar Health Studies, University of Alaska Anchorage, Anchorage, AK, USA
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14
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Matthews R, Menzel K. Vaccine Mandates and Cultural Safety. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:719-730. [PMID: 38165556 DOI: 10.1007/s11673-023-10319-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/20/2023] [Indexed: 01/04/2024]
Abstract
The issues and problems of mandatory vaccination policy and roll out in First Nations communities are unique and do not concern the safety and effectiveness of vaccines. These issues are also independent of more specific arguments of mandatory vaccination of healthcare workers as a condition of employment. As important as these issues are, they do not consider the complex politics of ongoing settler colonialism and First Nations community relations. In this paper, we also set aside the very real problems of disinformation, hesitancy, scientific and health illiteracy, and other concerns that drive vaccine hesitancy and refusal. These affect all communities, including First Nations communities. We, instead describe the dominant arguments in favour of mandatory vaccination and critique them in terms of the disputed legitimacy of Settler-Colonial decision-making as it impacts First Nations communities. We contend cultural responsiveness and safety-not state compulsion-must remain the first principles of any engagement-including vaccination-with First Nations Peoples, families, and communities.
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Affiliation(s)
- R Matthews
- Bond University, 14 University Drive, Robina, Queensland, 4226, Australia.
| | - K Menzel
- Southern Cross University, Military Road, Lismore, New South Wales, 2480, Australia
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15
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Fleury K, Chatwood S. Canadian Northern and Indigenous health policy responses to the first wave of COVID-19. Scand J Public Health 2023; 51:1016-1022. [PMID: 35676771 PMCID: PMC10599082 DOI: 10.1177/14034948221092185] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022]
Abstract
Aims: This study aimed to compare COVID-19 health policy and programme responses in 16 Northern and Indigenous regions in Canada. The goal was to summarise strategies used to mitigate the initial spread of the pandemic while highlighting aspects that reflect Indigenous values. Methods: A scoping review of grey literature was completed, focusing on territorial, regional health authority, and community level websites. Further media analysis was conducted to reach saturation regarding policy changes and programmes implemented to prevent transmission, improve health communication, access testing, provide health services effectively, secure borders, and provide financial assistance. Common responses were mapped on the Women's College Hospital's Wholistic Framework for Safe Wellness to identify aspects that reflected Indigenous values. This framework utilises the medicine wheel to discuss physical health (body), ceremony (spirit), community health (heart), and assessment (mind). Results: The Women's College Hospital's Wholistic Framework for Safe Wellness quadrants of the body, spirit and heart were covered by most regions via health communication efforts, adaptations to traditional practices, and continuation of care during the pandemic, respectively. It was found that 13 regions had pandemic responses adapted for Indigenous populations. Conclusions: The responses in each Northern region show that protecting each community was a priority; however, policies and programmes were developed as a kaleidoscope of what can be done quickly and evaluated later. Assessment, risk, and prevention, covered by the mind quadrant of the Women's College Hospital's Wholistic Framework for Safe Wellness, were missing in initial emergency responses. Increasing capacity for emergency management in Northern and Indigenous regions will require contingency planning that acknowledges and builds off traditional knowledge.
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Affiliation(s)
- Katherine Fleury
- Faculty of Veterinary Medicine, University of Calgary, Calgary, Canada
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Susan Chatwood
- School of Public Health, University of Alberta, Edmonton, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
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16
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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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17
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Ashfield S, Donelle L, Uppal G, Bauer MA, Kothari A. Community organization perspectives on COVID-19 vaccine hesitancy and how they increased COVID-19 vaccine confidence: a Canadian Immunization Research Network, social sciences and humanities network study. Front Public Health 2023; 11:1258742. [PMID: 37849717 PMCID: PMC10577219 DOI: 10.3389/fpubh.2023.1258742] [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: 09/11/2023] [Indexed: 10/19/2023] Open
Abstract
Background COVID-19 vaccines play a critical role in reducing the morbidity and mortality associated with SARS-CoV-2 infection and despite vaccine availability, disparities in COVID-19 vaccine uptake among Canadian subgroups exist. Community organizations are uniquely situated to relay important vaccine messaging around all vaccines, understand components of vaccine hesitancy, and facilitate vaccine uptake within the communities they serve. The objective of this research was to solicit community organizations perspectives specific to COVID-19 vaccines and explore strategies of increasing vaccine uptake within their communities. Methods A qualitative focus group study was held in the spring of 2021 with 40 community organizations from across the country. Discussions focused on COVID-19 vaccine communication and awareness within their communities, vaccine misinformation, and strategies to increase vaccine acceptance and access. Data were analyzed utilizing thematic and inductive techniques. Results Vaccine hesitancy was identified among staff and clients. Vaccine confidence, complacency, convenience, and mistrust in government and authorities were identified as contributors to vaccine hesitancy. Community organizations utilized innovative and novel methods to encourage vaccine uptake and increase vaccine confidence. Leveraging established trusting relationships was key to successful messaging within communities. Conclusion Community organizations used innovative methods, built on established trust, to increase vaccine confidence within their communities and among their staff. Community agencies played an important role in COVID-19 vaccine uptake within subgroups of the Canadian population. Community organizations are key public health partners and play a critical role in increasing COVID-19 vaccine confidence.
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Affiliation(s)
- Sarah Ashfield
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Lorie Donelle
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
- Emily Myrtle Smith Endowed Professor of Nursing, Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Gina Uppal
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Michael A. Bauer
- Department of Computer Science, The University of Western Ontario, London, ON, Canada
| | - Anita Kothari
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
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18
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Eichelberger L, Hansen A, Cochran P, Fried R, Hahn M. "In the beginning, I said I wouldn't get it.": Hesitant adoption of the COVID-19 vaccine in remote Alaska between November 2020 and 2021. Soc Sci Med 2023; 334:116197. [PMID: 37666096 DOI: 10.1016/j.socscimed.2023.116197] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/07/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023]
Abstract
Achieving sufficient COVID-19 vaccination coverage has been hindered in many areas by vaccine hesitancy. Many studies based on large survey samples have characterized vaccine refusal, but there are fewer in-depth qualitative studies that explore hesitant adoption: the middle-ground between vaccine acceptance and refusal, and how individuals may move across this continuum depending on their lived experience. For this paper, we use the narratives of 25 adults living in off-road, predominately Alaska Native communities to describe the complex decision-making processes undertaken by 'hesitant adopters', defined in our study as those who completed their initial COVID-19 series despite reporting hesitancy. Interviewees' stories help illustrate how hesitant adopters' decision-making processes involved making sense of information through interactions with trusted individuals, lived experiences, observations, emotions, and personal motivations. For the majority of these hesitant adopters' (n = 20, 80%) interpersonal interactions were key in helping to make the decision to get vaccinated. Over half of the interviewees (n = 14, 56%) described how conversations with individuals they trusted, including healthcare providers, family, friends, and interactions through their professional network made them feel safe. One third of the hesitant adopters (n = 7, 28%) attributed their decision to get vaccinated based on the influence of Alaska Native Elders including their knowledge, personal experiences, as well as being motivated by the desire to protect them. Independent research was also important to about a quarter of hesitant adopters (n = 6, 24%), and for these interviewees it was the process of gathering information on their own and learning from others, especially healthcare providers who could answer their questions and alleviate their concerns. This paper illustrates the temporality of vaccine decision-making: vaccine acceptance for those who are hesitant may be an ongoing process that is influenced by personal experience, relationships, and context.
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Affiliation(s)
- Laura Eichelberger
- Alaska Native Tribal Health Consortium, Tribal Water Center. 4000 Ambassador Drive Anchorage, Alaska, 99508, USA.
| | - Amanda Hansen
- Alaska Native Tribal Health Consortium, Tribal Water Center. 4000 Ambassador Drive Anchorage, Alaska, 99508, USA.
| | - Patricia Cochran
- Alaska Native Science Commission. 429 L Street, Anchorage, AK 99501, USA.
| | - Ruby Fried
- University of Alaska Anchorage (UAA), Institute for Circumpolar Health Studies (ICHS), 1901 Bragaw, Suite 220, Anchorage, Alaska, 99508, USA.
| | - Micah Hahn
- University of Alaska Anchorage (UAA), Institute for Circumpolar Health Studies (ICHS), 1901 Bragaw, Suite 220, Anchorage, Alaska, 99508, USA.
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19
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Herati H, Burns KE, Nascimento M, Brown P, Calnan M, Dubé È, Ward PR, Filice E, Rotolo B, Ike N, Meyer SB. Canadians' trust in government in a time of crisis: Does it matter? PLoS One 2023; 18:e0290664. [PMID: 37682915 PMCID: PMC10490979 DOI: 10.1371/journal.pone.0290664] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/11/2023] [Indexed: 09/10/2023] Open
Abstract
The ability of governments and nations to handle crises and protect the lives of citizens is heavily dependent on the public's trust in their governments and related social institutions. The aim of the present research was to understand public trust in government during a time of crisis, drawing on interview data (N = 56) collected during the COVID-19 pandemic (2021). In addition to the general public (n = 11), participants were sampled to obtain diversity as it relates to identifying as First Nations, Métis, and Inuit (n = 7), LGBT2SQ+ (n = 5), low-income (n = 8), Black Canadians (n = 7), young adult (n = 8), and newcomers to Canada (n = 10). Data were coded in consideration of social theories of trust, and specifically the nature of trust between individuals and institutions working with government in pandemic management. Canadians' trust in government was shaped by perceptions of pandemic communication, as well as decision-making and implementation of countermeasures. Data suggest that although participants did not trust government, they were accepting of measures and messages as presented through government channels, pointing to the importance of (re)building trust in government. Perhaps more importantly however, data indicate that resources should be invested in monitoring and evaluating public perception of individuals and institutions generating the evidence-base used to guide government communication and decision-making to ensure trust is maintained. Theoretically, our work adds to our understanding of the nature of trust as it relates to the association between interpersonal and institutional trust, and also the nature of trust across institutions.
