An experimental study of the effects of messaging strategies on vaccine acceptance and hesitancy among Black Americans

Does Experience of Vaccination Improve Vaccine Confidence and Trust? Policy Feedback Effects of Mass COVID-19 Vaccination in the United States

CONTEXT

Policy feedback research has demonstrated that a highly tangible policy that shapes public attitudes through direct and day-to-day experiences often reshapes public opinion, with the effect of generating supportive or skeptical constituencies that determine the sustainability of future programs. This article examines the impact of mass vaccination efforts on attitudes toward vaccines in a context of high vaccine hesitancy in the United States.

METHODS

The authors analyzed 73,092 survey responses from 9,229 participants in the longitudinal data from the Understanding America Study project, covering December 2020 to July 2023. Using two-way fixed-effects ordinary least squares regression and ordinal logistic regression, the authors estimated the changes in attitudes toward vaccines, including trust in vaccine manufacturing and approval processes, following COVID-19 vaccinations.

FINDINGS

COVID-19 vaccination was associated with improved perceptions of vaccine effectiveness and social benefits and reduced mistrust in vaccine-related processes. However, it did not significantly alleviate concerns regarding vaccine side effects and severe illness stemming from vaccination. The strongest effects were observed among initially hesitant respondents who eventually received vaccinations.

CONCLUSIONS

The experience of COVID-19 vaccination generally improved attitudes and confidence in COVID-19 vaccines among the US public, particularly among vaccine-hesitant people. These effects could have positive impacts on future immunization programs by mitigating vaccine hesitancy.

COVID-19 Vaccination Messengers, Communication Channels, and Messages Trusted Among Black Communities in the USA: a Review

Black and African American adults exhibited higher levels of mistrust and vaccine hesitancy and lower levels of vaccination throughout the COVID-19 pandemic. Vaccination and booster uptake remains disproportionately low among Black adults. We conducted a systematic review of empirical research published between February 2021 and July 2022 from five electronic databases and the grey literature. We screened studies that assessed COVID-19 vaccination information needs and preferences as well as communication strategies among Black adults in the USA. We extracted data, then analyzed and synthesized results narratively. Twenty-two articles were included: 2 interventions, 3 experimental surveys, 7 observational surveys, 8 qualitative inquiries, and 2 mixed methods studies. Studies reported credible and preferred COVID-19 vaccination information sources/messengers, channels, and content. Commonly trusted messengers included personal health care providers, social network connections, and church/faith leaders. Electronic outreach (e.g., email, text messages), community events (e.g., forums, canvassing), and social media were popular. Black communities wanted hopeful, fact-based messages that address racism and mistrust; persuasive messages using collective appeals about protecting others may be more influential in changing behavior. Future communication strategies aiming to increase vaccine confidence and encourage COVID-19 booster vaccination among Black communities should be developed in partnership with community leaders and local health care providers to disseminate trauma-informed messages with transparent facts and collective action appeals across multiple in-person and electronic channels.

Covid-19 Vaccine Hesitancy and Under-Vaccination among Marginalized Populations in the United States and Canada: A Scoping Review

BACKGROUND

Amid persistent disparities in Covid-19 vaccination and burgeoning research on vaccine hesitancy (VH), we conducted a scoping review to identify multilevel determinants of Covid-19 VH and under-vaccination among marginalized populations in the U.S. and Canada.

METHODS

Using the scoping review methodology developed by the Joanna Briggs Institute, we designed a search string and explored 7 databases to identify peer-reviewed articles published from January 1, 2020-October 25, 2022. We combine frequency analysis and narrative synthesis to describe factors influencing Covid-19 VH and under-vaccination among marginalized populations.

RESULTS

The search captured 11,374 non-duplicated records, scoped to 103 peer-reviewed articles. Among 14 marginalized populations identified, African American/Black, Latinx, LGBTQ+, American Indian/Indigenous, people with disabilities, and justice-involved people were the predominant focus. Thirty-two factors emerged as influencing Covid-19 VH, with structural racism/stigma and institutional mistrust (structural)(n = 71) most prevalent, followed by vaccine safety (vaccine-specific)(n = 62), side effects (vaccine-specific)(n = 50), trust in individual healthcare provider (social/community)(n = 38), and perceived risk of infection (individual)(n = 33). Structural factors predominated across populations, including structural racism/stigma and institutional mistrust, barriers to Covid-19 vaccine access due to limited supply/availability, distance/lack of transportation, no/low paid sick days, low internet/digital technology access, and lack of culturally- and linguistically-appropriate information.

