Trust in a COVID-19 vaccine in the U.S.: A social-ecological perspective

Boost your health (Refuerza tu Salud): Design of a randomized controlled trial of a community health worker intervention to reduce inequities in COVID-19 and influenza vaccinations

INTRODUCTION

Low-income and underserved populations, especially racial and ethnic minorities, experience health disparities linked to social determinants. The COVID-19 pandemic amplified these disparities, necessitating effective strategies to address structural racism and related factors. Vaccination, crucial for mitigating infectious diseases, including COVID-19 and influenza, remains challenging among underserved populations. Community health worker (CHW) interventions show promise in addressing these disparities but have not undergone rigorous evaluation with a randomized controlled trial to increase vaccination uptake among underserved populations. This study develops and evaluates a CHW vaccination behavior (CHW-VB) intervention to increase COVID-19 and influenza vaccination among adult patients in primary care settings.

METHODS

Tailoring of the Boost Your Health (Refuerza tu Salud) intervention is grounded in behavior change theory and integrates input from a Community Advisory Board. The study employs a patient randomized controlled trial design to test the effectiveness the CHW-VB intervention compared with usual care across six Federally Qualified Health Centers (FQHCs) in New York. Patients are being screened for eligibility (vaccinated but not up to date with the COVID-19 vaccine and have at least one of seven common chronic illnesses) and 800 are assessed at baseline and three months. Outcomes include COVID-19 vaccine (primary) and influenza vaccine (secondary) uptake. The study also evaluates intervention implementation using the RE-AIM model.

CONCLUSION

Boost Your Health aims to increase COVID-19 and influenza vaccination among racially/ethnically diverse, underserved populations with chronic illness through the CHW-VB intervention, targeting critical gaps in vaccination uptake to reduce health disparities and increase health equity.

TRIAL REGISTRATION

(ClinicalTrials.govNCT06156254).

The Roles of Acculturation and Pre-migration Experiences in Influencing the Confidence of Vietnamese Parents in Vaccine Use Among Adolescents

Vaccine confidence is a critical antecedent of vaccine uptake. Little research has examined vaccine confidence among Asian communities, particularly the associations with acculturation and pre-migration experiences. We explored this issue among U.S. Vietnamese parents. Our study uses an explanatory sequential mixed-methods design to investigate the influence of American acculturation, Vietnamese acculturation, and pre-migration experiences on U.S. Vietnamese parents' vaccine confidence for their adolescents. A cross-sectional web-based survey (n = 408) was followed by semi-structured interviews (n = 32). Quantitative analysis showed that many participants reported high or complete trust in scientists involved in vaccine development (61%), federal agencies responsible for vaccine safety monitoring and licensure (53%), the CDC (62%), and the FDA (58%). High or complete trust in scientists was associated with a higher Vietnamese acculturation score [aRR = 1.20 (1.03-1.40)], while trust in federal government agencies was associated with English medical proficiency [aRR = 1.42 (1.15-1.76)]. Qualitative findings provided deeper insights, with many parents expressing trust in vaccine efficacy, safety, and the rigorous development and approval process. Pre-migration experiences in Vietnam had mixed influences on vaccine confidence. Some participants cited positive experiences with the national immunization program, while others were influenced by negative vaccine-related injury stories. Newer immigrants reported limited familiarity with U.S. health authorities. Language preferences (Vietnamese versus English) for vaccine information varied. Our study highlights the complex interplay of acculturation, cultural identity, language, and historical experiences in shaping vaccine confidence among U.S. Vietnamese parents and emphasizes the need to take these factors into account with tailored public health strategies.

Reactance as a cause of COVID-19 vaccination hesitancy

COVID-19 remains a serious threat to public health. In the United States, 70 % of the population is considered fully vaccinated, a level too low to create "herd" immunity. Thus, vaccine hesitancy remains a current problem for public health and is an important constraint on mitigating future pandemics. This study evaluates three components of health messaging that might be targeted for counteracting hesitance, vested interests, reactance, and perceived threat. Structural equation modeling of survey data from a demographically representative and politically balanced sample of 1588 U.S. residents showed that reactance was the only significant explanation for self-reported vaccination status. Its effect was stronger for conservatives, with reactance strongly and negatively influencing vaccine acceptance as a mediating factor. The same path was significant for liberals but with a drastically smaller total effect. Liberals also had a small but significant direct effect of reactance on reported vaccination. These findings indicate that to encourage the highest possible acceptance, future vaccine policy and messaging must avoid threatening perceived individual freedoms and stress personal choice. We suggest such measures.

Exploring predictors of COVID-19 vaccine acceptance among students, faculty, and staff at a Southeastern University in the United States

OBJECTIVE

Explore predictors of early COVID-19 vaccine adoption on a university campus.

PARTICIPANTS

Students, faculty, staff, and administration (N = 1,234) completed an online survey exploring COVID-19 vaccine-related experiences, perspectives, and knowledge, from September to October 2021.

METHODS

Based on vaccination status participants were identified as vaccine hesitant or early vaccine adopters. Binary logistic regression was used to examine association between independent variables and vaccine adoption status.

RESULTS

Democrats (OR = 4.3, p = <.001), participants without a positive COVID-19 test (OR = 2.5, p = <.001), noted seeing/hearing COVID-19 misinformation (OR = 1.8, p = 0.27), and reported trust in public health agencies (OR = 26.2, p = <.001) were more likely to be early COVID-19 vaccine adopters, compared to Republicans, those with a positive COVID-19 test, those who had not seen/heard COVID-19 misinformation, and those reporting distrust in public health agencies, respectively.

CONCLUSION

Findings indicate that COVID-19 vaccine adoption is multifactorial. Future research should focus on vaccination status-related trust and health communication.

Unravelling disparity in age-specific acceptance of COVID-19 vaccination: the contextual and psychosocial influences

BACKGROUND

High COVID-19 vaccination uptake rates across all age groups are important for achieving herd immunity. However, age disparity in vaccination acceptance was consistently identified.

OBJECTIVE

Taking cues from tenets of socioemotional selectivity theory, this study examined how the contextual and psychosocial factors contributed to age-specific COVID-19 vaccination acceptance.

METHOD

Four rounds of population-based cross-sectional surveys were conducted before and after the COVID-19 vaccination programme started in Hong Kong (n = 3527). Participants' vaccination acceptance, trust in government, social norms, vaccine confidence and risk perception of COVID-19 were obtained. Vaccine-related news headlines were collected in the same timeframe.

RESULT

Sentiment analysis found that the impact of negative news sentiment on vaccine hesitancy was greater among older people. The path analyses found that older people had greater trust in government, perceived greater influence of social norms, and had greater vaccine confidence which all in turn were associated with greater vaccination acceptance. However, older people were found to have less worry about contracting COVID-19, which somewhat lowered their vaccination acceptance.

CONCLUSION

Communication to promote older people's vaccination uptake should focus on promoting the government's timely response to the negative news reports about vaccines and increasing the positive influences of social norms on their vaccination acceptance.

A Study on How Libraries Operate as Health Spaces in the United States

A health space is any physical, social, or virtual space that supports building health literacy skills, promotes health behavior, preventive health, and wellbeing, or provides health care, health information, or health or social services. To move the needle on health, especially preventive health, a focus on non-traditional health spaces is critical. Libraries serve various community needs such as food distribution, health literacy, education, immunization, and health screenings. This study explores the extent to which libraries are equipped to function as a health space. A convergent mixed-methods approach was utilized; 234 library personnel were randomly recruited using data from the 2017 Public Libraries Survey to complete a survey and 24 semi-structured follow-up interviews were conducted. Our findings support that libraries function as a health space in multiple ways including providing important health and social programming and services to patrons. They help meet patron's health information needs by leveraging the expertise of community partners and incorporating valuable input from patrons in programming decisions. However, the capacity of libraries to carry out these health initiatives varies, in particular due to limited staff expertise in health-related topics and structural issues (e.g., funding). Our research emphasizes the need to integrate organizational health literacy attributes into library operations, specifically by (1) streamlining strategic partnerships with community experts in libraries in high-need areas to extend their limited resources, and (2) incorporating health literacy into missions and operations to draw necessary financial and personnel support to overcome salient challenges (i.e., funding and staff training).

