COVID-19 Vaccination Rates and Vaccine Hesitancy Among Spanish-Speaking Free Clinic Patients

Attitudes and beliefs regarding COVID-19 and COVID-19 Omicron booster vaccine among adults in the vaccine safety datalink, 2022-2023

COVID-19 vaccination rates are decreasing despite vaccination being the most effective tool against severe disease from COVID-19. From October 1, 2022, to February 1, 2023, we conducted a cross-sectional study among adults in the Vaccine Safety Datalink about attitudes and beliefs regarding bivalent COVID-19 Omicron booster vaccine (hereafter referred to as COVID-19 bivalent vaccine) stratifying by vaccination status and race and ethnicity. Analysis was weighted for response and selection bias. The response rate was 27% (385/1430); 33% [95% CI: 21%-44%] of respondents were 'fully vaccinated' (had received COVID-19 bivalent vaccine), 54% [42%-67%] were partially vaccinated, and 13% [7%-19%] were unvaccinated. Fully vaccinated adults were more likely to consider COVID-19 bivalent vaccine 'very effective' (64%, [43%-86%]) at preventing hospitalization due to COVID-19 than partially (31%, [12%-50%]) or unvaccinated (2%, [0%-6%]) adults. Fully vaccinated adults were more likely to report COVID-19 bivalent vaccine was 'very safe' (83%, [69%-98%]) than partially (43%, [23%-63%]) or unvaccinated adults (2%, 0%-6%). Non-Hispanic White adults were more likely to report COVID-19 bivalent vaccine was 'very safe' (71%, [54%-87%]) than Non-Hispanic Black (36%, [21%-50%]) and Hispanic (26%, [7%-45%]) adults. A dose-response effect between vaccination status and perceptions of COVID-19 bivalent vaccine safety and effectiveness was observed, with fully vaccinated respondents having the most favorable attitudes. Racial and ethnic differences in perceived vaccine safety were also found. Improved communication about vaccine effectiveness and safety is key to improving low vaccination rates.

Vaccine Beliefs Among Uninsured People Receiving Care at Free Clinics

BACKGROUND

Misinformation and vaccination hesitancy contribute to disparities in vaccination rates, particularly in under-resourced communities. This study aims to investigate perceptions and factors influencing vaccination decisions at free clinics serving diverse, under-resourced communities.

METHODS

Surveys were conducted across eight free clinics in the Greater Sacramento area, targeting uninsured or underinsured individuals. Information on demographics, sources of vaccine information, access to vaccines, vaccine perceptions, and vaccination decisions as pertaining to influenza and COVID-19 were collected on Qualtrics software. Chi-square and t-tests were used to analyze associations between demographics and vaccination rates.

RESULTS

Among 109 participants (24-82 years old), vaccination rates were found to be higher than the county average, with notable demographic variations. Contrary to initial hypotheses, men had higher vaccination rates than women, and recent immigrants exhibited higher vaccination rates than more long-term U.S. residents. A higher number of participants regarded the COVID-19 vaccine as effective than as safe, while the reverse was true for the influenza vaccine. Healthcare providers were the most trusted and influential sources for vaccine information, followed by government agencies, and then family and friends. Answers to hypothetical vaccine scenarios elicited assessments on risks and benefits.

CONCLUSION

The study provides insight into the dynamics of vaccine hesitancy and factors that play into the decision-making process in under-resourced communities, underscoring the role of trust in healthcare providers. These findings are vital for tailoring community outreach strategies to create trust, address barriers, and enhance vaccine uptake within free community clinics.

Facilitators and Barriers to COVID-19 Vaccine Uptake Among Meat Processing Workers in Nebraska: A Mixed-Methods Analysis Using the COM-B Model

The meat processing industry was significantly impacted by the COVID-19 pandemic. Deemed essential, the meat processing workforce faced the risk of exposure to the SARS-CoV-2 virus. Along with other essential workforces, meat processing workers were prioritized in the national approach to receive COVID-19 vaccines by the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices. This mixed methods study aimed to identify the facilitators and barriers to COVID-19 vaccine uptake by meat processing workers in Nebraska through interviews (n = 29), a survey (n = 857), and application of the COM-B model. We found that facilitators for vaccine uptake included having information about the vaccine available; providing vaccines at the workplace, in pharmacies, and throughout the community to increase accessibility; feeling that there was a social responsibility to get vaccinated; believing that the vaccine was protective; and the use of various incentives. Barriers for vaccine uptake included workers' personal health issues; not having the right information to make an informed decision; logistical and contextual issues that made it challenging to get vaccinated; the disconnect between faith and science; individual choice being highly valued; and uncertainty and misinformation causing fear of the vaccine. Understanding facilitators and barriers to vaccine uptake by meat processing workers is critical to informing public health interventions, evidence-informed guidelines and policies, and tailored messaging to increase vaccination coverage among an essential workforce that inherently assumes occupational risk during infectious disease events, such as the COVID-19 pandemic. Implications for public health practitioners are provided.