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Affiliation(s)
- Hoda Herati
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Kathleen E. Burns
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Maria Nascimento
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Patrick Brown
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael Calnan
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, United Kingdom
| | - Ève Dubé
- Laval University, Québec, Canada
| | - Paul R. Ward
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University, Adelaide, Australia
| | - Eric Filice
- Department of Parks, Recreation and Tourism Management, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Bobbi Rotolo
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Nnenna Ike
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Samantha B. Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
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20
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Simms AJ, King KD, Tsui N, Edwards SA, Mecredy G. COVID-19 vaccine behaviour among citizens of the Métis Nation of Ontario: A qualitative study. Vaccine 2023; 41:5640-5647. [PMID: 37550144 DOI: 10.1016/j.vaccine.2023.07.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND The burden of the current COVID-19 pandemic is not shared equally in Canadian society, with Indigenous Peoples being disproportionately affected. Moreover, there is a lack of research pertaining to vaccination behaviour in Métis communities. This Métis-specific and Métis-led qualitative study endeavours to understand COVID-19 vaccine behaviour among citizens of the Métis Nation of Ontario (MNO). METHODS Data was collected via one-on-one interviews. Participants were recruited via the MNO's existing social media channels. Participants filled out a screening survey indicating their intention to vaccinate against COVID-19 as yes, no, or unsure. Sixteen participants (9 yes, 3 unsure, 4 no) were interviewed. Interviews averaged 30 min, and the questions and probes were developed in collaboration with the MNO. The interviewer received Métis-specific cultural safety training. Interviews were transcribed verbatim and uploaded to NVivo 12. RESULTS A deductive analysis using the Social Ecological Model framework (SEM) for vaccine behaviour and two blinded coders was used to understand the data. An additional factor, COVID-19 public health measures, was added to the framework to better capture the experiences of participants during the COVID-19 pandemic. Overall, the factors with the greatest number of coded references included Vaccine roll-out and availability, Organization of the public into priority groups, Public discourse, Interpersonal influences, Interface with health professionals, Knowledge state, Trust, and Vaccine risk perception. Bandwagoning (following others' behaviour) and Freeloading (perceiving enough people have been vaccinated), both factors of the SEM, were not discussed. Yes, no, and unsure participant groups were compared to understand the influences of each factor based on COVID-19 vaccination intention. CONCLUSIONS MNO citizens COVID-19 vaccine behaviour was negatively and positively influenced by a number of factors. This information will allow the MNO and public health units to better tailor their messaging for COVID-19 vaccine uptake campaigns and future pandemic emergencies.
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Affiliation(s)
- Abigail J Simms
- ICES Ontario, G1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
| | - Keith D King
- University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada.
| | - Noel Tsui
- ICES Ontario, G1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
| | - Sarah A Edwards
- ICES Ontario, G1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; University of Toronto, 27 King's College Cir, ON M5S, Canada; University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada.
| | - Graham Mecredy
- ICES Ontario, G1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
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21
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Grey C, Tian IL, Skakoon-Sparling S, Daroya E, Klassen B, Lessard D, Gaspar M, Sinno J, Sang JM, Perez-Brumer A, Lachowsky NJ, Moore DM, Jollimore J, Hart TA, Cox J, Grace D. Unpacking racism during COVID-19: narratives from racialized Canadian gay, bisexual, and queer men. Int J Equity Health 2023; 22:152. [PMID: 37553689 PMCID: PMC10410892 DOI: 10.1186/s12939-023-01961-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 07/13/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE Epidemics impact individuals unevenly across race, gender, and sexuality. In addition to being more vulnerable to COVID-19 infection, evidence suggests racialized gender and sexual minorities experienced disproportionate levels of discrimination and stigma during the COVID-19 epidemic. Drawing on Critical Race Theory (CRT), we examined the experiences of gay, bisexual, queer, and other men who have sex with men (GBQM) of colour facing discrimination during COVID-19. DESIGN Engage-COVID-19 is a mixed methods study examining the impact of COVID-19 on GBQM living in Vancouver, Toronto, and Montréal, Canada. We conducted two rounds of qualitative interviews (November 2020 to February 2021, and June to October 2021) with 93 GBQM to explore the evolving impact of COVID-19 on their lives. Transcripts were coded using inductive thematic analysis. Data analysis was conducted using Nvivo software. RESULTS Fifty-nine participants identified as Black, Indigenous, and/or a Person of Colour (BIPOC). These GBQM of colour described multiple experiences of discrimination during COVID-19. Although participants did not report experiences of discrimination based on their sexual identity during COVID-19, we found that experiences of racism affected how they were treated within their sexual networks. Experiences of racism were most often reported by East Asian and Black GBQM. These participants faced racism in public and online spaces, primarily in the form of verbal harassment. Several participants were also harassed because they wore face masks. Verbal abuse against GBQM of colour was largely prompted by racist discourses related to COVID-19. CONCLUSION Racism remains a pernicious threat to the well-being of GBQM of colour. CRT highlights the importance of assessing how sexualized and gendered discourses about race shape the experiences of GBQM of colour navigating multiple epidemics like COVID-19 and HIV. These pervasive discourses unevenly affect racial and sexual minorities across multiple epidemics, and negatively impact health outcomes for these populations.
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Affiliation(s)
- Cornel Grey
- Western University, London, Canada
- University of Toronto, Toronto, Canada
| | | | | | | | - Ben Klassen
- Community-Based Research Centre, Vancouver, Canada
| | | | | | - Jad Sinno
- University of Toronto, Toronto, Canada
| | | | | | | | - David M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jody Jollimore
- Canadian AIDS Treatment Information Exchange (CATIE), Toronto, Canada
| | - Trevor A Hart
- University of Toronto, Toronto, Canada
- Toronto Metropolitan University, Toronto, Canada
| | - Joseph Cox
- McGill University Health Centre, Montréal, Canada
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22
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Mikhail H, Button B, LeBlanc J, Cervin C, Cameron E. Operation Remote Immunity: exploring the impact of a service-learning elective in remote Indigenous communities. BMC MEDICAL EDUCATION 2023; 23:456. [PMID: 37340413 DOI: 10.1186/s12909-023-04434-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/07/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND The novel coronavirus, COVID-19, emerged in December 2019. Shortly after, vaccines against the virus were distributed in Canada for public use, but the remoteness of many northern Indigenous communities in Ontario posed a challenge for vaccine distribution and dissemination. The Ministry of Health partnered with the Northern Ontario School of Medicine University (NOSMU) and the air ambulance service, Ornge, to assist in delivering the vaccination doses to 31 fly-in communities in the Nishnawbe Aski Nation and Moosonee, all within Ontario. These deployments were considered "service-learning electives" for Undergraduate and Postgraduate medical learners from NOSMU who joined the operation in two-week deployments. NOSMU is renowned for its social accountability mandate and gives its medical learners opportunities to participate in service-learning to enhance their medical skills and cultural sensitivity. The purpose of this study is to examine the relationship between social accountability and medical learners' experiences during a service-learning elective in northern Indigenous communities in Ontario during the COVID-19 pandemic. METHODS Data were collected through a planned post-placement activity completed by eighteen Undergraduate and Postgraduate medical learners, who participated in the vaccine deployment. The activity consisted of a 500-word reflective response passage. Thematic analysis was used to identify, analyze, and report the themes within the collected data. RESULTS Two themes were identified by the authors, which formed a concise overview of the collected data: (1) confronting the realities of working in Indigenous communities; and (2) service-learning as a path to social accountability. CONCLUSIONS These vaccine deployments were an opportunity for medical learners to engage in service-learning and engage with Indigenous communities in Northern Ontario. Service-learning is an exceptional method which provides an opportunity to expand knowledge on the social determinants of health, social justice, and social accountability. The medical learners in this study reiterated the idea that learning medicine through a service-learning model leads to a greater depth of knowledge on Indigenous health and culture, and enhances medical knowledge compared to classroom learning.
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Affiliation(s)
- Hannah Mikhail
- Northern Ontario School of Medicine University in Sudbury, 935 Ramsey Lake Rd, Sudbury, ON, P3E 2C6, Canada.
- Northern Ontario School of Medicine University in Thunder Bay, 955 Oliver Rd, Thunder Bay, P7B 5E1, Canada.