Debunking COVID-19 vaccine misinformation with an audio drama in Ghana, a randomized control trial

Misinformation about COVID-19 vaccines has hampered their uptake worldwide. In Ghana, a belief that COVID-19 vaccines affect fertility is prevalent and difficult to counter. UNICEF Ghana co-produced a context-driven, behavioral science-based audio drama ('A shot of love') that aimed to debunk this misinformation narrative. In a randomized controlled trial, 13,000 young adults who had previously interacted with UNICEF's Agoo platform were randomized to either control (audio about nutrition) or intervention (audio drama debunking the COVID-19 misinformation). We found that the intervention had a strong protective effect against belief in misinformation, both directly after listening to the audio drama (adjusted Odds Ratio (aOR) 0.45, 95% Confidence Interval (CI) 0.34-0.59) as well as at the one-month follow-up (aOR 0.66, 95% CI 0.49-0.91). Similarly, the intervention had a strong effect on perceived safety of the COVID-19 vaccines directly after listening to the audio drama (aOR 1.56, 95% CI 1.22-2.00) and at one-month follow-up (aOR 1.53, 95% CI 1.13-2.07). Overall, our behavioral science-based, context-driven audio drama was effective in reducing the strength of belief in COVID-19 vaccine misinformation and increasing the perceived safety of the vaccines in Ghana.

Access Barriers, Trusted Channels, and Misconceptions About the COVID-19 Vaccine Among Rural Immigrant Farmworkers

Background: Although COVID-19 has disproportionately impacted immigrant agricultural workers, vaccination efforts have been challenging. Barriers to immunization include language, visa status, and access to medical care. Additionally, vaccine hesitancy, mistrust, and misinformation contributed to low uptake. Methods: A community needs assessment was conducted with immigrant agricultural workers (n = 9) and community stakeholders (n = 15) in rural areas of Maryland and Delaware. In-depth interviews were recorded, transcribed verbatim, and analyzed using template analysis. Results: The participants named trusted and untrusted sources, sources of misinformation, and barriers to accessing information and physical locations to receive the vaccine as reasons for not getting the vaccine. Trusted sources included known community leaders and television programs. Some barriers mentioned were fear of deportation, lack of paid time off, language barriers, and difficulty navigating the U.S. healthcare system. Discussion: There is a need for culturally-tailored programs that address misinformation and barriers and use community-based programming.

A Survival Analysis of Rural-Urban Disparities in COVID-19 Vaccination Uptake in the United States

PURPOSE

Though urban-rural disparities in COVID-19 vaccination coverage was documented at a point of time, little is known on the evolution of vaccination uptake over time. This study, using individual level time-to-event data, intend to assess the differences in monthly progression of vaccination uptake among U.S. adults by urban/rural residence.

DESIGN

Survival analysis.

SETTING

Urban and rural areas in 29 U.S. states.

SUBJECTS

135,969 adults aged 18+ years.

MEASURES

Time (in months) to receive the first dose of COVID-19 vaccine since the U.S. Food and Drug Administration (FDA) Emergency Use Authorization of Pfizer-BioNTech- and Moderna- COVID-19 Vaccine in December 2020.

ANALYSIS

Kaplan-Meier survivor functions and stratified Cox proportional hazard models were estimated for the event of being vaccinated by urban/rural residence for 25 months starting from December 2020. Monthly survival probabilities for urban- and rural- adults were further assessed within certain demographic and socioeconomic groups.

RESULTS

We found a gradual divergence of COVID-19 vaccination uptake in favor of urban adults, which was robust across sex, age groups, race and ethnicity, education, and income levels. In April 2021, after vaccine eligibility was expanded, 42.2% adults in urban and 53.3% adults in rural areas were unvaccinated. While only 19.3% urban adults remained unvaccinated in December 2022, this rate was 32.5% among rural adults. Compared to their urban counterparts, rural adults were 0.77 (95% CI: 0.76 - 0.79) times as likely to receive the first dose of COVID-19 vaccine.

CONCLUSIONS

Time-to-event analysis of vaccination against COVID-19 indicated a lower uptake among rural adults, which was persistent across different demographic and socioeconomic groups.

'Yeah, they suck. It's like they don't care about our health.' Medical mistrust among Black women under community supervision in New York city

Black women in the USA experience some of the poorest health outcomes and this is especially true for those involved in the carceral system who are at elevated risks for HIV/STIs, reproductive health, and chronic diseases. This study aimed to investigate Black women's experience accessing healthcare services. We conducted semi-structured interviews with 43 women from Project EWORTH under community supervision in New York City. We analysed responses focusing on barriers to healthcare engagement. All interviews were recorded, and data analysis was conducted using NVivo. Themes influencing Black women's ability to engage with healthcare providers and systems included: 1) disclosed provider mistrust/judgement; 2) feeling disrespected by providers and the medical system; 3) mistrust of medical providers/system/hospital/government; 4) lack of health communication; 5) low health literacy; 6) provider gender preference. Findings highlight the need to improve trust and collaboration between healthcare providers and Black women. This study addresses the critical gap in understanding perceptions of discrimination, stigma, and barriers to attaining health care. Funders and accreditation agencies must hold providers and organisations accountable for acquiring and making available diversity, equity and inclusion training for providers, demonstrating increasingly equitable medical relationships through responsiveness to patient feedback, and increasing the number of Black providers.

Perception of COVID-19 Vaccination and Uptake Willingness in Northern Nigeria: Understanding Strategies to Optimize Coverage

Background: Vaccination is a proven and safe method for combating COVID-19; however, coverage remains low in many low- and middle-income countries, including Nigeria. There is also a lack of contextual evidence regarding the public perception of and willingness to receive vaccines. This study aims to contribute to efforts to optimize the vaccination coverage and improve public health in northern Nigeria. Objective: This study investigated the perceptions of COVID-19 vaccination and willingness to uptake the vaccine in northern Nigeria, aiming to identify strategies for optimizing coverage and enhancing vaccination rates. Methods: A cross-sectional household survey was conducted across the Federal Capital Territory and five northern states in Nigeria. The survey assessed the respondents' perceptions of COVID-19, their knowledge of the COVID-19 vaccine, and their willingness to be vaccinated. Descriptive and inferential (multivariate logistic regression) statistical analyses were employed to characterize the population and identify predictors of vaccine uptake. Results: The mean age of the respondents was 28.00 years. The majority reported at least one piece of misinformation regarding COVID-19. While awareness of the vaccine was high, its actual uptake was low, and future willingness to receive the vaccine was also limited. Employment status emerged as a significant predictor of vaccine uptake, as determined through the multivariate analysis. Furthermore, collaboration with NGOs and community-based organizations (CBOs) was identified as the most effective strategy for enhancing vaccine uptake. Conclusions: This study found a concerningly low willingness to receive the COVID-19 vaccine among participants in northern Nigeria. To address this issue, we recommend establishing partnerships with NGOs and CBOs, implementing extensive public awareness campaigns, and conducting community outreach programs. These efforts should focus on dispelling misinformation, building community trust, and promoting vaccine uptake through culturally appropriate communication materials.

A survey of perceptions and behavioural responses towards the COVID-19 pandemic in South Africa

BACKGROUND

 The South African response to the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus was swift and assertive, although it came with economic and social costs. An understanding of the pandemic experiences of different population groups is integral to enhancing disease control.

AIM

 The aim of this study was to identify behavioural responses and public perceptions relating to the coronavirus disease 2019 (COVID-19) pandemic.

SETTING

 The study was conducted in South Africa.

METHODS

 In June 2022, a national online survey (N = 3018) was conducted among adults ( 18 years). Logistic regression was used to examine the factors associated with adherence to government measures and vaccination. Structural equation modelling (SEM) was applied to examine the direct and indirect relationship of socioeconomic status (SES) with protective behaviours.

RESULTS

 Data showed no direct association between SES and vaccination uptake, but SES was indirectly and positively associated with vaccination uptake. Socioeconomic status was also indirectly and positively associated with adherence to government measures through pathways mediated by access to the Internet, access to local news, government trust and positive government experiences.

CONCLUSION

 This study highlights the complexity of government measures and vaccination adoption and the socioeconomic barriers affecting these.Contribution: Results from this study should be used to inform future pandemic preparedness plans. In particular, policymakers should consider the importance of providing scientific information through channels accessible to each socioeconomic group to promote positive behavioural changes, as well as the need to adapt pandemic responses to different socioeconomic groups.