Preventative care in student-run free clinics: a narrative review on feasibility, ethics, and recommendations

BACKGROUND

Student-run free clinics are critical for medical education and medical care of underserved populations. This paper explores the feasibility of establishing ethical preventative health services at student-run free clinics such as the Rochester Education and Advocacy for Community Health (REACH) Clinic, affiliated with the Mayo Clinic Alix School of Medicine. Our analysis discusses the challenges and ethical considerations of providing preventative healthcare in student-run clinics. This paper also provides recommendations for implementing preventative care at REACH and other student-run clinics.

METHODS

A literature search was conducted by an experienced librarian across four databases using keywords "student-run clinics" and "preventative healthcare." Additionally, contributing authors identified and gathered data about community service organizations that provide preventative healthcare services to residents of Rochester, MN and surrounding areas.

RESULTS

The literature search yielded 50 articles, 20 of which were included in the narrative review. Vaccinations and cancer screenings were the two preventative care initiatives most commonly undertaken by student-run clinics. The benefits of student-run clinic initiatives for both patients and students were an emerging theme. Clinics often achieved high vaccination and screening rates, and integration of preventative care topics into medical curricula was valued by students. However, the limitations of student-run clinics also emerged as a theme, particularly limitations to resources and comprehensive follow-up. 15 community health organizations in/around Rochester, MN were identified; of these, five provide preventative healthcare services.

CONCLUSION

Student-run clinics like REACH play a key role in delivering preventative care to underserved populations, bridging critical gaps in our healthcare system, and benefiting patients and students alike. However, the ethical principles of beneficence and non-maleficence should be considered when student-run clinics decide what services to offer. Preventative care has been successfully implemented at other student-run clinics but requires careful arrangement of adequate follow-up care, especially when it comes to cancer screening. Vaccinations are a low-cost, high-impact initiative that can be feasibly implemented at most student-run clinics.

Latinx youth's and parents' covid-19 beliefs, vaccine hesitancy and vaccination rates: Longitudinal associations in a community sample

INTRODUCTION

The Latinx population has the second highest COVID-19 death rate among racial/ethnic groups in the United States and less than half of Latinx youth aged 5-17 years old completed their COVID-19 primary vaccination series as of September 2022. COVID-19 vaccine misinformation detrimentally impacts vaccination rates. In this study, we examined factors that predicted Latinx youth COVID-19 vaccine hesitancy and vaccination status.

METHODS

A community-based sample of 290 Latinx parent and adolescent dyads from a Southwestern metropolitan area of the United States who were recruited to complete an online survey at baseline at T1 (August 2020 -March 2021) and one year later. We tested a longitudinal mediation model in which we examined individual and family factors that would predict youth COVID-19 vaccine hesitancy and vaccination status over time.

RESULTS

Youth's pandemic disbelief (i.e., the belief that the COVID-19 pandemic is a conspiracy or not real) predicted greater youth's COVID-19 vaccine hesitancy, and in turn, a lower likelihood of youth's COVID-19 vaccination. Youth's pandemic disbelief also predicted greater parent's vaccination hesitancy which, in turn, predicted greater youth's vaccination hesitancy and a lower likelihood of COVID-19 vaccination. Parents' pandemic disbelief predicted their own COVID-19 hesitancy, but not youth hesitancy.

DISCUSSION

Our study findings provide initial evidence that general pandemic disbelief was a significant driver of vaccine hesitancy and vaccination among Latinx families. The study contributes to the limited research investigating COVID-19 vaccination in the Latinx community and among Latinx youth, further aiding how COVID-19 vaccine disparities can be mitigated among racial/ethnic populations.

Latino Parents' Reactions to and Engagement With a Facebook Group-Based COVID-19 Vaccine Promotion Intervention: Mixed Methods Pilot Study

BACKGROUND

Misinformation in Spanish on social media platforms has contributed to COVID-19 vaccine hesitancy among Latino parents. Brigada Digital de Salud was established to disseminate credible, science-based information about COVID-19 in Spanish on social media.

OBJECTIVE

This study aims to assess participants' reactions to and engagement with Brigada Digital content that sought to increase COVID-19 vaccine uptake among US Latino parents and their children.