| | - Brenton Button
- University of Winnipeg, 515 Portage Avenue, Winnipeg, MB, R3B 2E9, Canada
| | - Joseph LeBlanc
- Northern Ontario School of Medicine University in Sudbury, 935 Ramsey Lake Rd, Sudbury, ON, P3E 2C6, Canada
- Northern Ontario School of Medicine University in Thunder Bay, 955 Oliver Rd, Thunder Bay, P7B 5E1, Canada
| | - Catherine Cervin
- Northern Ontario School of Medicine University in Sudbury, 935 Ramsey Lake Rd, Sudbury, ON, P3E 2C6, Canada
- Northern Ontario School of Medicine University in Thunder Bay, 955 Oliver Rd, Thunder Bay, P7B 5E1, Canada
| | - Erin Cameron
- Northern Ontario School of Medicine University in Sudbury, 935 Ramsey Lake Rd, Sudbury, ON, P3E 2C6, Canada
- Northern Ontario School of Medicine University in Thunder Bay, 955 Oliver Rd, Thunder Bay, P7B 5E1, Canada
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23
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Sullivan P, Starr V, Dubois E, Starr A, Acharibasam JB, McIlduff C. Where past meets present: Indigenous vaccine hesitancy in Saskatchewan. MEDICAL HUMANITIES 2023; 49:321-331. [PMID: 36604166 PMCID: PMC10439261 DOI: 10.1136/medhum-2022-012501] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 06/17/2023]
Abstract
In Canada, colonisation, both historic and ongoing, increases Indigenous vaccine hesitancy and the threat posed by infectious diseases. This research investigated Indigenous vaccine hesitancy in a First Nation community in Saskatchewan, ways it can be overcome, and the influence of a colonial history as well as modernity. Research followed Indigenous research methodologies, a community-based participatory research design, and used mixed methods. Social media posts (interventions) were piloted on a community Facebook page in January and February (2022). These interventions tested different messaging techniques in a search for effective strategies. The analysis that followed compared the number of likes and views of the different techniques to each other, a control post, and community-developed posts implemented by the community's pandemic response team. At the end of the research, a sharing circle occurred and was followed by culturally appropriate data analysis (Nanâtawihowin Âcimowina Kika-Môsahkinikêhk Papiskîci-Itascikêwin Astâcikowina procedure). Results demonstrated the importance of exploring an Indigenous community's self-determined solution, at the very least, alongside the exploration of external solutions. Further, some sources of vaccine hesitancy, such as cultural barriers, can also be used to promote vaccine confidence. When attempting to overcome barriers, empathy is crucial as vaccine fears exist, and antivaccine groups are prepared to take advantage of empathetic failures. Additionally, the wider community has a powerful influence on vaccine confidence. Messaging, therefore, should avoid polarising vaccine-confident and vaccine-hesitant people to the point where the benefits of community influence are limited. Finally, you need to understand people and their beliefs to understand how to overcome hesitancy. To gain this understanding, there is no substitute for listening.
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Affiliation(s)
- Patrick Sullivan
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Victor Starr
- Kihew Kawaskasit Health Services, Star Blanket Cree Nation, Saskatchewan, Canada
| | - Ethel Dubois
- Star Blanket Cree Nation, Star Blanket Cree Nation, Saskatchewan, Canada
| | - Alyssa Starr
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Cari McIlduff
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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24
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Cha E, Vyas V, King KD, Reifferscheid L, MacDonald SE. Inclusion of intersectionality in studies of immunization uptake in Canada: A scoping review. Vaccine 2023:S0264-410X(23)00510-8. [PMID: 37202274 DOI: 10.1016/j.vaccine.2023.04.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Intersectionality refers to the interconnectedness of various social locations creating unique experiences for individuals and groups, in the context of systems of privilege and oppression. As part of immunization coverage research, intersectionality allows healthcare professionals and policymakers to become aware of the constellation of characteristics contributing to low vaccine uptake. The objective of this study was to examine the application of intersectionality theory or concepts, and the appropriate use of sex and gender terminology, in Canadian immunization coverage research. MATERIALS AND METHODS The eligibility criteria for this scoping review included English or French language studies on immunization coverage among Canadians of all ages. Six research databases were searched without date restrictions. We searched provincial and federal websites, as well as the Proquest Dissertations and Theses Global database for grey literature. RESULTS Of 4725 studies identified in the search, 78 were included in the review. Of these, 20 studies included intersectionality concepts, specifically intersections of individual-level characteristics influencing vaccine uptake. However, no studies explicitly used an intersectionality framework to guide their research. Of the 19 studies that mentioned "gender", 18 had misused this term, conflating it with "sex". CONCLUSIONS Based on our findings, there is an evident lack of intersectionality framework utilization in immunization coverage research in Canada, as well as misuse of the terms "gender" and "sex". Rather than only focusing on discrete characteristics, research should explore the interaction between numerous characteristics to better understand the barriers to immunization uptake in Canada.
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Affiliation(s)
- Eunah Cha
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - Vidhi Vyas
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - Keith D King
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - Laura Reifferscheid
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - Shannon E MacDonald
- University of Alberta, Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada.
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25
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Kang B, Goldlust S, Lee EC, Hughes J, Bansal S, Haran M. Spatial distribution and determinants of childhood vaccination refusal in the United States. Vaccine 2023; 41:3189-3195. [PMID: 37069031 DOI: 10.1016/j.vaccine.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/19/2023]
Abstract
Parental refusal and delay of childhood vaccination has increased in recent years in the United States. This phenomenon challenges maintenance of herd immunity and increases the risk of outbreaks of vaccine-preventable diseases. We examine US county-level vaccine refusal for patients under five years of age collected during the period 2012-2015 from an administrative healthcare dataset. We model these data with a Bayesian zero-inflated negative binomial regression model to capture social and political processes that are associated with vaccine refusal, as well as factors that affect our measurement of vaccine refusal. Our work highlights fine-scale socio-demographic characteristics associated with vaccine refusal nationally, finds that spatial clustering in refusal can be explained by such factors, and has the potential to aid in the development of targeted public health strategies for optimizing vaccine uptake.
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Affiliation(s)
- Bokgyeong Kang
- Department of Statistics, Pennsylvania State University, University Park 16802, PA, USA
| | - Sandra Goldlust
- New York University School of Medicine, New York 10016, NY, USA
| | - Elizabeth C Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore 21205, MD, USA
| | - John Hughes
- College of Health, Lehigh University, Bethlehem 18015, PA, USA
| | - Shweta Bansal
- Department of Biology, Georgetown University, Washington 20007, DC, USA
| | - Murali Haran
- Department of Statistics, Pennsylvania State University, University Park 16802, PA, USA
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26
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Cohen Tervaert JW, van Eeden C, Butt I, Redmond D, Clifford A, Osman M, Yacyshyn E. Vaccine hesitancy is not increased in patients with ASIA (autoimmune/inflammatory syndrome induced by adjuvants) when compared to patients with vasculitis. Clin Rheumatol 2023; 42:1727-1728. [PMID: 37004592 PMCID: PMC10066990 DOI: 10.1007/s10067-023-06591-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Jan Willem Cohen Tervaert
- Division of Rheumatology, Department of Medicine, University of Alberta, Alberta, Edmonton, Canada.
- Maastricht University, Maastricht, the Netherlands.
| | - Charmaine van Eeden
- Division of Rheumatology, Department of Medicine, University of Alberta, Alberta, Edmonton, Canada
| | - Imama Butt
- Division of Rheumatology, Department of Medicine, University of Alberta, Alberta, Edmonton, Canada
| | - Desiree Redmond
- Division of Rheumatology, Department of Medicine, University of Alberta, Alberta, Edmonton, Canada
| | - Alison Clifford
- Division of Rheumatology, Department of Medicine, University of Alberta, Alberta, Edmonton, Canada
| | - Mo Osman
- Division of Rheumatology, Department of Medicine, University of Alberta, Alberta, Edmonton, Canada
| | - Elaine Yacyshyn
- Division of Rheumatology, Department of Medicine, University of Alberta, Alberta, Edmonton, Canada
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27
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Kelly KJ, Mears K, Doak S, Macartney G, Burns M, Loo J, Michael L, Jia BB, Montelpare W. Characteristics of immunisation support programmes in Canada: a scoping review and environmental scan. BMJ Open 2023; 13:e070400. [PMID: 36990478 PMCID: PMC10069581 DOI: 10.1136/bmjopen-2022-070400] [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] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE To identify, characterise and map the existing knowledge about programmes that provide immunisation support to Canadians and barriers and facilitators to their delivery. DESIGN Scoping review and environmental scan. INTRODUCTION Vaccine hesitancy may be associated with unmet support needs of individuals. Immunisation support programmes that provide multicomponent approaches can improve vaccine confidence and equitable access. INCLUSION CRITERIA Canadian programmes that focus on providing information about immunisation for the general public, but excluding articles targeting health professionals. The primary concept involves mapping the characteristics of programmes and our secondary concept examines barriers and facilitators to programme delivery. METHODS The Joanna Briggs Institute (JBI) methodology guided this review, reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A search strategy was developed and translated for six databases in November 2021 (updated October 2022). Unpublished literature was identified through the Canadian Agency for Drugs and Technologies in Health Grey Matters checklist and other relevant sources. Stakeholders (n=124) from Canadian regional health authorities were also contacted by email for publicly accessible information. Two independent raters screened and extracted data from identified material. Results are presented in tabular form. RESULTS The search strategy and environmental scan resulted in 15 287 sources. A total of 161 full-text sources were reviewed after applying eligibility criteria, resulting in 50 articles. Programmes were delivered in multiple Canadian provinces, focusing on various vaccine types. All programmes aimed to increase vaccine uptake and were mostly provided in person. Multidisciplinary delivery teams based on collaborations among multiple entities were credited as a facilitator to programme delivery across settings. Limitations on programme resources, attitudes of programme staff and participants, and systems organisation were identified as barriers to delivery. CONCLUSIONS This review highlighted characteristics of immunisation support programmes across various settings and described multiple facilitators and barriers. These findings can inform future interventions that aim to support Canadians in making decisions about immunisation.