Medical mistrust and COVID-19 vaccine attitudes and behavior: Findings from a population-based cohort study in Michigan

Background

Uptake of COVID-19 vaccines has stalled in the U.S. Some studies suggest that medical mistrust may be a barrier, but evidence is limited due to cross-sectional designs or convenience sampling.

Methods

We examined associations of medical mistrust with COVID-19 vaccine attitudes at baseline and vaccination uptake at follow-up using a population-based sample of Michigan adults with PCR-confirmed SARS-CoV-2 infection. We summed ratings for three items of the Medical Mistrust Index (MMI) to measure trust in healthcare providers. For vaccine attitudes, we averaged ratings for two items on importance of getting the COVID-19 vaccine. For vaccination uptake as ever receiving at least one dose of a COVID-19 vaccine. We conducted (1) linear regression models to examine cross-sectional associations between MMI and vaccine attitudes (n = 3865), (2) modified Poisson regression with robust standard errors to estimate prospective associations between MMI and vaccination uptake (n = 3741), and (3) effect modification and stratified analyses by race and ethnicity.

Results

The mean MMI score was 1.89. The mean of positive vaccine attitudes measure at baseline was 3.45 and the prevalence of receiving a vaccine at follow-up was 75.3 %. Higher MMI was associated with worse vaccine attitudes at baseline (coefficient = -0.64, 95 % confidence interval [CI]: -0.71, -0.56), and lower vaccine uptake at follow-up (adjusted risk ratio: 0.83, 95 % CI: 0.80, 0.86). Both associations were pronounced among non-Hispanic White and another non-Hispanic race and ethnicity individuals.

Conclusions

Understanding drivers of medical mistrust may help rebuild public trust in healthcare systems to promote vaccine uptake and improve public health.

The politicisation of vaccines and its influence on Brazilian caregivers' opinions on childhood routine vaccination

Progressive declines in vaccination coverage have been recorded in Brazil in recent years. The COVID-19 pandemic has introduced even more challenges to this scenario. Considering the pandemic as an event, the scope of this article was to analyze the politicization of vaccines from the perspective of caregivers of young children. This qualitative research was conducted in two Brazilian state capitals, namely São Luís (Maranhão) and Florianópolis (Santa Catarina). The study included families with children up to 6 years of age who were fully or partially vaccinated, as well as children who had never been vaccinated. Snowball sampling was used and in-depth interviews were conducted between March 2021 and April 2022. Forty-eight caregivers, most of them mothers, were interviewed. The study revealed that, regardless of their previous stance regarding vaccines, the health-political event of the COVID-19 pandemic shook beliefs and attitudes about childhood vaccination. The results also showed that the pandemic led to delays in routine childhood immunization and caused caregivers to seek private health services. Finally, the results reveal the politicization of vaccines as a new phenomenon to be addressed in the Brazilian context.

COVID-19 vaccine acceptance and 5C psychological antecedents amid the omicron surge in South Korea and China

BACKGROUND

It is crucial to emphasize the necessity of annual COVID-19 vaccination, particularly for vulnerable populations like older and chronically ill individuals.

OBJECTIVES

This study aimed to quantify the level of vaccination acceptance and its 5C psychological antecedents in the South Korean and Chinese populations and also to identify the predictors, considering contextual variations that influence vaccine acceptance in both countries.

METHODS

A cross-sectional survey study was undertaken in South Korea and China between March 15 and March 30, 2023, coinciding with the emergence of the SARS-CoV-2 Omicron variant in both nations. The study comprised 1000 participants from South Korea and 3000 participants from China. A chi-square analysis, t-tests and multivariable logistic regression analysis were employed to evaluate the factors influencing the acceptance of COVID-19 vaccines.

RESULTS

A higher degree of vaccine acceptance was observed among Chinese participants (48.5 %), in contrast to the 16.8 % among South Koreans. Analyzing the psychological antecedents for vaccination, the Chinese cohort showed high vaccine confidence, whereas South Koreans had increased constraint perceptions. Psychological antecedents, particularly Confidence, play a significant positive role in vaccine acceptance in both South Korea (OR 2.98, CI [2.26-4.01], p < 0.001) and China (OR 2.93, CI [2.58-3.33], p < 0.001), while Constraints in South Korea (OR 0.83, CI [0.69-0.99], p < 0.05) and China (OR 0.86, CI [0.79-0.94], p < 0.001) contribute negatively to vaccine acceptance. Notably, divergent trends in the impact of age and underlying health conditions on vaccine acceptance were observed.

CONCLUSIONS

This study reveals a substantial disparity in acceptance, psychological antecedents, and predictors of vaccine acceptance between China and South Korea. This importance of understanding contextual factors influencing public vaccine acceptance is emphasized. There is an urgent need for robust vaccination strategies that boost confidence and alleviate constraints to COVID-19 vaccination, which should be tailored to the unique contextual factors of each country.

How COVID-19 illness perceptions and individual shocks are associated with trust during the COVID-19 pandemic in Australia, France, Germany, and South Africa

The COVID-19 pandemic jeopardized individuals' health and economic stability, and the associated shocks might have decreased individuals' trust. In this paper, we study the relationship between subjective perceptions of the pandemic and individuals' institutional and interpersonal trust (e.g., trust towards the government or health representatives), while considering objective health and economic shocks due to the pandemic as drivers. We collected data across Australia, France, Germany, and South Africa during a later stage of the COVID-19 pandemic (i.e., from mid-April to early-June 2021) when individuals had time to personally experience the pandemic and its effects. COVID-19 illness perception was associated with lower institutional and interpersonal trust. The health shock of having experienced COVID-19 was associated with higher interpersonal trust, while economic shocks were associated with lower institutional trust when they were due to the pandemic. The results suggest that public policy interventions in a later stage of a pandemic should consider objective economic and health outcomes as well as subjective ones, such as individual's perceptions. Authorities should communicate in a way that helps concerned people understand that they can take control of their health and the possibility of infection, and reassure them that health measures such as vaccination can help prevent the spread of the virus.

Factors that influence recruitment to COVID-19 vaccine trials: a qualitative evidence synthesis

BACKGROUND

The COVID-19 pandemic marked a unique period characterised by an extraordinary global virus spread. The collective effort to halt the transmission of the virus led to various public health initiatives, including a variety of COVID-19 vaccine trials. Many of these trials used adaptive methods to address the pandemic's challenges, such as the need for rapid recruitment. These adaptive methods allow for modifications to the trial procedures without undermining the trial's integrity, making the research process more flexible and efficient. However, recruiting participants for vaccine trials remains a considerable challenge. The aim of this qualitative evidence synthesis (QES) is to explore the factors that influence a person's decision to participate in a COVID-19 vaccine trial. Lessons learned from this could help shape future trials' design and conduct, particularly those conducted within a pandemic.

METHODS

We conducted a systematic search for qualitative studies and mixed methods studies with a qualitative component in the WHO COVID-19 Research Database, MEDLINE, CINAHL, PsycINFO, Epistemomikos, Online Resource for Research in Clinical Trials (ORCCA), and the Cochrane COVID-19 Study Register. We used the best-fit framework synthesis approach and the Social Ecological Model as an a priori framework. We used the GRADE-CERQual approach to assess our confidence in the review findings.

RESULTS

Five studies involving 539 participants were included. One of these studies included participants in a COVID-19 vaccine trial. In three of the studies, participants were asked hypothetically about their attitudes. Another study included people who had either not responded to or declined an invitation to participate in a COVID-19 vaccine trial. We developed six themes outlining the factors that influence a person's decision to participate in a COVID-19 vaccine trial: (1) personal gains, (2) perceived risk, (3) influence of family and community, (4) contributing for others, (5) institutional trust and mistrust, and (6) accessibility of the trial.

CONCLUSION

This review sheds light on how people perceive the potential personal, family, and community advantages of trial participation and how these perceptions may be weighed against concerns about vaccine safety. The findings also point toward specific aspects of trial methodology to consider when designing COVID-19 vaccine trials.

Healthcare providers' and community stakeholders' perception of using drones for tuberculosis diagnosis in Nepal: an exploratory qualitative study

BACKGROUND

In rural Nepal, poor road and transport networks and few testing laboratories impede tuberculosis diagnosis. A drone transport system was established to transport sputum samples to laboratories with advanced molecular diagnostic machines - GeneXpert MTB/RIF. This study explored the perceptions of using drones for tuberculosis diagnosis among community stakeholders, female community health volunteers, and healthcare providers from communities with drones implemented and without drone programs.