DISCUSSION

We identified multilevel and complex drivers of Covid-19 under-vaccination among marginalized populations. Distinguishing vaccine-specific, individual, and social/community factors that may fuel decisional ambivalence, more appropriately defined as VH, from structural racism/structural stigma and systemic/institutional barriers to vaccination access may better support evidence-informed interventions to promote equity in access to vaccines and informed decision-making among marginalized populations.

Interventions employed to address vaccine hesitancy among Black populations outside of African and Caribbean countries: a scoping review

BACKGROUND

Black people are disproportionately affected by structural and social determinants of health, resulting in greater risks of exposure to and deaths from COVID-19. Structural and social determinants of health feed vaccine hesitancy and worsen health disparities.

OBJECTIVE

This scoping review explored interventions that have been employed to address vaccine hesitancy among Black population outside of African and Caribbean countries. This review provides several strategies for addressing this deep-rooted public health problem.

METHODS

The scoping review followed the five-step framework outlined by Arksey and O'Malley. It complies with reporting guidelines from the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Research studies that examined interventions utilized to promote vaccine confidence within Black populations living outside of African and Caribbean countries were reviewed.

FINDINGS

A total of 20 articles met the inclusion criteria for this study: 17 were quantitative studies and three were mixed-method studies. This scoping review highlighted six themes: educational advancement, messaging, multi-component approaches, outreach efforts, enhancing healthcare access, and healthcare provider leadership.

CONCLUSION

The review identified effective interventions for addressing vaccine hesitancy among Black populations outside Africa and the Caribbean, emphasizing education, multidimensional approaches, and healthcare provider recommendations. It calls for more qualitative research and interventions in countries like Canada and the UK to enhance vaccine confidence and reduce mistrust.

Acceptance-Hesitancy of COVID-19 Vaccination and Factors Affecting It in Adults: Systematic Review Study

BACKGROUND

Despite the advent of vaccines against COVID-19, there is considerable variation in the acceptance and hesitancy towards the vaccination program across different countries. The objective of this study was to ascertain the prevalence of hesitancy and acceptance regarding the use of the vaccine against the novel coronavirus, also known as COVID-19, and to identify the factors that influence these attitudes.

MATERIALS AND METHODS

All the cross-sectional studies were retrieved from the PubMed databases, the Web of Science ISI, Scopus, and the Cochrane Library. Papers published in English between 2 November 2019 and 23 May 2023 were subjected to further assessment based on their title, abstract, and main text, with a view to ensuring their relevance to the present study.

RESULTS

Following an exhaustive investigation, 59 studies were selected for screening in this systematic review. The most frequently employed method of data collection was the online survey. The study sample comprised 59.12% women and 40.88% men, with ages ranging from 16 to 78 years. The proportion of individuals accepting the vaccine ranged from 13% to 96%, while the proportion of those exhibiting hesitancy ranged from 0% to 57.5%. The primary reasons for accepting the COIVD-19 vaccine were a heightened perception of risk associated with the virus and a general trust in the healthcare system. The most frequently cited reasons for vaccine hesitancy in the context of the ongoing pandemic include concerns about the potential dangers of the vaccines, the rapid pace of their development, the possibility of adverse effects (such as infertility or death), and the assumption that they have been designed to inject microchips.

DISCUSSION

A variety of socio-demographic factors are implicated in determining the rate of vaccine acceptance. A number of socio-demographic factors have been identified as influencing vaccine acceptance. These include high income, male gender, older age, marriage, the presence of older children who have been vaccinated and do not have chronic diseases, high education, and health insurance coverage.

CONCLUSION

Eliminating vaccine hesitancy or increasing vaccine acceptance is a crucial factor that should be addressed through various means and in collaboration with regulatory and healthcare organizations.

Interventions to Reduce COVID-19 Vaccine Hesitancy among Black and African American Individuals in the United States: A Systematic Literature Review

COVID-19 vaccine hesitancy had major implications for racial health equity at the beginning of the vaccination campaign in the U.S. Interventions to reduce vaccine hesitancy among Black and African American individuals partially helped to reduce vaccine hesitancy in specific communities. This article describes findings on interventions to reduce COVID-19 vaccine hesitancy among Black and African American individuals from a literature review we conducted. We found 12 studies that described communication, partnerships, and distribution interventions. Regarding communication, examples include a webinar hosted by an academic-community partnership team, information sessions, social media campaigns, educational materials, and virtual town halls. Effective partnerships identified through this literature review were a statewide alliance and one between an academic institution and faith and community leaders. Distribution interventions identified through the literature review were the deployment of multiple tactics to increase COVID-19 vaccine uptake (virtual town halls, a confidential employee hotline, department huddles, written educational material, and accessible vaccination stations) and offering to administer the COVID-19 vaccine during medical appointments. The results of this review show that implementing interventions directed at specific minority groups improves COVID-19 vaccine acceptance without undermining overall vaccine distribution or uptake.