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Affiliation(s)
- Katherine Jennifer Kelly
- Health Research Network, Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Kim Mears
- Data and Research Services, Robertson Library, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Sarah Doak
- Health Research Network, Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Gail Macartney
- Faculty of Nursing, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Margie Burns
- Faculty of Nursing, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Janet Loo
- Faculty of Nursing, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Laurie Michael
- Health Research Network, Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Bei Bei Jia
- Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - William Montelpare
- Health Research Network, Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
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28
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Pickering K, Galappaththi EK, Ford JD, Singh C, Zavaleta-Cortijo C, Hyams K, Miranda JJ, Arotoma-Rojas I, Togarepi C, Kaur H, Arvind J, Scanlon H, Namanya DB, Anza-Ramirez C. Indigenous peoples and the COVID-19 pandemic: a systematic scoping review. ENVIRONMENTAL RESEARCH LETTERS : ERL [WEB SITE] 2023; 18:033001. [PMID: 36798651 PMCID: PMC9923364 DOI: 10.1088/1748-9326/acb804] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/17/2022] [Accepted: 02/01/2023] [Indexed: 05/06/2023]
Abstract
Past influenza pandemics including the Spanish flu and H1N1 have disproportionately affected Indigenous Peoples. We conducted a systematic scoping review to provide an overview of the state of understanding of the experience of Indigenous peoples during the first 18 months of the COVID-19 pandemic, in doing so we capture the state of knowledge available to governments and decision makers for addressing the needs of Indigenous peoples in these early months of the pandemic. We addressed three questions: (a) How is COVID-19 impacting the health and livelihoods of Indigenous peoples, (b) What system level challenges are Indigenous peoples experiencing, (c) How are Indigenous peoples responding? We searched Web of Science, Scopus, and PubMed databases and UN organization websites for publications about Indigenous peoples and COVID-19. Results were analyzed using descriptive statistics and content analysis. A total of 153 publications were included: 140 peer-reviewed articles and 13 from UN organizations. Editorial/commentaries were the most (43%) frequent type of publication. Analysis identified Indigenous peoples from 19 different countries, although 56% of publications were centered upon those in Brazil, United States, and Canada. The majority (90%) of articles focused upon the general adult population, few (<2%) used a gender lens. A small number of articles documented COVID-19 testing (0.04%), incidence (18%), or mortality (16%). Five themes of system level challenges affecting exposure and livelihoods evolved: ecological, poverty, communication, education and health care services. Responses were formal and informal strategies from governments, Indigenous organizations and communities. A lack of ethnically disaggregated health data and a gender lens are constraining our knowledge, which is clustered around a limited number of Indigenous peoples in mostly high-income countries. Many Indigenous peoples have autonomously implemented their own coping strategies while government responses have been largely reactive and inadequate. To 'build back better' we must address these knowledge gaps.
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Affiliation(s)
- Kerrie Pickering
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Eranga K Galappaththi
- Department of Geography, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States of America
| | - James D Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, United Kingdom
| | - Chandni Singh
- School of Environment and Development, Indian Institute for Human Settlements, Bangalore, India
| | - Carol Zavaleta-Cortijo
- Unidad de Ciudadanía Intercultural y Salud Indígena (UCISI), Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Keith Hyams
- Department of Politics and International Studies, University of Warwick, Coventry, United Kingdom
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ingrid Arotoma-Rojas
- Priestley International Centre for Climate, University of Leeds, Leeds, United Kingdom
| | - Cecil Togarepi
- Department of Animal Production, Agribusiness and Economics, School of Agriculture and Fisheries Sciences, University of Namibia, Windhoek, Namibia
| | - Harpreet Kaur
- Indian Institute for Human Settlements, Bangalore, India
| | | | - Halena Scanlon
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Didacus B Namanya
- Ministry of Health, Uganda National Health Research Organisation, Entebbe, Uganda
| | - Cecilia Anza-Ramirez
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
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Abstract
PURPOSE OF REVIEW The literature on racism and anxiety-related disorders, especially social anxiety, specific phobia, and generalized anxiety disorder, is notably lacking. This report aims to review recent evidence demonstrating the link between racial discrimination and various anxiety-related disorders. RECENT FINDINGS Anxiety-related disorders were the most significant mediator for daily discrimination and suicidal thoughts, above both depression and substance use. Further, studies showed that racial discrimination promotes posttraumatic stress and racial trauma among people of color. Systemic racism puts people of color at a higher risk for anxiety disorders than White people. Clinical case examples provide lived evidence of diverse racial and ethnic individuals suffering from anxiety-related disorders, with the development and worsening of symptoms due to racism and microaggressions. There is a prominent need for recent research on anxiety-related disorders and racism. Recommendations for clinicians and future research directions are provided. These actions are required to address bias and mental health inequities and empower people of color.
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Affiliation(s)
- M Myriah MacIntyre
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON, K1N 6N5, Canada
| | - Manzar Zare
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON, K1N 6N5, Canada
| | - Monnica T Williams
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON, K1N 6N5, Canada.
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30
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Skinner NA, Sanders K, Lopez E, Sotz Mux MS, Abascal Miguel L, Vosburg KB, Johnston J, Diamond-Smith N, Kraemer Diaz A. Barriers to COVID-19 vaccine acceptance to improve messages for vaccine uptake in indigenous populations in the central highlands of Guatemala: a participatory qualitative study. BMJ Open 2023; 13:e067210. [PMID: 36707110 PMCID: PMC9884572 DOI: 10.1136/bmjopen-2022-067210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION As of July 2022, a little over one-third of Guatemalans were fully vaccinated. While COVID-19 vaccination rates are not officially reported nationally by racial/ethnic groups, non-governmental organisations and reporters have observed that COVID-19 vaccination rates are especially low among high-risk Indigenous populations. We conducted one of the first studies on COVID-19 vaccine acceptance in Indigenous populations in the Central Highlands of Guatemala, which aimed to better understand the barriers to COVID-19 vaccine uptake and how to improve vaccine promotional campaigns. METHODS In November 2021, we conducted eight focus group discussions (FGDs) with 42 Indigenous men and women and 16 in-depth interviews (IDIs) with community health workers, nurses and physicians in Chimaltenango and Sololá. Using a participatory design approach, our qualitative analysis used constant comparative methods to understand the inductive and deductive themes from the FGD and IDI transcripts. RESULTS We found three major overarching barriers to vaccination within the sampled population: (1) a lack of available easily understandable, linguistically appropriate and culturally sensitive COVID-19 vaccine information; (2) vaccine access and supply issues that prevented people from being vaccinated efficiently and quickly; and (3) widespread misinformation and disinformation that prey on people's fears of the unknown and mistrust of the medical establishment and government. CONCLUSION When developing COVID-19 vaccine messages, content should be culturally relevant, appropriate for low-literacy populations and in the languages that people prefer to speak. Promotional materials should be in multiple modalities (print, radio and social media) and also have specific Maya cultural references (dress, food and concepts of disease) to ensure messaging connects with intended targets. This study supports the need for more robust research into best practices for communicating about COVID-19 vaccines to marginalised communities globally and suggests that policy makers should invest in targeted local solutions to increase vaccine uptake.
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Affiliation(s)
- Nadine Ann Skinner
- Stanford Center for Health Education, Stanford University School of Medicine, Stanford, California, USA
| | - Kelly Sanders
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Emily Lopez
- Maya Health Alliance Wuqu' Kawoq, Tecpan, Guatemala
| | | | - Lucía Abascal Miguel
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Kathryn B Vosburg
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Jamie Johnston
- Stanford Center for Health Education, Stanford University School of Medicine, Stanford, California, USA
| | - Nadia Diamond-Smith
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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31
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AlShurman BA, Butt ZA. Proposing a New Conceptual Syndemic Framework for COVID-19 Vaccine Hesitancy: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1561. [PMID: 36674314 PMCID: PMC9864682 DOI: 10.3390/ijerph20021561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Discussions regarding syndemics have dominated research in recent years. Vaccine hesitancy has also been propelled to the forefront. In this narrative review, we aim to frame a novel syndemic framework to understand the interaction between vaccine hesitancy, COVID-19, and negative health outcomes. METHODS A non-systematic electronic search was conducted in PubMed and Google Scholar. Search criteria were limited to articles published between November 2019 and June 2022. Articles related to the COVID-19 syndemic and vaccine hesitancy were included. RESULTS Our review revealed that the adherence to COVID-19 regulations-although they were effective in preventing COVID-19 transmission, cases, and deaths-created a dynamically unstable 'vicious cycle' between undesirable health, economic, and social outcomes. The "accumulation" of complex stressors decreased individuals' cognitive flexibility and hindered them from making decisions and getting vaccinated. Furthermore, it increased individuals' risk of acquiring COVID-19, losing their employment, increasing poverty, and decreasing healthcare utilization. We illustrated how the amalgamation of sociodemographic and contextual factors associated with COVID-19 might impact people's vaccine decisions, making them more hesitant toward COVID-19 vaccination. Failing to receive vaccinations increases the chances of COVID-19 transmission, hospitalization, and other negative health outcomes. CONCLUSIONS Understanding the interaction between these factors is essential to provide policymakers with inspiration to set appropriate interventions for promoting COVID-19 vaccination acceptance to decrease the overall burden of pandemics.
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Affiliation(s)
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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MacDonald SE, Kenzie L, Letendre A, Bill L, Shea-Budgell M, Henderson R, Barnabe C, Guichon JR, Colquhoun A, Ganshorn H, Bedingfield N, Vandenboogaard PD, Bednarczyk RA, Glaze S, Nelson G. Barriers and supports for uptake of human papillomavirus vaccination in Indigenous people globally: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001406. [PMID: 36962871 PMCID: PMC10021254 DOI: 10.1371/journal.pgph.0001406] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/08/2022] [Indexed: 01/09/2023]
Abstract
Despite the availability of effective and safe human papillomavirus (HPV) vaccines that reduce the incidence and impact of cervical cancer and other cancers, HPV vaccine coverage rates remain persistently low and the cervical cancer burden disproportionately high among Indigenous people globally. This study aimed to systematically identify, appraise, and summarize the literature on documented barriers and supports to HPV vaccination in Indigenous populations internationally. Forty-three studies were included and an inductive, qualitative, thematic synthesis was applied. We report on 10 barrier themes and 7 support themes to vaccine uptake, and provide a quantitative summary of metrics. Focusing on Indigenous perspectives reported in the literature, we propose recommendations on community-research collaboration, culturally safe intergenerational and gender-equitable community HPV vaccine education, as well as multi-level transparency to ensure informed consent is secured in the context of reciprocal relationships. Although the voices of key informant groups (e.g., HPV-vaccine eligible youth and community Elders) are underrepresented in the literature, the identification of barriers and supports to HPV vaccination in a global Indigenous context might help inform researchers and health policy makers who aim to improve HPV vaccine uptake in Indigenous populations.