METHODS

In December 2019, we conducted focus group discussions in two drone-implemented and three without drone programs. We purposively selected 40 participants: Female community health volunteers (n=16), community stakeholders (n=18), and healthcare providers (n=6). Focus group discussions employed semi-structured questions, which were audio-recorded, transcribed, and translated into English. Codebook thematic analysis was performed and charted using three levels of the socioecological model: individual, community, and health system.

RESULTS

We identified four themes (i) Trust in drones underpins successful use for tuberculosis diagnosis; (ii) Drone-based sample transport optimised connectivity and accessibility for people with tuberculosis and healthcare providers; (iii) Drones create opportunities to improve community and health system, and (iv) External factors impede the use of drones to facilitate tuberculosis diagnosis. The study reported, at an individual level, people's trust in drones mainly through community-based events. For local healthcare providers, drones reduce transport time, opportunity costs, and immediate cash costs of transport. At the community level, drone use creates opportunities to increase the skills of local people as drone pilots. At the health system level, drone transport increases efficient sputum sample delivery and provides opportunities to transport medicines and other biomedical samples. Perceived challenges of using drones were adverse weather, limitations in skilled human resources, and financial resources to operate drones sustainably.

CONCLUSIONS

Healthcare providers, female community health volunteers, and community stakeholders reported high levels of trust in drones and perceived their use for tuberculosis diagnosis and care to substantially benefit people with tuberculosis and providers in rural Nepal. There was a high level of demand for application to other healthcare services and wider geographical coverage, demonstrating drones as a potential tool for enhancing access to healthcare in geographically remote communities.

Communities conquering COVID-19: Black and Latinx community perspectives on the impact of COVID-19 in regions of Michigan hardest hit by the pandemic

Introduction

In Michigan, the COVID-19 pandemic severely impacted Black and Latinx communities. These communities experienced higher rates of exposure, hospitalizations, and deaths compared to Whites. We examine the impact of the pandemic and reasons for the higher burden on communities of color from the perspectives of Black and Latinx community members across four Michigan counties and discuss recommendations to better prepare for future public health emergencies.

Methods

Using a community-based participatory research approach, we conducted semi-structured interviews (n = 40) with Black and Latinx individuals across the four counties. Interviews focused on knowledge related to the pandemic, the impact of the pandemic on their lives, sources of information, attitudes toward vaccination and participation in vaccine trials, and perspectives on the pandemic's higher impact on communities of color.

Results

Participants reported overwhelming effects of the pandemic in terms of worsened physical and mental health, financial difficulties, and lifestyle changes. They also reported some unexpected positive effects. They expressed awareness of the disproportionate burden among Black and Latinx populations and attributed this to a wide range of disparities in Social Determinants of Health. These included racism and systemic inequities, lack of access to information and language support, cultural practices, medical mistrust, and varied individual responses to the pandemic.

Conclusion

Examining perspectives and experiences of those most impacted by the pandemic is essential for preparing for and effectively responding to public health emergencies in the future. Public health messaging and crisis response strategies must acknowledge the concerns and cultural needs of underrepresented populations.

Association of National Identity and Trust in Government with COVID-19 Vaccination and Brand Choice in Taiwan

In Taiwan, hesitancy regarding COVID-19 vaccination centered more on the choice of vaccine brand than on the decision to vaccinate. However, there is limited research exploring the factors influencing COVID-19 vaccine brand preferences from a sociopolitical perspective. Thus, we aimed to examine how Taiwanese national identity and trust in government influence vaccination status and vaccine brand choice, using longitudinal data from 2020, 2021, and 2023. This study utilized data from the Taiwan Panel Study of Family Dynamics 2020 survey, and combined it with data from two self-administered surveys conducted in 2021 and 2023. We focused on four vaccines commonly administered in Taiwan: AstraZeneca, Moderna, Pfizer-BioNTech, and the domestically-developed Medigen. Using Poisson regression models with robust standard errors, we assessed the effects of national identity and trust in government on the choice of COVID-19 vaccine brand. By analyzing data from 2361 participants, we found that national identity and trust in government were associated with the likelihood of COVID-19 vaccination, the number of vaccine doses received, and the brand of vaccine taken. Those who identified themselves as Taiwanese were more inclined to receive the Medigen and AstraZeneca vaccines, but less willing to receive Pfizer-BioNTech vaccine. Those who trusted the government were more likely to prefer and receive the Medigen vaccine. Conversely, those who didn't trust the government were less likely to prefer Medigen and AstraZeneca vaccines, but were willing to receive Pfizer-BioNTech vaccine. Vaccine brand preferences and uptake in Taiwan were affected by individuals' national identity and their trust in government. This highlights the critical role of sociopolitical factors in shaping public health strategies.

COVID-19 Vaccination Hesitancies: A Spanish-Language Focus Group Analysis in Texas

COVID-19 related health disparities are prevalent among higher risk populations like the Hispanic community. Vaccination is one readily available public health tool, yet vaccine uptake is lower among minority populations and hesitations and concerns are high. In the present study, interpersonal and media sources of information about COVID-19 were discussed in a series of six focus groups with Spanish-language dominant and bilingual English-Spanish respondents in a large metropolitan area in Texas. Participants reported using legacy media as a main source of information about COVID-19 vaccines and encountered conspiracy theories and misinformation on social media. Using the Health Belief Model as the theoretical lens, we found individuals' and family members' perceived susceptibility to COVID-19 played a part in participants wanting to find and get the vaccine. Provider recommendations may have served as cues to action. Ease of receiving the vaccines at church and pharmacies may have served to boost participants self-efficacy. Perceived barriers include vaccine specific reasons such as the fast pace of initial authorization, side effects, and long-term effects along with conspiracy theories. Prevailing information gaps regarding the COVID-19 vaccines and the resulting uncertainty are discussed. Understanding information sources and the trust Hispanic communities place in these sources is important in designing effective health messages.

Accuracy-sensitisation promotes the sharing of pro- (but not anti-) vaccine information

OBJECTIVE

This study investigated (i) factors predicting the seeking and sharing of vaccinerelated information, and (ii) the effect of an accuracy-sensitisation prime on sharing intentions. Design:This was a preregistered online survey with 213 participants. Participants were randomly assigned to an intervention group (who were exposed to an accuracy-sensitisation prime) or a control group.

DESIGN

This was a preregistered online survey with 213 participants. Participants were randomly assigned to an intervention group (who were exposed to an accuracy-sensitisation prime) or a control group.

MAIN OUTCOME MEASURES

Measures included decision-making style, COVID-19 anxiety, and percentages of pro and anti-vaccine friends. We also measured preferences to seek pro or anti-vaccine-related information and sharing intentions with respect to this information.

RESULTS

Compared with those seeking both pro and anti-vaccine information, participants seeking only pro-vaccine information had lower hypervigilance and buck-passing and higher COVID-19 anxiety. The likelihood of sharing anti-vaccine information was positively predicted by the percentage of one's anti-vaccine friends, the size of one's social network, and conservative political orientation. Conversely, the likelihood of sharing pro-vaccine information was positively predicted by the percentage of one's pro-vaccine friends, and liberal political orientation. Participants sensitised to accuracy were significantly more likely to share provaccine information; however, accuracy-sensitisation had no effect on anti-vaccine information sharing.

CONCLUSIONS

Individuals who seek anti-vaccine information have a tendency towards disorganised and impulsive decision-making. Accuracy-sensitisation may prime people to internalise a norm promoting truth-sharing.

An Experimental Test of the Effects of Public Mockery of a Social Media Health Campaign: Implications for Theory and Health Organizations' Social Media Strategies

This study explored how social media users' mocking of a public health campaign can affect other users' emotions, cognitions, and behavioral intentions. Inspired by public mocking of the CDC's "Say No to Raw Dough" campaign aiming to prevent food poisoning caused by eating raw flour-based products, this experiment (N = 681) employed a 2 (Public responses to a PSA: Mocking or serious) x 3 (Organizational response to public responses: Self-mocking, serious, or none) + 1 (control condition) design. Statistical tests revealed that user-generated mocking can lower intentions to avoid the health risk by decreasing perceptions of injunctive norms (that is, seeing others mock a public health campaign resulted in weaker perceptions that others think you should avoid the risky behavior). Mockery of a public health campaign also engender anger at the CDC and at other users, with the target of the anger having differential effects on intentions to avoid eating raw dough. Implications for theory and the practice of social media-based health promotion are discussed.

