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Purvis RS, Moore R, Rojo MO, Riklon S, Alik E, Alik D, Maddison BK, McElfish PA. COVID-19 vaccine hesitancy among Marshallese in Northwest Arkansas (USA). J Public Health Res 2024; 13:22799036241231549. [PMID: 38440055 PMCID: PMC10910884 DOI: 10.1177/22799036241231549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/23/2024] [Indexed: 03/06/2024] Open
Abstract
Background COVID-19 has disproportionately affected Pacific Islander communities, with disparities in the prevalence of infection, serious illness, and death compared to non-Hispanic whites in the US. Marshallese Pacific Islanders face significant COVID-19 disparities. Design and methods This exploratory study aimed to understand Marshallese community attitudes about the COVID-19 vaccine to identify and implement culturally relevant strategies to encourage vaccine uptake. Data were collected from 17 participants in three focus groups. Results Using content analysis, researchers identified two global themes: (1) barriers to vaccination and (2) facilitators of COVID-19 vaccine uptake. Within these themes, participants described fear, lack of knowledge about vaccines, negative perceptions of the COVID-19 vaccine, health concerns, and transportation as barriers to vaccination. Participants described several factors influencing vaccine behavior, including location of and personnel at vaccine clinics, vaccine experiences, the need for trusted information, positive perceptions, cultural leaders, and mandates. Conclusions The qualitative study makes a significant contribution as the first to report community perceptions and experiences related to the COVID-19 vaccine in Marshallese participants' own words. Findings show that cultural influencers and brokers are crucial bridges for public health messaging related to COVID-19 vaccination targeted to this vulnerable and underserved population. Culturally appropriate and effective public health messaging can help achieve vaccine equity and improve COVID-19-related health disparities in the Marshallese community.
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Affiliation(s)
- Rachel S Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | - Martha O Rojo
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR, USA
| | - Eldon Alik
- Republic of the Marshall Islands Consulate, Springdale, AR, USA
| | - Derek Alik
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
| | | | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, USA
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Andersen JA, Purvis RS, Scott AJ, Henske J, Edem D, Selig JP, Hudson J, Bing WI, Niedenthal J, Otuafi H, Riklon S, Anzures E, George A, Alik D, McElfish PA. Lessons learned from the pilot family model of diabetes self-management intervention in the Republic of the Marshall Islands. Contemp Clin Trials Commun 2023; 32:101086. [PMID: 36817737 PMCID: PMC9929673 DOI: 10.1016/j.conctc.2023.101086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
Background The Republic of the Marshall Islands (RMI) has a high rate of type 2 diabetes mellitus (T2DM). To address the high rate of T2DM, we tested a culturally adapted family model of diabetes self-management education and support (F-DSMES). We report the results of the 12-month post-intervention data collection and describe the lessons learned from the delivery of the F-DSMES intervention. Methods Recruitment took place in four churches in Majuro and included 10 h of content delivered over 8-10 weeks. Forty-one participants with T2DM were included. The primary study outcome was glycemic control measured by a change in HbA1c. We also conducted participant interviews to document the participant-reported barriers encountered during the F-DSMES intervention. Results Participants did not show improvements in their biometric markers; however, participants did show improvement on multiple measures of diabetes knowledge and family support. We identified five areas to improve future interventions: 1) issues with recruitment, retention, and attendance; 2) needing help accessing information and additional healthcare provider counseling; 3) struggles with adhering to diet recommendations; 4) difficulty getting exercise, and 5) improving lessons within the intervention. Conclusion Although the biomarker data did not show improvement, valuable information was gained to improve the development of larger-scale trials. The results provide evidence of the need for these trials and the desire of participants to continue pursuing this effort. Others doing similar work in other low-to-middle income countries will need to take into consideration the potential barriers and facilitators within participants' social and physical environments.
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Affiliation(s)
- Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Aaron J. Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Joseph Henske
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Dinesh Edem
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - James P. Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Jonell Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Williamina Ioanna Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Jack Niedenthal
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH, 96960, USA
| | - Henry Otuafi
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH, 96960, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA
| | - Edlen Anzures
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH, 96960, USA
| | - Ainrik George
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH, 96960, USA
| | - Derek Alik
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, 72762, USA,Corresponding author. College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA.
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Willis DE, Montgomery BE, Selig JP, Andersen JA, Shah SK, Li J, Reece S, Alik D, McElfish PA. COVID-19 vaccine hesitancy and racial discrimination among US adults. Prev Med Rep 2022; 31:102074. [PMID: 36466305 PMCID: PMC9703864 DOI: 10.1016/j.pmedr.2022.102074] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Vaccination is a critical preventive measure to reduce COVID-19 health risks. We utilize full information maximum likelihood (FIML) logistic regression to analyze COVID-19 vaccine hesitancy in a national sample of United States (US) adults (N = 2,022). Online survey data was collected between September 7th and October 3rd, 2021. Before weighting, the racial composition of the sample was as follows: Asian American (15.0 %), Black/African American (20.0 %), Hispanic/Latino (20.0 %), American Indian or Alaska Native (12.6 %), Native Hawaiian or Pacific Islander (12.5 %), and White (20.0 %). Informed by the Increasing Vaccination Model (IVM), we assessed the relationship between COVID-19 vaccine hesitancy and experiences of racial discrimination (Krieger's 9-item measure). Odds of COVID-19 vaccine hesitancy were greater for most younger age groups, women (OR = 1.96; 95 % CI[1.54, 2.49]), Black/African American respondents (OR = 1.68; 95 % CI[1.18, 2.39]), those with a high school education or less (OR = 1.46; 95 % CI[1.08, 1.98]), Independent (OR = 1.77; 95 % CI[1.34, 2.35]) or Republican political affiliation (OR = 2.69; 95 % CI[1.92, 3.79]), and prior COVID-19 infection (OR = 1.78; 95 % CI[1.29, 2.45]). Odds of COVID-19 vaccine hesitancy were 1.04 greater for every-one unit increase in lifetime experiences of racial discrimination (95 % CI[1.02, 1.05]). Odds of COVID-19 vaccine hesitancy were lower for Asian American respondents (OR = 0.682; 95 % CI[0.480, 0.969]), and those who had a primary care doctor had reduced odds of COVID-19 vaccine hesitancy (OR = 0.735; 95 % CI[0.542, 0.998). Our primary finding provides support for a link between experiences of racial discrimination and hesitancy towards a COVID-19 vaccine among US adults. We discuss implications for public health officials and future research.
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Affiliation(s)
- Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Brooke E.E. Montgomery
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - James P. Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Sumit K. Shah
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Ji Li
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Sharon Reece
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Derek Alik
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA,Corresponding author.
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