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Affiliation(s)
| | - Lisa Kenzie
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Angeline Letendre
- Cancer Prevention and Screening Innovation, Alberta Health Services, Edmonton, Canada
| | - Lea Bill
- Alberta First Nations Information Governance Centre, Calgary, Canada
| | | | - Rita Henderson
- Department of Family Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Cheryl Barnabe
- Department of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Juliet R Guichon
- Department of Community Health Sciences and Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Amy Colquhoun
- Performance Reporting, Alberta Health, Edmonton, Canada
| | - Heather Ganshorn
- Libraries and Cultural Resources, University of Calgary, Calgary, Canada
| | - Nancy Bedingfield
- Department of Community Health Sciences and Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Robert A Bednarczyk
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Sarah Glaze
- Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
| | - Gregg Nelson
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
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Ike N, Burns KE, Nascimento H, Filice E, Ward PR, Herati H, Rotolo B, Betini GS, Perlman CM, Meyer SB. Examining factors impacting acceptance of COVID-19 countermeasures among structurally marginalised Canadians. Glob Public Health 2023; 18:2263525. [PMID: 37801704 DOI: 10.1080/17441692.2023.2263525] [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: 04/18/2023] [Accepted: 09/19/2023] [Indexed: 10/08/2023]
Abstract
The COVID-19 pandemic highlighted and exacerbated inequities in health for structurally marginalised Canadians. Their location on society's hierarchies constrained their ability to access healthcare and follow recommended health behaviours. The aim of this article is to identify, from the perspective of marginalised populations, factors influencing the acceptance or rejection of COVID-19 countermeasures by structurally marginalised Canadians. Interviews were conducted with Canadians 18 + who identified as Black (n = 8), First Nations, Métis, or Inuit (n = 7) and low-income (<40,000 annual household income) (n = 8) between August and December 2021. Measures were said to impact well-being and interfere with revenue generating activities. Longstanding unfavourable living and environmental conditions as they relate to structural marginalisation was said to fuel anger toward the government and lead to a greater reluctance to accept countermeasures. Participants described concerns about government decisions being made without considering their unique contexts, or knowledge of the experiences of the population for whom these decisions were being made. Effective proactive action from government is important to foster trust with marginalised populations to support acceptance of health information and address growing inequities. Action that demonstrates government competence and commitment to the interests of marginalised populations is critical.
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Affiliation(s)
- Nnenna Ike
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Kathleen E Burns
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Helena Nascimento
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | | | - Paul R Ward
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University, Adelaide, Australia
| | - Hoda Herati
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Bobbi Rotolo
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Gustavo S Betini
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | | | - Samantha B Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
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Wijewickrama ES, Abdul Hafidz MI, Robinson BM, Johnson DW, Liew A, Dreyer G, Caskey FJ, Bello AK, Zaidi D, Damster S, Salaro S, Luyckx VA, Bajpai D. Availability and prioritisation of COVID-19 vaccines among patients with advanced chronic kidney disease and kidney failure during the height of the pandemic: a global survey by the International Society of Nephrology. BMJ Open 2022; 12:e065112. [PMID: 36585149 PMCID: PMC9808761 DOI: 10.1136/bmjopen-2022-065112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/25/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Patients with advanced chronic kidney disease (CKD) or kidney failure receiving replacement therapy (KFRT) are highly vulnerable to COVID-19 infection, morbidity and mortality. Vaccination is effective, but access differs around the world. We aimed to ascertain the availability, readiness and prioritisation of COVID-19 vaccines for this group of patients globally. SETTING AND PARTICIPANTS Collaborators from the International Society of Nephrology (ISN), Dialysis Outcomes and Practice Patterns Study and ISN-Global Kidney Health Atlas developed an online survey that was administered electronically to key nephrology leaders in 174 countries between 2 July and 4 August 2021. RESULTS Survey responses were received from 99 of 174 countries from all 10 ISN regions, among which 88/174 (50%) were complete. At least one vaccine was available in 96/99 (97%) countries. In 71% of the countries surveyed, patients on dialysis were prioritised for vaccination, followed by patients living with a kidney transplant (KT) (62%) and stage 4/5 CKD (51%). Healthcare workers were the most common high priority group for vaccination. At least 50% of patients receiving in-centre haemodialysis, peritoneal dialysis or KT were estimated to have completed vaccination at the time of the survey in 55%, 64% and 51% of countries, respectively. At least 50% of patients in all three patient groups had been vaccinated in >70% of high-income countries and in 100% of respondent countries in Western Europe.The most common barriers to vaccination of patients were vaccine hesitancy (74%), vaccine shortages (61%) and mass vaccine distribution challenges (48%). These were reported more in low-income and lower middle-income countries compared with high-income countries. CONCLUSION Patients with advanced CKD or KFRT were prioritised in COVID-19 vaccination in most countries. Multiple barriers led to substantial variability in the successful achievement of COVID-19 vaccination across the world, with high-income countries achieving the most access and success.
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Affiliation(s)
| | | | | | - David W Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | | | - Gavin Dreyer
- Renal Medicine, Barts Health NHS Trust, London, UK
| | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Aminu K Bello
- Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Silvia Salaro
- International Society of Nephrology, Brussels, Belgium
| | - Valerie Ann Luyckx
- Nephrology, University Children's Hospital, Zurich, Switzerland
- Department of Paediatrics and Child Heath, University of Cape Town, Cape Town, South Africa
- Renal Division, Brigham and Women's Hospital, Harvard medical School, Boston, MA, USA
| | - Divya Bajpai
- Nephrology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Antabe R, Robinson K, Husbands W, Miller D, Harriot A, Johnson K, Wong JPH, Poon MKL, Kirya JW, James C. "You have to make it cool": How heterosexual Black men in Toronto, Canada, conceptualize policy and programs to address HIV and promote health. PLoS One 2022; 17:e0278600. [PMID: 36584118 PMCID: PMC9803177 DOI: 10.1371/journal.pone.0278600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 11/18/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Black Canadian communities are disproportionately impacted by HIV. To help address this challenge, we undertook research to engage heterosexual Black men in critical dialogue about resilience and vulnerability. They articulated the necessity of making health services 'cool'. METHODS We draw on the analyses of focus groups and in-depth interviews with 69 self-identified heterosexual Black men and 12 service providers who took part in the 2016 Toronto arm of the weSpeak study to explore what it means to make health and HIV services 'cool' for heterosexual Black Canadian men. RESULTS Our findings revealed four themes on making health services cool: (1) health promotion as a function of Black family systems; (2) opportunities for healthy dialogue among peers through non-judgmental interactions; (3) partnering Black men in intervention design; and (4) strengthening institutional health literacy on Black men's health. CONCLUSIONS We discuss the implications of these findings for improving the health of Black Canadians.
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Affiliation(s)
- Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada
- Graduate Department of Geography and Planning, University of Toronto, Toronto, ON, Canada
| | - Kimberley Robinson
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Winston Husbands
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- * E-mail:
| | - Desmond Miller
- Daphne Cockwell School of Nursing, Faculty of Community Services, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Andre Harriot
- Daphne Cockwell School of Nursing, Faculty of Community Services, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Kwesi Johnson
- School of Child and Youth Care, Faculty of Community Services Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Josephine Pui-Hing Wong
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Daphne Cockwell School of Nursing, Faculty of Community Services, Toronto Metropolitan University, Toronto, Ontario, Canada
| | | | | | - Carl James
- Faculty of Education, York University, Toronto, ON, Canada
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An equitable vaccine delivery system: Lessons from the COVID-19 vaccine rollout in Canada. PLoS One 2022; 17:e0279929. [PMID: 36584230 PMCID: PMC9803301 DOI: 10.1371/journal.pone.0279929] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/18/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic exacerbated existing health disparities and disproportionately affected vulnerable individuals and communities (e.g., low-income, precariously housed or in institutional settings, racialized, migrant, refugee, 2SLBGTQ+). Despite their higher risk of infection and sub-optimal access to healthcare, Canada's COVID-19 vaccination strategy focused primarily on age, as well as medical and occupational risk factors. METHODS We conducted a mixed-methods constant comparative qualitative analysis of epidemiological data from a national database of COVID-19 cases and vaccine coverage in four Canadian jurisdictions. Jurisdictional policies, policy updates, and associated press releases were collected from government websites, and qualitative data were collected through 34 semi-structured interviews of key informants from nine Canadian jurisdictions. Interviews were coded and analyzed for themes and patterns. RESULTS COVID-19 vaccines were rolled out in Canada in three phases, each accompanied by specific challenges. Vaccine delivery systems typically featured large-venue mass immunization sites that presented a variety of barriers for those from vulnerable communities. The engagement and targeted outreach that featured in the later phases were driven predominantly by the efforts of community organizations and primary care providers, with limited support from provincial governments. CONCLUSIONS While COVID-19 vaccine rollout in Canada is largely considered a success, such an interpretation is shaped by the metrics chosen. Vaccine delivery systems across Canada need substantial improvements to ensure optimal uptake and equitable access for all. Our findings suggest a more equitable model for vaccine delivery featuring early establishment of local barrier-free clinics, culturally safe and representative environment, as well as multi-lingual assistance, among other vulnerability-sensitive elements.