Generational Factors Associated with SARS-CoV-2 Vaccine Completion for Americans of Mexican Decent Living along the United States-Mexico Border Region

Background: SARS-CoV-2 vaccine uptake variation remains a significant barrier to overcoming the spread of COVID-19. Individual beliefs/attitudes about the SARS-CoV-2 vaccine vary significantly across generations due to personal experiences, access to accurate information, education levels, political beliefs, and trust in healthcare systems. Methods: This analysis used data from the baseline visit of Project 2VIDA!, a cohort of Americans of Mexican descent (AoDM) and African American individuals (n = 1052) in San Diego, CA, along the U.S.-Mexico border region. The survey assessed sociodemographics, healthcare access, socioeconomic factors, and trust in public health information/SARS-CoV-2 prevention. We conducted a logistic regression involving AoDM individuals to identify generational factors associated with completing the SARS-CoV-2 vaccine series. Results: The results of the logistic regression analysis revealed that Generation X (OR = 0.52, 95% CI = 0.33-0.82), Millennials (OR = 0.24, 95% CI = 0.14-0.41), and Generation Z (OR = 0.10, 95% CI = 0.05-0.22) were less likely to complete the SARS-CoV-2 vaccine series when compared to Baby Boomers and the Silent Generation. Conclusions: Participants with a history of SARS-CoV-2 testing and trust in the SARS-CoV-2 vaccine were significantly more likely to complete the SARS-CoV-2 vaccine series. Efforts to address vaccine series completion should be tailored to the specific concerns and motivations of different age groups.

Identifying Population Segments by Differing Levels of COVID-19 Vaccine Confidence and Evaluating Subsequent Uptake of COVID-19 Prevention Behaviors: Web-Based, Longitudinal, Probability-Based Panel Survey

BACKGROUND

The COVID-19 pandemic prompted the launch of the US Department of Health and Human Services' COVID-19 Public Education Campaign to boost vaccine confidence and uptake among adults, as vaccines are key to preventing severe illness and death.

OBJECTIVE

Past segmentation research relevant to COVID-19 behavior has found important differences in attitudes, sociodemographics, and subsequent COVID-19 prevention behaviors across population segments. This study extends prior work by incorporating a more comprehensive set of attitudes, behaviors, and sociodemographic variables to identify population segments by differing levels of COVID-19 vaccine confidence and evaluate differences in their subsequent uptake of COVID-19 prevention behaviors.

METHODS

Data were obtained from 5 waves (January 2021 to June 2022) of a web-based longitudinal, probability-based panel survey of US adults (N=4398) administered in English and in Spanish. Participants were recruited from NORC at the University of Chicago's national AmeriSpeak panel and were invited to participate across multiple waves. Latent class cluster analysis estimated segments of respondents based on over 40 COVID-19 attitudes, beliefs, behaviors, and sociodemographics as reported in wave 1. Survey-weighted cross-tabulations and bivariate regression analyses assessed differences in COVID-19 vaccine uptake, booster uptake, mask use, and social distancing in all segments across all 5 survey waves.

RESULTS

A total of 6 segments (hardline nonintenders, prevention-compliant nonintenders, burned-out waiters, anxious waiters, skeptical confidents, and ready confidents) were identified, which differed by their COVID-19 vaccine confidence, prevention-related attitudes and behaviors, and sociodemographics. Cross-tabulations and regression results indicated significant segment membership differences in COVID-19 vaccine and booster timing, mask use, and social distancing. Results from survey-weighted cross-tabulations comparing COVID-19 vaccine and booster uptake across segments indicate statistically significant differences in these outcomes across the 6 segments (P<.001). Results were statistically significant for each segment (P<.01 for booster uptake among burned-out waiters; P<.001 for all other coefficients), indicating that, on average, respondents in segments with lower intentions to vaccinate reported later receipt of COVID-19 vaccines and boosters relative to the timing of vaccine and booster uptake among ready confidents.

CONCLUSIONS

Results extend previous research by showing that initial beliefs and behaviors relevant to COVID-19 vaccination, mask use, and social distancing are important for understanding differences in subsequent compliance with recommended COVID-19 prevention measures. Specifically, we found that across respondent segments, the probability of vaccine and booster uptake corresponded with both COVID-19 vaccine confidence and mask use and social distancing compliance; more compliant segments were more likely to get vaccinated or boosted than less compliant segments given similar levels of vaccine confidence. These findings help identify appropriate audiences for campaigns. Results highlight the use of a comprehensive list of attitudes, behaviors, and other individual-level characteristics that can serve as a basis for future segmentation efforts relevant to COVID-19 and other infectious diseases.

Faith and vaccination: a scoping review of the relationships between religious beliefs and vaccine hesitancy

BACKGROUND

Throughout history, vaccines have proven effective in addressing and preventing widespread outbreaks, leading to a decrease in the spread and fatality rates of infectious diseases. In a time where vaccine hesitancy poses a significant challenge to public health, it is important to identify the intricate interplay of factors exemplified at the individual and societal levels which influence vaccination behaviours. Through this analysis, we aim to shed new light on the dynamics of vaccine hesitancy among religious groups, contributing to the broader effort to promote vaccine uptake, dispel misunderstandings, and encourage constructive dialogue with these groups.

METHODS

We used the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) using the 20-point checklist to guide this review. The inclusion criteria for our study were that the literature should be in English, concerned with vaccine hesitancy as the focus of study, study the impact religiosity or religious beliefs as either an outcome or control variable, concerning population levels, and be peer-reviewed.

RESULTS

We analysed 14 peer-reviewed articles that included components related to religiosity or religious beliefs and their impact on vaccine hesitancy published until September 2023. All the articles were published in approximately the last decade between 2012 and 2023, with only 4 of the articles published before 2020. Out of the 14 studies included in our review, twelve utilized quantitative methods, while the remaining two employed qualitative approaches. Among the studies included in our analysis, we found various approaches to categorizing religious belief and identity. In most studies when religion is uniformly regarded as the sole determinant of vaccine hesitancy, it consistently emerges as a significant factor in contributing to vaccine hesitancy. All studies in our review reported sociodemographic factors to some degree related to vaccine hesitancy within their sample populations. Our analysis underscored the need for nuanced approaches to addressing vaccine hesitancy among religious groups.

CONCLUSION

Vaccine hesitancy is a complex issue and driven by a myriad of individual and societal factors among which religious beliefs is commonly associated to be a driver of higher levels among populations.

"Do not inject our babies": a social listening analysis of public opinion about authorizing pediatric COVID-19 vaccines

Designing effective childhood vaccination counseling guidelines, public health campaigns, and school-entry mandates requires a nuanced understanding of the information ecology in which parents make vaccination decisions. However, evidence is lacking on how best to "catch the signal" about the public's attitudes, beliefs, and misperceptions. In this study, we characterize public sentiment and discourse about vaccinating children against SARS-CoV-2 with mRNA vaccines to identify prevalent concerns about the vaccine and to understand anti-vaccine rhetorical strategies. We applied computational topic modeling to 149 897 comments submitted to regulations.gov in October 2021 and February 2022 regarding the Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee's emergency use authorization of the COVID-19 vaccines for children. We used a latent Dirichlet allocation topic modeling algorithm to generate topics and then used iterative thematic and discursive analysis to identify relevant domains, themes, and rhetorical strategies. Three domains emerged: (1) specific concerns about the COVID-19 vaccines; (2) foundational beliefs shaping vaccine attitudes; and (3) rhetorical strategies deployed in anti-vaccine arguments. Computational social listening approaches can contribute to misinformation surveillance and evidence-based guidelines for vaccine counseling and public health promotion campaigns.

What Caused the Narrowing of Black-White COVID-19 Vaccination Disparity in the US? A Test of 5 Hypotheses

Despite differential uptake of COVID-19 vaccination between Black and non-Hispanic White Americans early in the pandemic, the gap narrowed over time. We tested five hypotheses that could explain the reduction in the disparity. Using a national probability panel of over 1800 individuals surveyed from April 2021 to July 2022, we assessed receipt of recommended doses of COVID-19 vaccines along with (a) reported exposure to deaths due to COVID-19, (b) trust in US health authorities, such as the CDC, (c) knowledge about the safety and efficacy of COVID-19 vaccination, (d) media use as a source of information, and (e) access to COVID-19 vaccines. Only increases in knowledge about the safety and efficacy of COVID-19 vaccines uniquely mediated the increase in vaccination uptake among non-Hispanic Black compared to White, Asian and Hispanic panelists. While trust in CDC and exposure to COVID-19 deaths were related to vaccination acceptance at baseline, those factors were not associated with change in reported vaccination coverage. In addition, neither differential access nor media use explained the increase. Enhanced knowledge about the safety and efficacy of COVID-19 vaccination transmitted from within the Black community likely helped to increase vaccination relative to other racial-ethnic groups.