Understanding Low Vaccine Uptake in the Context of Public Health in High-Income Countries: A Scoping Review

Although the COVID-19 pandemic has caused the need for the largest mass vaccination campaign ever undertaken to date, African, Caribbean, and Black (ACB) populations have shown both a disproportionately high degree of negative impacts from the pandemic and the lowest willingness to become vaccinated. This scoping review aims to investigate low vaccine uptake in ACB populations relative to public health in high-income countries. A search was conducted in MEDLINE(R) ALL (OvidSP), Embase (OvidSP), CINAHL (EBSCOHost), APA PsycInfo (OvidSP), the Cochrane Central Register of Controlled Trials (OvidSP), the Cochrane Database of Systematic Reviews (OvidSP), the Allied and Complimentary Medicine Database (Ovid SP), and the Web of Science following the Joanna Briggs Institute (JBI) framework for scoping reviews, supplemented by PRISMA-ScR. Theoretical underpinnings of the intersectionality approach were also used to help interpret the complexities of health inequities in the ACB population. The eligibility criteria were based on the population, concept, context (PCC) framework, and publications from 2020-19 July 2022 which discussed vaccine uptake amongst ACB people in high-income countries were included. Analysis was carried out through thematic mapping and produced four main themes: (1) racism and inequities, (2) sentiments and behaviors, (3) knowledge and communication, and (4) engagement and influence. This study has contributed to the identification and definition of the issue of low vaccine uptake in ACB populations and has illustrated the complexity of the problems, as vaccine access is hampered by knowledge, psychological, socioeconomic, and organizational barriers at the individual, organizational, and systemic levels, leading to structural inequities that have manifested as low vaccine uptake.

Timing of preventive behavior in the case of a new and evolving health risk: the case of COVID-19 vaccination

BACKGROUND

Time preferences for preventive behavior under novel risks and uncertain contexts may differ from timing preferences related to familiar risks. Therefore, it is crucial to examine drivers of preventative health behavior timing in light of new health risks. Using the case of COVID-19, we examine factors affecting vaccination timing plans when vaccines were widely available in the European Union (EU).

METHODS

We use data from the Flash Eurobarometer 494 survey (May 21-26, 2021), which collected information on EU residents' attitudes towards COVID-19 vaccinations. We also use the 'Our World in Data' vaccination database for country-level COVID-19 vaccination rates. Probit regressions were conducted to determine how local vaccination rates, trust in information sources, social norms, vaccine safety beliefs, and risk understanding affected the probability of COVID-19 vaccination delay.

RESULTS

Of total participants (n = 26,106), 9,063 (34.7%) were vaccinated, 7,114 (27.3%) wanted to get vaccinated as soon as possible, 5,168 (19.8%) wanted to delay vaccination and 2,962 (11.4%) resisted vaccination. Participants were more likely to delay COVID-19 vaccination if they lived in a country with lower vaccination prevalence, trusted online social networks, family, friends, and colleagues for vaccination information, were eager to follow vaccination-related social norms, expressed vaccine safety concerns, and understood the risk of catching COVID-19 without a vaccine to be lower.

CONCLUSIONS

Results from the study contribute to understanding important factors that predict timing of vaccination plans. These findings can also contribute to the wider knowledge base about timing of preventive behavior uptake in novel risk contexts.

Interventions for COVID-19 Vaccine Hesitancy: A Systematic Review and Narrative Synthesis

Vaccines effectively protect against COVID-19, but vaccine hesitancy and refusal hinder vaccination rates. This systematic review aimed to (1) review and describe current interventions for addressing COVID-19 vaccine hesitancy/refusal and (2) assess whether these interventions are effective for increasing vaccine uptake. The protocol was registered prospectively on PROSPERO and comprehensive search included Medline, Embase, CINAHL, PsycInfo, and Web of Science databases. Only studies that evaluated the effectiveness of non-financial interventions to address COVID-19 vaccine hesitancy were included, while those focusing intentions or financial incentive were excluded. Risk of bias for all included studies was evaluated using Cochrane risk of bias tools. In total, six articles were included in the review (total participants n = 200,720). A narrative synthesis was performed due to the absence of common quantitative metrics. Except for one randomized controlled trial, all studies reported that interventions were effective, increasing COVID-19 vaccination rates. However, non-randomized studies were subject to confounding biases. Evidence on the effectiveness of COVID-19 vaccine hesitancy interventions remains limited and further evidence is needed for the development of clear guidance on effective interventions to increase vaccine uptake.