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Apprehensions and Optimism among Dental Professionals during the COVID-19 Pandemic-A Nationwide Cross-Sectional Evaluation. Vaccines (Basel) 2022; 10:vaccines10122081. [PMID: 36560491 PMCID: PMC9784201 DOI: 10.3390/vaccines10122081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Globally, the pandemic of the coronavirus disease, which started in Wuhan, China, has become a major issue for public health. The COVID-19 epidemic notably causes health professionals to experience significantly more emotional stress than the general populace. The present study proposes to investigate the fear aspect in dentists in the initiation of clinical practice during these times. An online cross-sectional study was conducted among dental practitioners based on a pre-validated questionnaire. The data were expressed as frequency and percentage analyzed using the chi-square test using SPSS version 25. The data was obtained from 271 participants, where clinical practice after the first wave was mostly by freelancers (p-value = 0.01); most of whom were married (p-value = 0.065); 19.1% attached to institutes did not have changes in earnings; 28.1% of private practitioners had less than 10% reduction in cases. A total of 62% of private practitioners are concerned about the vaccine's preventative effects (p-value = 0.026), and 57% of private practitioners worry about being sued for the delay in treatment (p-value = 0.036). Only 33.1% of employees in institutions worry that becoming sick could endanger their family. As dentists continue to work their way through this pandemic, these pressures only occasionally have an impact on them. According to the researchers, this is the first study that has captured the anxiety and apprehensions that dental practitioners experienced during the height of the COVID-19 outbreak in India in April 2021. The study's findings demonstrate that the study population was generally upbeat and confident that they could quickly overcome their fear.
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Koehle H, Kronk C, Lee YJ. Digital Health Equity: Addressing Power, Usability, and Trust to Strengthen Health Systems. Yearb Med Inform 2022; 31:20-32. [PMID: 36463865 PMCID: PMC9719765 DOI: 10.1055/s-0042-1742512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Without specific attention to health equity considerations in design, implementation, and evaluation, the rapid expansion of digital health approaches threatens to exacerbate rather than ameliorate existing health disparities. METHODS We explored known factors that increase digital health inequity to contextualize the need for equity-centered informatics. This work used a narrative review method to summarize issues about inequities in digital health and to discuss future directions for researchers and clinicians. We searched literature using a combination of relevant keywords (e.g., "digital health", "health equity", etc.) using PubMed and Google Scholar. RESULTS We have highlighted strategies for addressing medical marginalization in informatics according to vectors of power such as race and ethnicity, gender identity and modality, sexuality, disability, housing status, citizenship status, and criminalization status. CONCLUSIONS We have emphasized collaboration with user and patient groups to define priorities, ensure accessibility and localization, and consider risks in development and utilization of digital health tools. Additionally, we encourage consideration of potential pitfalls in adopting these diversity, equity, and inclusion (DEI)-related strategies.
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Affiliation(s)
- Han Koehle
- Student Affairs Health Equity Initiative, University of California Santa Barbara, Santa Barbara, California, USA
| | - Clair Kronk
- Center for Medical Informatics, Yale University School of Medicine, Connecticut, USA,Correspondence to: Clair Kronk Center for Medical Informatics, Yale School of Medicine300 George Street, PO Box 208009 New Haven, CT 06520USA
| | - Young Ji Lee
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Tiwari S, Petrov AN, Devlin M, Welford M, Golosov N, DeGroote J, Degai T, Ksenofontov S. The second year of pandemic in the Arctic: examining spatiotemporal dynamics of the COVID-19 "Delta wave" in Arctic regions in 2021. Int J Circumpolar Health 2022; 81:2109562. [PMID: 35976076 PMCID: PMC9387323 DOI: 10.1080/22423982.2022.2109562] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 11/09/2022] Open
Abstract
The second year of the COVID-19 pandemic in the Arctic was dominated by the Delta wave that primarily lasted between July and December 2021 with varied epidemiological outcomes. An analysis of the Arctic's subnational COVID-19 data revealed a massive increase in cases and deaths across all its jurisdictions but at varying time periods. However, the case fatality ratio (CFR) in most Arctic regions did not rise dramatically and was below national levels (except in Northern Russia). Based on the spatiotemporal patterns of the Delta outbreak, we identified four types of pandemic waves across Arctic regions: Tsunami (Greenland, Iceland, Faroe Islands, Northern Norway, Northern Finland, and Northern Canada), Superstorm (Alaska), Tidal wave (Northern Russia), and Protracted Wave (Northern Sweden). These regionally varied COVID-19 epidemiological dynamics are likely attributable to the inconsistency in implementing public health prevention measures, geographical isolation, and varying vaccination rates. A lesson remote and Indigenous communities can learn from the Arctic is that the three-prong (delay-prepare-respond) approach could be a tool in curtailing the impact of COVID-19 or future pandemics. This article is motivated by previous research that examined the first and second waves of the pandemic in the Arctic. Data are available at https://arctic.uni.edu/arctic-covid-19.
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Affiliation(s)
- Sweta Tiwari
- ARCTICenter, University of Northern Iowa, Cedar Falls, Iowa, USA
- Department of Geography, University of Northern Iowa, Cedar Falls, Iowa, USA
| | - Andrey N. Petrov
- ARCTICenter, University of Northern Iowa, Cedar Falls, Iowa, USA
- Department of Geography, University of Northern Iowa, Cedar Falls, Iowa, USA
| | - Michele Devlin
- ARCTICenter, University of Northern Iowa, Cedar Falls, Iowa, USA
- Center for Strategic Leadership, USA Army War College, Carlisle, Pennsylvania, USA
| | - Mark Welford
- Department of Geography, University of Northern Iowa, Cedar Falls, Iowa, USA
| | - Nikolay Golosov
- Department of Geography, Pennsylvania State University, Harrisburg, Pennsylvania, USA
| | - John DeGroote
- Department of Geography, University of Northern Iowa, Cedar Falls, Iowa, USA
| | - Tatiana Degai
- ARCTICenter, University of Northern Iowa, Cedar Falls, Iowa, USA
- Department of Anthropology, University of Victoria, Victoria, British Columbia, Canada
| | - Stanislav Ksenofontov
- ARCTICenter, University of Northern Iowa, Cedar Falls, Iowa, USA
- Department of Geography, University of Northern Iowa, Cedar Falls, Iowa, USA
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Aylsworth L, Manca T, Dubé È, Labbé F, Driedger SM, Benzies K, MacDonald N, Graham J, MacDonald SE. A qualitative investigation of facilitators and barriers to accessing COVID-19 vaccines among Racialized and Indigenous Peoples in Canada. Hum Vaccin Immunother 2022; 18:2129827. [PMID: 36218335 DOI: 10.1080/21645515.2022.2129827] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Structural and systemic inequalities can contribute to susceptibility to COVID-19 disease and limited access to vaccines. Recognizing that Racialized and Indigenous Peoples may experience unique barriers to COVID-19 vaccination, this study explored early COVID-19 vaccine accessibility, including barriers and potential solutions to vaccine access, for these communities in Canada. We conducted semi-structured interviews about challenges to accessing COVID-19 vaccination with Racialized and Indigenous Peoples, including linguistic minorities and newcomers, in Spring 2021, just as COVID-19 vaccines were becoming more widely available in Canada. Participants were purposely selected from respondents to a Canadian national online survey. Three researchers analyzed the interviews for emergent themes using a descriptive content analysis approach in NVivo. At the time of the interview, interview participants (N = 27) intended to receive (n = 15) or had received (n = 11) at least one vaccine dose, or did not state their status (n = 1). Participants described multiple barriers to COVID-19 vaccination that they personally experienced and/or anticipated they or others could experience - including technology requirements, language barriers, lack of identification documentation, and travel challenges - as well as related solutions. These were organized into three broad categories: 1) COVID-19 disease and vaccination information, 2) vaccination booking procedures, and 3) vaccination sites. These structural and systemic barriers during the initial months of vaccine rollout substantially restricted participants' COVID-19 vaccination access, even when they were eager to get vaccinated, and should be addressed early in vaccine rollouts to facilitate optimal uptake for everyone everywhere.
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Affiliation(s)
- Laura Aylsworth
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Terra Manca
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Ève Dubé
- Direction des risques biologiques et de la Santé au travail, Institut National de Santé Publique du Québec, Québec, Quebec, Canada
| | - Fabienne Labbé
- Direction des risques biologiques et de la Santé au travail, Institut National de Santé Publique du Québec, Québec, Quebec, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.,Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Noni MacDonald
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janice Graham
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Technoscience & Regulation Research Unit, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Lowe M, Harmon SHE, Kholina K, Parker R, Graham JE. Public health communication in Canada during the COVID-19 pandemic. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:34-45. [PMID: 36329358 PMCID: PMC9633012 DOI: 10.17269/s41997-022-00702-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Communication is central to the implementation and effectiveness of public health measures. Informed by theories of good governance, COVID-19 pandemic public health messaging in 3 Canadian provinces is assessed for its potential to encourage or undermine public trust and adherence. METHODS This study employed a mixed-methods constant comparative approach to triangulate epidemiological COVID-19 data and qualitative data from news releases, press briefings, and key informant interviews. Communications were analyzed from January 2020 to October 2021 in Nova Scotia, Ontario, and Alberta. Interview data came from 34 semi-structured key informant interviews with public health actors across Canada. Team-based coding and thematic analysis were conducted to analyze communications and interview transcripts. RESULTS Four main themes emerged as integral to good communication: transparency, promptness, clarity, and engagement of diverse communities. Our data indicate that a lack of transparency surrounding evidence and public health decision-making, delays in public health communications, unclear and inconsistent terminology and activities within and across jurisdictions, and communications that did not consider or engage diverse communities' perspectives may have decreased the effectiveness of public health communications and adherence to public health measures throughout the COVID-19 pandemic. CONCLUSION This study suggests that increased federal guidance with wider jurisdictional collaboration backed by transparent evidence could improve the effectiveness of communication practices by instilling public trust and adherence with public health measures. Effective communication should be transparent, supported by reliable evidence, prompt, clear, consistent, and sensitive to diverse values. Improved communication training, established engagement infrastructure, and increased collaborations and diversity of decision-makers and communicators are recommended.