Geographic Variation in Racial Disparities in Receipt of High-Dose Influenza Vaccine Among US Older Adults

BACKGROUND

Racial disparities in receipt of high-dose influenza vaccine (HDV) have been documented nationally, but whether small-area geographic variation in such disparities exists remains unknown. We assessed the distribution of disparities in HDV receipt between Black and White traditional Medicare beneficiaries vaccinated against influenza within states and hospital referral regions (HRRs).

METHODS

We conducted a nationally representative retrospective cohort study of 11,768,724 community-dwelling traditional Medicare beneficiaries vaccinated against influenza during the 2015-2016 influenza season (94.3% White and 5.7% Black). Our comparison was marginalized versus privileged racial group measured as Black versus White race. Vaccination and type of vaccine were obtained from Medicare Carrier and Outpatient files. Differences in the proportions of individuals who received HDV between Black and White beneficiaries within states and HRRs were used to measure age- and sex-standardized disparities in HDV receipt. We restricted to states and HRRs with ≥ 100 beneficiaries per age-sex strata per racial group.

RESULTS

We detected a national disparity in HDV receipt of 12.8 percentage points (pps). At the state level, the median standardized HDV receipt disparity was 10.7 pps (minimum, maximum: 2.9, 25.6; n = 30 states). The median standardized HDV receipt disparity among HRRs was 11.6 pps (minimum, maximum: 0.4, 24.7; n = 54 HRRs).

CONCLUSION

Black beneficiaries were less likely to receive HDV compared to White beneficiaries in almost every state and HRR in our analysis. The magnitudes of disparities varied substantially across states and HRRs. Local interventions and policies are needed to target geographic areas with the largest disparities to address these inequities.

How Different Uses of Social Media Inform Perceptions of Offline Social Norms and Changes in Vaccine Intentions

As the boundaries between our online and offline lives are increasingly blurred, it is important to attend to the ways in which online behaviors shape our offline perceptions and actions. While a great deal of health communication research has examined the effects of exposure to specific social media content, it is also important to investigate how broader patterns of everyday social media use may affect perceptions of health norms and behaviors in different ways. In this panel survey, we explored how using social media for informational, connection, and aspirational purposes affected perceptions of COVID-19 vaccination norms and changes in vaccine intentions between December 2020 and March 2021 in the US Using social media to seek information and to connect with others positively influenced vaccine intentions via strengthening perceptions of offline social norms supporting vaccination. These findings highlight how social media use is integrated with and informs our offline lives, as well as the important role apolitical social media use plays in shaping attitudes toward politicized science.

Longitudinal attenuation in political polarization: Evidence from COVID-19 vaccination adherence in Brazil

BACKGROUND

While political polarization in policy opinions, preferences, and observance is well established, little is known about whether and how such divisions evolve, and possibly attenuate, over time. Using the COVID-19 pandemic in Brazil as the backdrop, we examine the longitudinal evolution of a highly relevant and polarizing policy: adherence to the COVID-19 vaccination.

METHODS

Studies 1 (N = 3346) and 2 (N = 10,214) use nationwide surveys to document initial differences and subsequent changes in vaccination adherence between conservatives ("Bolsonaristas") and non-conservatives ("non-Bolsonaristas"). Study 3 (N = 742) uses an original dataset to investigate belief changes among conservatives and their association with asymmetric changes in vaccination adherence.

RESULTS

Despite substantial differences at the early stages of rollout, the gap in vaccination adherence between conservatives and non-conservatives significantly decreased with the passage of time, driven essentially by a much faster uptake among the initially most skeptic-the conservatives. Study 3 demonstrates that the asymmetric changes in vaccination adherence were associated with meaningful belief changes among the conservatives, especially about the perceived effectiveness of the COVID-19 vaccines and the expected adherence of peers to the vaccination campaign.

CONCLUSIONS

Together, these studies show that, in a context where the superiority of the promoted policy becomes clear over time and individuals have the opportunity to revisit prior beliefs, even intense political polarization can be attenuated.

Sustaining the momentum for adult vaccination post-COVID-19 to leverage the global uptake of life-course immunisation: A scoping review and call to action

OBJECTIVES

The COVID-19 pandemic changed the adult vaccination landscape, possibly permanently. This review attempts to quantitate the magnitude of those changes.

METHODS

PubMed was searched for studies on adult / life-course vaccination between 1 January 2020 until 8 November 2022.

RESULTS

Twenty-one articles were identified and observations summarised as positive developments/impediments to life-course immunisation, and areas needing policy and structural reform. Unprecedented funding, international co-operation and technical advances led to COVID-19 vaccines authorised in record time. Investments in infrastructure and an expanded healthcare workforce streamlined vaccine delivery to adults. Constant media coverage and targeted messaging have improved health literacy. Conversely, the speed of vaccine development was perceived as a safety risk, and an 'infodemic' of misinformation propagated through social media negatively influenced vaccine uptake. Vaccine access and affordability remains inequitable among older adults and minority groups.

CONCLUSIONS

The COVID pandemic led to an opportunity to permanently change policies, attitudes, and systems for vaccine delivery to adults to establish a global life-course approach to immunisation. This is a call for action to sustain the momentum triggered by the COVID-19 pandemic. Addressing inequalities, improving health literacy and optimally using social media are critical to sustain adult vaccinations in post-COVID-19 era.

COVID-19 vaccine acceptance: A comparative longitudinal analysis of the association between risk perception, confidence, and the acceptance of a COVID-19 vaccine

Following the outbreak of COVID-19, scientists rushed to develop vaccines to protect individuals and ferry the world out of the pandemic. Unfortunately, vaccine hesitancy is a major threat to the success of vaccination campaigns. Research on previous pandemics highlighted the centrality of perceived risk and confidence as core determinants of vaccine acceptance. Research on COVID-19 is less conclusive, and frequently it relies on one-country, cross-sectional data, thus making it hard to generalize results across contexts and observe these relationships over time. To bridge these gaps, in this article, we analyzed the association between perceived risk, confidence, and vaccine acceptance cross-sectionally at individual and country levels. Then, we longitudinally explored whether a within-country variation in perceived risk and confidence was correlated with a variation in vaccine acceptance. We used data from a large-scale survey of individuals in 23 countries and 19 time-points between June 2020 and March 2021 and comparative longitudinal multilevel models to estimate the associations at different levels of analysis simultaneously. Results show the existence of cross-sectional relationships at the individual and country levels but no significant associations within countries over time. This article contributes to our understanding of the roles of risk perception and confidence in COVID-19 vaccines' acceptance by underlining that these relationships might differ at diverse levels of analysis. To foster vaccine uptake, it might be important to address individual concerns and persisting contextual characteristics, but increasing levels of perceived risk and confidence might not be a sufficient strategy to increase vaccine acceptance rates.

Toward trustworthy COVID-19 interventions: Building vaccine trust through community-university partnerships

Prior research identifies trust as critical to increase vaccine acceptance and uptake. However, few intervention studies have sought to develop or test strategies for bolstering vaccine-related trust. To address this gap, this exploratory study identifies features of COVID-19 vaccine hesitancy interventions that can promote or undermine trust across three interconnected domains: institutional, interpersonal, and product (the vaccine itself). We draw on focus groups (N = 27 participants) with community and university partners involved with hosting COVID-19 testing and vaccine events in underserved Oklahoma communities. Focus groups explored participants' experiences serving community health needs and elicited feedback on proposed vaccine hesitancy interventions. Proposed interventions included two technology-based strategies (text message reminders and tablet-based testimonials and education) and one dialogue-based strategy (anti-body test interpretation). We find that community partners perceived local universities as trustworthy institutions because of their association with popular sports programs, academic credentials, and proximity, creating opportunities to address vaccine-related distrust through community-university partnerships. The most promising intervention strategies for building interpersonal trust included engaging in one-on-one dialogue and using autonomy enhancing approaches. Finally, interventions that successfully encouraged vaccine trust did so by incorporating personalized health information about individuals' potential level of protection and susceptibility to the COVID-19 virus. These findings can inform future public health efforts to create trustworthy vaccine hesitancy interventions.