METHODS

We conducted a 5-week intervention in a private, moderator-led Facebook (Meta Platforms, Inc) group with Spanish-speaking Latino parents of children aged ≤18 years (N=55). The intervention participants received 3 to 4 daily Brigada Digital posts and were encouraged to discuss the covered topics through comments and polls. To assess participants' exposure, reactions, and engagement, we used participants' responses to a web-based survey administered at 2 time points (baseline and after 5 weeks) and Facebook analytics to calculate the average number of participant views, reactions, and comments. Descriptive statistics were assessed for quantitative survey items, qualitative responses were thematically analyzed, and quotes were selected to illustrate the themes.

RESULTS

Overall, 101 posts were published. Most participants reported visiting the group 1 to 3 times (22/55, 40%) or 4 to 6 (18/55, 33%) times per week and viewing 1 to 2 (23/55, 42%) or 3 to 4 (16/55, 29%) posts per day. Facebook analytics validated this exposure, with 36 views per participant on average. The participants reacted positively to the intervention. Most participants found the content informative and trustworthy (49/55, 89%), easy to understand, and presented in an interesting manner. The participants thought that the moderators were well informed (51/55, 93%) and helpful (50/55, 91%) and praised them for being empathic and responsive. The participants viewed the group environment as welcoming and group members as friendly (45/55, 82%) and supportive (19/55, 35%). The 3 most useful topics for participants were the safety and efficacy of adult COVID-19 vaccines (29/55, 53%), understanding child risk levels (29/55, 53%), and the science behind COVID-19 (24/55, 44%). The preferred formats were educational posts that could be read (38/55, 69%) and videos, including expert (28/55, 51%) and instructional (26/55, 47%) interviews. Regarding engagement, most participants self-reported reacting to posts 1 to 2 (16/55, 29%) or 3 to 4 (15/55, 27%) times per week and commenting on posts 1 to 2 (16/55, 29%) or <1 (20/55, 36%) time per week. This engagement level was validated by analytics, with 10.6 reactions and 3 comments per participant, on average, during the 5 weeks. Participants recommended more opportunities for engagement, such as interacting with the moderators in real time.

CONCLUSIONS

With adequate intervention exposure and engagement and overall positive participant reactions, the findings highlight the promise of this digital approach for COVID-19 vaccine-related health promotion.

Assessing Changes in COVID-19 Vaccine Uptake and Intentions among the Brigada Digital Latino Social Media Audience: A Repeated Cross-Sectional Study

BACKGROUND

U.S. Latinos experienced disproportionate COVID-19 impacts in terms of morbidity and mortality. Vaccination against COVID-19 is an important strategy for mitigating health impacts, and yet, vaccine uptake was slower among U.S. Latino adults compared to other racial/ethnic groups. Vaccine hesitancy has been a significant barrier within Latino communities, and exposure to misinformation has been associated with negative attitudes toward vaccination. While some COVID-19 mitigation efforts have included community-based outreach, few studies have explored the impact of community-based digital messaging in Spanish to counter COVID-19 misinformation, build trust, and promote vaccination.

METHODS

To address this gap, we conducted a one-year repeated cross-sectional study to assess changes in COVID-19 vaccine uptake, intentions, and perceived norms, as well as barriers to accessing reliable information and levels of trust in COVID-19 information sources among Latino adults exposed to Brigada Digital de Salud social media content. This culturally-tailored content disseminated on Facebook, Instagram, and X platforms was amplified by community health workers and partners, and focused on COVID-19 risk and prevention, vaccine safety and efficacy, and correcting related misinformation.

RESULTS

Statistically significant increases in COVID-19 vaccination, intentions to vaccinate children, and vaccination subjective norms were observed from May 2022 (wave 1) to April 2023 (wave 2). Among perceived difficulties accessing information, respondents indicated the most difficulty in judging the reliability of COVID-19 information in the media; however, a statistically significant decrease in perceived difficulty was observed between waves. With regard to trust in COVID-19 information sources, levels of trust were highest for healthcare providers in both waves. From wave 1 to wave 2, there were statistically significant increases in trust in the FDA to ensure COVID-19 vaccine safety and trust in the federal government to ensure child COVID-19 vaccine safety.

CONCLUSIONS

Social media messaging by trusted community-based sources shows promise as a strategy for combating health misinformation and ameliorating information access gaps for language minority populations. This digital approach represents an important tool for deploying critical information to underserved populations in public health emergency and crisis contexts, and for supporting changes in attitudes, trust, and behaviors to improve health outcomes.