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Affiliation(s)
- Maya Lowe
- Department of Pediatrics (Infectious Diseases), Faculty of Medicine, Dalhousie University, Halifax, NS Canada ,Technoscience & Regulation Research Unit, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Shawn H. E. Harmon
- Department of Pediatrics (Infectious Diseases), Faculty of Medicine, Dalhousie University, Halifax, NS Canada ,Technoscience & Regulation Research Unit, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Ksenia Kholina
- Department of Pediatrics (Infectious Diseases), Faculty of Medicine, Dalhousie University, Halifax, NS Canada ,Technoscience & Regulation Research Unit, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Rachel Parker
- Department of Pediatrics (Infectious Diseases), Faculty of Medicine, Dalhousie University, Halifax, NS Canada ,Technoscience & Regulation Research Unit, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
| | - Janice E. Graham
- Department of Pediatrics (Infectious Diseases), Faculty of Medicine, Dalhousie University, Halifax, NS Canada ,Technoscience & Regulation Research Unit, Faculty of Medicine, Dalhousie University, Halifax, NS Canada
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Manca T, Humble RM, Aylsworth L, Cha E, Wilson SE, Meyer SB, Greyson D, Sadarangani M, Parsons Leigh J, MacDonald SE. "We need to protect each other": COVID-19 vaccination intentions and concerns among Racialized minority and Indigenous Peoples in Canada. Soc Sci Med 2022; 313:115400. [PMID: 36206660 PMCID: PMC9519366 DOI: 10.1016/j.socscimed.2022.115400] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/21/2022] [Accepted: 09/24/2022] [Indexed: 01/26/2023]
Abstract
People may choose to receive vaccines in response to pressures that outweigh any concerns that they have. We explored Racialized minority and Indigenous Peoples' motivations for, perceptions of choice in, and concerns about, COVID-19 vaccination. We used a sequential explanatory mixed methods approach, including a national survey administered around the time vaccines were first authorized (Dec 2020) followed by qualitative interviews when vaccines were becoming more readily available to adults (May-June 2021). We analyzed survey data using descriptive statistics and interviews using critical feminist methodologies. Survey respondents self-identified as a Racialized minority (n = 1488) or Indigenous (n = 342), of which 71.4% and 64.6%, respectively, intended to receive a COVID-19 vaccine. Quantitative results indicated perceptions of COVID-19 disease were associated with vaccination intention. For instance, intention was associated with agreement that COVID-19 disease is severe, risk of becoming sick is great, COVID-19 vaccination is necessary, and vaccines available in Canada will be safe (p < 0.001). COVID-19 vaccines were in short supply in Canada when we subsequently completed qualitative interviews with a subset of Racialized minority (n = 17) and Indigenous (n = 10) survey respondents. We coded interview transcripts around three emergent themes relating to governmentality and cultural approaches to intersectional risk theories: feelings of collective responsibility, choice as privilege, and remaining uncertainties about COVID-19 vaccines. For example, some mentioned the responsibility and privilege to receive a vaccine earlier than those living outside of Canada. Some felt constraints on their freedom to choose to receive or refuse a vaccine from intersecting oppressions or their health status. Although all participants intended to get vaccinated, many mentioned uncertainties about the safety and effectiveness of COVID-19 vaccination. Survey respondents and interview participants demonstrated nuanced associations of vaccine acceptance and hesitancy shaped by perspectives of vaccine-related risks, symbolic associations of vaccines with hope, and intersecting social privileges and inequities (including racialization).
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Affiliation(s)
- Terra Manca
- Faculty of Nursing, University of Alberta, Canada,Corresponding author
| | | | | | - Eunah Cha
- Faculty of Nursing, University of Alberta, Canada
| | - Sarah E. Wilson
- Public Health Ontario, ICES, Canada,Dalla School of Public Health, University of Toronto, Canada
| | - Samantha B. Meyer
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Canada
| | - Devon Greyson
- School of Population and Public Health, University of British Columbia, Canada,Vaccine Evaluation Center, BC Children's Hospital Research Institute, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Canada,Department of Pediatrics, University of British Columbia, Canada
| | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Canada
| | - Shannon E. MacDonald
- Faculty of Nursing, University of Alberta, Canada,School of Public Health, University of Alberta, Canada
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Loukes KA, Anderson S, Beardy J, Rondeau MC, Robidoux MA. Wapekeka's COVID-19 Response: A Local Response to a Global Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11562. [PMID: 36141860 PMCID: PMC9517115 DOI: 10.3390/ijerph191811562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/26/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Two years after the onset of the COVID-19 pandemic, many nations and communities continue to grapple with waves of infection and social fallout from pandemic fatigue and frustration. While we are still years away from realizing the full impacts of COVID-19, reflecting on our collective responses has offered some insights into the impact that various public health policies and decisions had on nations' abilities to weather the multifaceted impacts of the pandemic. Widely believed to have the potential to be devastated by COVID-19, many Indigenous communities in Canada were extremely successful in managing outbreaks. This paper outlines one such example, Wapekeka First Nation, and the community's formidable response to the pandemic with a specific focus on food mobilization efforts. Built on over a decade of community-based participatory action research and informed by six interviews with key pandemic leaders in the community, this paper, co-led by two community hunters and band council members, emphasizes the various decisions and initiatives that led to Wapekeka's successful pandemic response. Proactive leadership, along with strong traditional harvesting and processing efforts, helped to take care of the community while they remained strictly isolated from virus exposure.
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Affiliation(s)
- Keira A. Loukes
- School of Outdoor Recreation, Parks, and Tourism, Lakehead University, Thunder Bay, ON P7B5E1, Canada
- Indigenous Health Research Group (IHRG), University of Ottawa, Ottawa, ON K1N6N5, Canada
| | - Stan Anderson
- Wapekeka First Nation, Angling Lake, ON P0V1B0, Canada
| | - Jonas Beardy
- Wapekeka First Nation, Angling Lake, ON P0V1B0, Canada
| | | | - Michael A. Robidoux
- Indigenous Health Research Group (IHRG), University of Ottawa, Ottawa, ON K1N6N5, Canada
- School of Human Kinetics, University of Ottawa, Ottawa, ON K1N6N5, Canada
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Yeo J, Furr Gudmundsen C, Fazel S, Corrigan A, Fullerton MM, Hu J, Jadavji T, Kuhn S, Kassam A, Constantinescu C. A Behavior Change Model to Address Caregiver Hesitancy around COVID-19 Vaccination in Pediatrics. Vaccine 2022; 40:5664-5669. [PMID: 35987872 PMCID: PMC9353609 DOI: 10.1016/j.vaccine.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022]
Abstract
Introduction Many families express hesitancy around immunizing their children against COVID-19. We sought to better understand the perspectives of vaccine hesitant caregivers, and develop targeted recommendations for health care workers and policymakers to engage in more effective vaccine discussions. Methods We conducted semi-structured telephone interviews with 23 caregivers recruited from a pediatric infectious diseases clinic, including a subset of patients referred to discuss vaccine hesitancy. Thematic analysis of the interviews identified themes that were mapped using behavior change models to identify perceived barriers and facilitators towards COVID-19 immunization. Results Barriers and facilitators were mapped to the WHO (World Health Organization) 3C’s (confidence, complacency, convenience) model of vaccine hesitancy as well as the COM-B (capability, opportunity, motivation) behavior change model. Barriers included mistrust in authorities, misperception of the risk of COVID-19 in children, and perceived health contraindications and negative previous vaccine experiences. Facilitators included positive relationships with healthcare workers, the promise of a “return to normal”, and societal pressures to immunize. Conclusions Efforts to increase vaccine uptake in the pediatric population must target specific barriers and facilitators to immunization expressed by caregivers. To address these concerns, we suggest: 1. Educating hesitant caregivers by highlighting the long-term pandemic effects on children and the threat of COVID-19 to children’s health, 2. Building on the trust caregivers have in healthcare workers by involving frontline workers in public health policy, and 3. Harnessing the power of peer pressure by mobilization of societal pressures and establishing COVID-19 vaccination as the norm in children.
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Affiliation(s)
- Jordan Yeo
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Sajjad Fazel
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alex Corrigan
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Jia Hu
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Taj Jadavji
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Section of Pediatric Infectious Diseases, Alberta Children's Hospital, Calgary, AB, Canada
| | - Susan Kuhn
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Section of Pediatric Infectious Diseases, Alberta Children's Hospital, Calgary, AB, Canada
| | - Aliya Kassam
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Cora Constantinescu
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Section of Pediatric Infectious Diseases, Alberta Children's Hospital, Calgary, AB, Canada.
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Leslie M, Pinto N, Fadaak R. Improving Conversations With COVID-19 Vaccine Hesitant Patients: Action Research to Support Family Physicians. Ann Fam Med 2022; 20:368-373. [PMID: 35443974 PMCID: PMC9328713 DOI: 10.1370/afm.2816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 02/01/2022] [Accepted: 03/02/2022] [Indexed: 11/09/2022] Open
Abstract
Vaccination delivery and efforts to counter vaccine hesitancy have become focal issues for family medicine teams as the COVID-19 pandemic has evolved. Conducting action research, our team developed an interactive web-based guide to improve clinical conversations around a broad range of vaccine hesitancies presented by patients. The paper presents a step-by-step account of the guide being codesigned with family physicians-its targeted end users-in a process that included validation interviews; role-play interviews; and user-tested design. The validation interviews sought to understand the pragmatic realities of vaccine hesitancy in family medicine clinical practice relative to relevant psychological theories. The role-play interviews drew out conversational strategies and advice from family physicians. The principles of motivational interviewing-an evidence-based approach to vaccine hesitancy conversations that supplements information deficit approaches-were used to codesign the content and layout of the guide. User counts, stakeholder engagement, and web-based analytics indicate the guide is being used extensively. Formal evaluation of the guide is presently underway.Originally published as Annals "Online First" article.