Heritage and hesitancy: how preference for traditional Chinese medicine influences vaccine attitudes

Introduction

Vaccine hesitancy, amplified by the COVID-19 pandemic, is a pressing public health challenge. This study investigates the association between Traditional Chinese Medicine (TCM) preference and COVID-19 vaccine hesitancy within China.

Methods

The study uses data from the 2021 Chinese General Social Survey (CGSS) (N = 2,690). Logistic regressions and Karlson-Holm-Breen (KHB) method are employed to analyzed the relationship between TCM preference and vaccine hesitancy.

Results

The study reaffirms prior findings by revealing a robust and stable association between TCM preference and vaccine hesitancy, which remains unaffected by socioeconomic and demographic confounders, as well as institutional trust dynamics of healthcare system. Contrary to expectations, TCM enthusiasts do not exhibit vaccine hesitancy based on divergent epistemological views concerning vaccine risks and immunity acquisition compared to biomedicine.

Discussion

This research enriches understandings of the intricate relations between healthcare paradigms and vaccine attitudes, inviting further inquiry into the role of CAM in shaping vaccination behaviors across different cultures and contexts. The insights bear significant public health implications for enhancing vaccine acceptance and coverage, particularly among populations where CAM practices wield substantial influence.

Willingness to Use Digital Health Screening and Tracking Tools for Public Health in Sexual Minority Populations in a National Probability Sample: Quantitative Intersectional Analysis

BACKGROUND

Little is known about sexual minority adults' willingness to use digital health tools, such as pandemic-related tools for screening and tracking, outside of HIV prevention and intervention efforts for sexual minority men, specifically. Additionally, given the current cultural climate in the United States, heterosexual and sexual minority adults may differ in their willingness to use digital health tools, and there may be within-group differences among sexual minority adults.

OBJECTIVE

This study compared sexual minority and heterosexual adults' willingness to use COVID-19-related digital health tools for public health screening and tracking and tested whether sexual minority adults differed from each other by age group, gender, and race or ethnicity.

METHODS

We analyzed data from a cross-sectional, national probability survey (n=2047) implemented from May 30 to June 8, 2020, in the United States during the height of the public health response to the COVID-19 pandemic. Using latent-variable modeling, heterosexual and sexual minority adults were tested for differences in their willingness to use digital health tools for public health screening and tracking. Among sexual minority adults, specifically, associations with age, gender, and race or ethnicity were assessed.

RESULTS

On average, sexual minority adults showed greater willingness to use digital health tools for screening and tracking than heterosexual adults (latent factor mean difference 0.46, 95% CI 0.15-0.77). Among sexual minority adults, there were no differences by age group, gender, or race or ethnicity. However, African American (b=0.41, 95% CI 0.19-0.62), Hispanic or Latino (b=0.36, 95% CI 0.18-0.55), and other racial or ethnic minority (b=0.54, 95% CI 0.31-0.77) heterosexual adults showed greater willingness to use digital health tools for screening and tracking than White heterosexual adults.

CONCLUSIONS

In the United States, sexual minority adults were more willing to use digital health tools for screening and tracking than heterosexual adults. Sexual minority adults did not differ from each other by age, gender, or race or ethnicity in terms of their willingness to use these digital health tools, so no sexual orientation-based or intersectional disparities were identified. Furthermore, White heterosexual adults were less willing to use these tools than racial or ethnic minority heterosexual adults. Findings support the use of digital health tools with sexual minority adults, which could be important for other public health-related concerns (eg, the recent example of mpox). Additional studies are needed regarding the decision-making process of White heterosexual adults regarding the use of digital health tools to address public health crises, including pandemics or outbreaks that disproportionately affect minoritized populations.

The politics of vaccination: a closer look at the beliefs, social norms, and prevention behaviors related to COVID-19 vaccine uptake within two US political parties

COVID-19 vaccine hesitancy and suboptimal vaccine uptake rates are pressing public health challenges. Vaccine hesitancy has been observed for different vaccines. For COVID-19 vaccines, multiple factors influence vaccine uptake in the U.S. including political ideology. A more nuanced understanding of the factors influencing COVID-19 vaccine uptake within political parties is needed. This study assesses the relationship between known vaccine hesitancy factors and vaccine uptake within two major political parties. Data from 804 U.S. participants in an online survey from June 2021 was used to assess the association between COVID-19 vaccine uptake (no dose vs. any dose) and categories of factors thought to influence vaccine uptake (sociodemographic variables, COVID-19 disease and vaccine belief variables, belief in COVID-19 prevention behavior variables, and social network features variables) for Republicans and Democrats using bivariate and multivariate regression. 65.4% of the sample reported having received at least one dose of the COVID-19 vaccine (22.6% Republican and 52.1% Democrat). In the total sample bivariate model, Democrat participants had significantly greater odds of having received a dose of the vaccine as compared to Republican participants (OR = 2.51, 95%CI = 1.73-3.64). In adjusted models, the speed of vaccine development was negatively associated with vaccine uptake for both Republicans (aOR = 0.18, 95%CI = 0.06-0.57) and Democrats (aOR = 0.40, 95%CI = 0.19-0.86), as was concern about side effects from the vaccine (Republicans: aOR = 0.15; 95%CI = 0.05-0.47; Democrats: aOR = 0.14, 95%CI = 0.06-0.31). COVID-19 vaccine uptake among Republicans, but not Democrats, was associated with belief that the vaccine prevents COVID-19 (aOR = 3.29, 95%CI = 1.29-8.37) and belief about friends' vaccine intentions (aOR = 6.19, 95%CI = 2.39-16.05). There were no significant factors unique to Democrats. Concerns about aspects of COVID-19 vaccine safety for both political groups suggest that vaccine advocacy interventions should universally address these factors. However, Republican beliefs in vaccine efficacy and in friends' vaccine intentions suggest a need for Republican-specific messaging.

Testing an extended theory of planned behaviour in predicting Covid-19 vaccination intention over the course of the pandemic: A three-wave repeated cross-sectional study

Background

Mass vaccination against Covid-19 has been recognised as the most effective strategy for overcoming the pandemic emergency and remains crucial in the ongoing efforts to mitigate the impact of the virus. The present study aimed to test the efficacy of an extended Theory of Planned Behaviour (TPB) model in predicting vaccination intention in three different phases of the pandemic. Understanding how psychological drivers of vaccine acceptance may have changed throughout the pandemic is essential for informing public health strategies and addressing vaccine hesitancy, even in the current post-pandemic context.

Methods

Using a repeated cross-sectional survey, we tested the hypothesised extended TPB model (intention, attitude, subjective norms, perceived behavioural control, anticipated affective reactions, risk perception, trust in science, trust in institutions and religiosity) across three independent samples: before (T1: November-December 2020; N = 657), during (T2: March-May 2021; N = 818), and after (T3: February-March 2022; N = 605) the start of the vaccination campaign in Italy.

Results

Results indicated significant differences between the time points in all investigated variables, pointing to a general trend of improvement in vaccine acceptability levels at T2 compared to T1, and a worsening at T3 compared to the other two time points. Interestingly, net of these differences, a multi-group Structural Equation Modeling analysis supported the invariance, across time, of the structural relationships examined within the extended TPB.

Conclusion

Findings demonstrated the efficacy of the TPB in predicting Covid-19 vaccination intention at different stages of the pandemic, suggesting that the model, in its extended version, represents a valuable framework for designing interventions aimed at promoting vaccine acceptance.