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Affiliation(s)
- Myles Leslie
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Pinto
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
| | - Raad Fadaak
- School of Public Policy, University of Calgary, Calgary, Alberta, Canada
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Juarez R, Phankitnirundorn K, Okihiro M, Maunakea AK. Opposing Role of Trust as a Modifier of COVID-19 Vaccine Uptake in an Indigenous Population. Vaccines (Basel) 2022; 10:968. [PMID: 35746577 PMCID: PMC9229995 DOI: 10.3390/vaccines10060968] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 01/26/2023] Open
Abstract
Native Hawaiians and other Pacific Islanders (NHPIs) were disproportionately impacted by COVID-19 and remain significantly under-vaccinated against SARS-CoV-2. To understand vaccine hesitancy, we surveyed 1124 adults residing in a region with one of the lowest vaccination rates in Hawaii during our COVID-19 testing program. Probit regression analysis revealed that race/ethnicity was not directly associated with the probability of vaccine uptake. Instead, a higher degree of trust in official sources of COVID-19 information increased the probability of vaccination by 20.68%, whereas a higher trust in unofficial sources decreased the probability of vaccination by 12.49% per unit of trust. These results revealed a dual and opposing role of trust on vaccine uptake. Interestingly, NHPIs were the only racial/ethnic group to exhibit a significant positive association between trust in and consumption of unofficial sources of COVID-19 information, which explained the vaccine hesitancy observed in this indigenous population. These results offer novel insight relevant to COVID-19 mitigation efforts in minority populations.
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Affiliation(s)
- Ruben Juarez
- Department of Economics and UHERO, University of Hawaii, Honolulu, HI 96822, USA;
| | - Krit Phankitnirundorn
- Department of Economics and UHERO, University of Hawaii, Honolulu, HI 96822, USA;
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA;
| | - May Okihiro
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA;
| | - Alika K. Maunakea
- Department of Anatomy, Biochemistry and Physiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA;
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Leigh JP, Brundin-Mather R, Soo A, FitzGerald E, Mizen S, Dodds A, Ahmed S, Burns KEA, Plotnikoff KM, Rochwerg B, Perry JJ, Benham JL, Honarmand K, Hu J, Lang R, Stelfox HT, Fiest K. Public perceptions during the first wave of the COVID-19 pandemic in Canada: a demographic analysis of self-reported beliefs, behaviors, and information acquisition. BMC Public Health 2022; 22:699. [PMID: 35397530 PMCID: PMC8994420 DOI: 10.1186/s12889-022-13058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
We explored associations between sociodemographic factors and public beliefs, behaviors, and information acquisition related to the coronavirus disease 2019 (COVID-19) to identify how the experiences of subpopulations in Canada may vary.
Methods
We administered a national online survey through Ipsos Incorporated to adults residing in Canada. Sampling was stratified by population age, sex, and regional distributions. We used descriptive statistics to summarize responses and test for differences based on gender, age, educational attainment, and household income using chi-squared tests, followed by weighted logistic regression.
Results
We collected 1996 eligible questionnaires between April 26th and May 1st, 2020. Respondents mean age was 50 years, 51% were women, 56% had a post-secondary degree, and 72% had a household income <$100,000. Our analysis found differences within the four demographic groups, with age effects most acutely evidenced. Respondents 65 years and older were more likely to perceive the pandemic as very serious, less likely to report declines in overall health, and more likely to intend to get vaccinated, compared to 18–29 year olds. Women overall were more likely to report negative outcomes than men, including stress due to the pandemic, and worsening social, mental/emotional, and spiritual health. Respondents 45 and older were more likely to seek and trust information from traditional Canadian news sources, while 18-29 year olds were more likely to seek and trust information on social media; overall, women and respondents with a post-secondary degree were more likely to access and trust online information from public health sites.
Conclusion
This study found important demographic differences in how adults living in Canada perceived the COVID-19 pandemic, the impacts on their health, and their preferences for information acquisition. Our results highlight the need to consider demographic characteristics in tailoring the format and information medium to improve large scale acceptance and uptake of mitigation and containment measures.
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Lessard D, Ortiz-Paredes D, Park H, Varsaneux O, Worthington J, Basta NE, MacDonald SE, Lebouché B, Cox J, Ismail SJ, Kronfli N. Barriers and facilitators to COVID-19 vaccine acceptability among people incarcerated in Canadian federal prisons: A qualitative study. Vaccine X 2022; 10:100150. [PMID: 35243324 PMCID: PMC8883835 DOI: 10.1016/j.jvacx.2022.100150] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/24/2022] [Accepted: 02/16/2022] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Canadian correctional institutions have been prioritized for COVID-19 vaccination given the multiple outbreaks that have occurred since the start of the pandemic. Given historically low vaccine uptake, we aimed to explore barriers and facilitators to COVID-19 vaccination acceptability among people incarcerated in federal prisons. METHODS Three federal prisons in Quebec, Ontario, and British Columbia (Canada) were chosen based on previously low influenza vaccine uptake among those incarcerated. Using a qualitative design, semi-structured interviews were conducted with a diverse sample (gender, age, and ethnicity) of incarcerated people. An inductive-deductive analysis of audio-recorded interview transcripts was conducted to identify and categorize barriers and facilitators within the Theoretical Domains Framework (TDF). RESULTS From March 22-29, 2021, a total of 15 participants (n = 5 per site; n = 5 women; median age = 43 years) were interviewed, including five First Nations people and six people from other minority groups. Eleven (73%) expressed a desire to receive a COVID-19 vaccine, including two who previously refused influenza vaccination. We identified five thematic barriers across three TDF domains: social influences (receiving strict recommendations, believing in conspiracies to harm), beliefs about consequences (believing that infection control measures will not be fully lifted, concerns with vaccine-related side effects), and knowledge (lack of vaccine-specific information), and eight thematic facilitators across five TDF domains: environmental context and resources (perceiving correctional employees as sources of outbreaks, perceiving challenges to prevention measures), social influences (receiving recommendations from trusted individuals), beliefs about consequences (seeking individual and collective protection, believing in a collective "return to normal", believing in individual privileges), knowledge (reassurance about vaccine outcomes), and emotions (having experienced COVID-19-related stress). CONCLUSIONS Lack of information and misinformation were important barriers to COVID-19 vaccine acceptability among people incarcerated in Canadian federal prisons. This suggests that educational interventions, delivered by trusted health care providers, may improve COVID-19 vaccine uptake going forward.
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Affiliation(s)
- David Lessard
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trial in HIV, Research Institute of the McGill University Health Centre, Canada
| | - David Ortiz-Paredes
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Canada
| | - Hyejin Park
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Canada
| | | | | | - Nicole E. Basta
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Canada
| | - Shannon E. MacDonald
- Faculty of Nursing, University of Alberta, Canada
- School of Public Health, University of Alberta, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trial in HIV, Research Institute of the McGill University Health Centre, Canada
- Department of Family Medicine, McGill University, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Canada
| | - Joseph Cox
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Canada
| | - Shainoor J. Ismail
- Division of Immunization Programs and Pandemic Preparedness, Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada and Metro City Medical Clinic, Canada
| | - Nadine Kronfli
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Canada
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Abstract
In several countries, governments have implemented so-called 'COVID passport' schemes, which restrict access to venues such as bars or sports events to those who are vaccinated against COVID-19 and/or exempt vaccinated individuals from public health measures such as curfews or quarantine requirements. These schemes have been the subject of a heated debate. Concerns about inequality have played an important role in the opposition to such schemes. This article highlights that determining how COVID passports affect equality requires a much more nuanced analysis than is typically assumed. I identify a range of broadly egalitarian considerations that could be affected by the introduction of COVID passport schemes. While these schemes could undermine certain aspects of equality, I argue that they could also be used to promote equality. The magnitude and severity of these different effects, both promoting and undermining equality, depend on how precisely these schemes are framed and the local context in which they are implemented.
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Affiliation(s)
- Kristin Voigt
- Institute for Health and Social Policy and Department of Philosophy, McGill University, Canada
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COVID-19 vaccine hesitancy among marginalized populations in the U.S. and Canada: Protocol for a scoping review. PLoS One 2022; 17:e0266120. [PMID: 35358267 PMCID: PMC8970476 DOI: 10.1371/journal.pone.0266120] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Despite the development of safe and highly efficacious COVID-19 vaccines, extensive barriers to vaccine deployment and uptake threaten the effectiveness of vaccines in controlling the pandemic. Notably, marginalization produces structural and social inequalities that render certain populations disproportionately vulnerable to COVID-19 incidence, morbidity, and mortality, and less likely to be vaccinated. The purpose of this scoping review is to provide a comprehensive overview of definitions/conceptualizations, elements, and determinants of COVID-19 vaccine hesitancy among marginalized populations in the U.S. and Canada. Materials and methods The proposed scoping review follows the framework outlined by Arksey and O’Malley, and further developed by the Joanna Briggs Institute. It will comply with reporting guidelines from the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The overall research question is: What are the definitions/conceptualizations and factors associated with vaccine hesitancy in the context of COVID-19 vaccines among adults from marginalized populations in the U.S. and Canada. Search strategies will be developed using controlled vocabulary and selected keywords, and customized for relevant databases, in collaboration with a research librarian. The results will be analyzed and synthesized quantitatively (i.e., frequencies) and qualitatively (i.e., thematic analysis) in relation to the research questions, guided by a revised WHO Vaccine Hesitancy Matrix. Discussion This scoping review will contribute to honing and advancing the conceptualization of COVID-19 vaccine hesitancy and broader elements and determinants of underutilization of COVID-19 vaccination among marginalized populations, identify evidence gaps, and support recommendations for research and practice moving forward.
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