"Every Time It Comes Time for Another Shot, It's a Re-Evaluation": A Qualitative Study of Intent to Receive COVID-19 Boosters among Parents Who Were Hesitant Adopters of the COVID-19 Vaccine

COVID-19 vaccine coverage remains low for US children, especially among those living in rural areas and the Southern/Southeastern US. As of 12 September 2023, the CDC recommended bivalent booster doses for everyone 6 months and older. Emerging research has shown an individual may be vaccine hesitant and also choose to receive a vaccine for themselves or their child(ren); however, little is known regarding how hesitant adopters evaluate COVID-19 booster vaccinations. We used an exploratory qualitative descriptive study design and conducted individual interviews with COVID-19 vaccine-hesitant adopter parents (n = 20) to explore COVID-19 parental intentions to have children receive COVID-19 boosters. Three primary themes emerged during the analysis: risk, confidence, and intent, with risk assessments from COVID-19 and COVID-19 vaccine confidence often related to an individual parent's intent to vaccinate. We also found links among individuals with persistent concerns about the COVID-19 vaccine and low COVID-19 vaccine confidence with conditional and/or low/no intent and refusal to receive recommended boosters for children. Our findings suggest that healthcare providers and public health officials should continue making strong recommendations for vaccines, continue to address parental concerns, and provide strong evidence for vaccine safety and efficacy even among the vaccinated.

Ideological differences in COVID-19 vaccine intention: the effects of trust in the healthcare system, in complementary and alternative medicine, and perceived threat from the disease

Introduction

Politically left-leaning individuals are more likely to get vaccinated against COVID-19, although little is known about the mechanisms underlying the ideological differences in vaccination intentions. Understanding the extent to which trust in the healthcare system, in complementary and alternative medicine, and the perceived threat from the disease contribute to these disparities is crucial, as it could inform targeted interventions to address vaccine hesitancy across the political spectrum.

Methods

The present cross-sectional study conducted among adults living in Slovenia (n = 858) examined the mediating role of trust in the healthcare system, trust in complementary and alternative medicine (CAM), and the perceived threat from the virus on COVID-19 vaccination intention.

Results

We found that leftist ideology and trust in the healthcare system positively predicted vaccination intention, whereas CAM negatively predicted this intention. In addition, left-leaning individuals expressed greater trust in the healthcare system and lower trust in CAM, resulting in higher levels of COVID-19 vaccination intention. The serial mediation model confirmed that trust in CAM was a negative predictor, while trust in the healthcare system positively predicted perceived threat.

Discussion

When dealing with vaccine hesitancy among right-oriented individuals, strategies should focus on enhancing trust in the healthcare system and critically evaluating the reliance on CAM.

A Psychosocial Model of COVID-19 Vaccination: Antecedent and Concurrent Effects of Demographics, Traits, Political Beliefs, Vaccine Intention, Information Sources, Mandates, and Flu Vaccine History

BACKGROUND

To date, research investigating psychosocial correlates of COVID-19 vaccination has been cross-sectional, parochial, and/or reliant upon non-stratified international samples, resulting in difficulty in clarifying the contributions of various vaccination-related influences.

PURPOSE

The present study tested a novel integration of prospective and concurrent associations of demographic and dispositional tendencies, intervening illness and preventive beliefs, vaccine intention, illness experiences, and concurrent contextual vaccine-related influences with subsequent COVID-19 vaccination.

METHODS

The preregistered study used a stratified online U.S. sample (N = 500), with assessments aligned to (a) "15 days to slow the spread" in March 2020, (b) vaccine authorization and major case/mortality surge during December 2020 and January 2021, and (c) the period following full vaccine approval in August 2021 during the third major/case mortality surge during September and October 2021.

RESULTS

Path modeling showed the absence of children in the household and greater education were prospective predictors of vaccination. Trait openness and less conservative political beliefs showed indirect prospective associations with vaccination via stronger intermediating vaccine intention. Contextual vaccine-related influences of vaccine-related information sources, employer mandates, and flu vaccine history also showed direct associations with vaccination. In contrast to expectations, lower conscientiousness showed a direct prospective association with vaccination.

CONCLUSIONS

Controlling for interrelations among study variables, the results of the integrative psychosocial model clarified the unique contributions and pathways from antecedent characteristics to vaccination while accounting for vaccine-related contextual influences, providing further direction for refining the timing and content of public health messaging for vaccination.

Different roles of interpersonal trust and institutional trust in motivating older adults to receive COVID-19 vaccines in Singapore

Since the approvals of several vaccines against COVID-19 by the World Health Organization, a large body of research has studied the determinants of individuals' intention to be vaccinated against COVID-19 in a variety of societies. Vaccine intention is a complex construct rooted in the social context that informs the decision-making process. The underlying reasons for older adults' intention to receive the vaccination is even more important to health authorities in societies with large proportions of older adults. In this paper, we interview 27 women over age 55 in Singapore about their COVID-19 vaccine decision-making. Using a social-ecological framework of trust, we identify factors at both individual and institutional levels that build or undermine trust and underlie older women's decisions to receive COVID-19 vaccinations in an authoritarian regime. Findings show that both interpersonal trust and institutional trust contribute to vaccine uptake, however, trust can also contribute to delays in vaccination. Moreover, a sizable minority of respondents report that they were vaccinated not because of institutional trust, but because they felt compelled to do so. The results shed light on directions for future vaccination campaigns.

What drives the vaccination intention against COVID-19? Application of EPPM, TAM, and theories of risk assessment

Vaccines are widely used to fight against COVID-19. However, COVID-19 vaccine hesitancy appears as some individuals are concerned with COVID-19 vaccines. This study investigates the vaccination intention against COVID-19 in China with the Extended Parallel Process Model (EPPM), Technology Acceptance Model (TAM), and theories of risk information assessment. Results showed that the formation mechanism of vaccination intention could be considered a psychological process, as subjective knowledge was a primary influence on correspondents' weighting of both the potentially positive (usefulness) and negative effects (threat) of vaccination. This unequal consideration then resulted in different levels of fear arousal between subjects. Driven by usefulness/threat perception and fear, people conducted different decision strategies, so-called analytical assessment, and experiential assessment to make vaccination decision. In addition to the direct effects of experiential assessment on vaccination intention, two decision strategies and fear arousal also affected people's vaccination intention through the mediation role of vaccination attitude. For policymakers and stakeholders, this study provides a knowledge base for confidence-building, and emotional guidance concerning against COVID-19 vaccination.

Exploring First Responder Beliefs and Decisions to Vaccinate Against SARS-COV-2

As frontline providers, first responders are not always thought of as patients with unique health beliefs. During early and continued distribution, many first responders in the United States chose to refuse vaccination. Guided by the health belief model and emerging research related to SARS-COV-2, the aim of this study was to further explore the complex message conditions that contributed to first responders' early vaccination decisions. An online survey was conducted between March 1 and March 31 2021, among first responders in the state of Kentucky, which has lagged behind most states in the percentage of the population who are fully vaccinated. The first responder sample included Firefighters, Emergency Medical Technicians (EMTs), and paramedics who completed a Qualtrics survey that included measures aimed at assessing health beliefs about SARS-COV-2, beliefs about SARS-COV-2 vaccines, source trustworthiness, and vaccine motivation. First responders were also asked to rank the importance of various information sources about SARS-COV-2 and its vaccines. Findings suggest significant differences exist among first responders who have chosen to receive SARS-COV-2 vaccines and those who have refused, including source preference, conspiracy beliefs, and perceived risk. Future directions, including the exploration of institutional mistrust as a health belief are discussed. These findings offer practical insights that may improve continuing approaches to discover and use preferred communication sources to reach the vaccine-hesitant.

Understanding Stakeholders' Perspectives to Increase COVID-19 Vaccine and Booster Uptake Among Black Individuals With Rheumatic Conditions

OBJECTIVE

Disparities in COVID-19 vaccine and booster uptake persist. This study aimed to obtain perspectives from community and physician stakeholders on COVID-19 vaccine and booster hesitancy and strategies to promote vaccine uptake among Black individuals with rheumatic and musculoskeletal conditions.

METHODS

We invited community leaders and physicians in greater Boston and Chicago to participate in semi-structured interviews using a moderator guide developed a priori. Participants were queried about how to best address vaccine hesitancy, strategies to target high-risk populations, and factors to identify future community leaders. Interviews were audio recorded, transcribed verbatim, and analyzed thematically using Dedoose.

RESULTS

A total of 8 physicians and 12 community leaders participated in this study between November 2021 and October 2022. Qualitative analyses revealed misinformation/mixed messaging and mistrust, with subthemes including conspiracy theories, concerns regarding vaccine development and function, racism and historical injustices, and general mistrust of health care systems as the top cited reasons for COVID-19 vaccine hesitancy. Participants also shared demographic-specific differences, such as race, ethnicity, age, and gender that influenced the identified themes, with emphasis on COVID-19 vaccine access and apathy. Strategies for community-based vaccine-related information dissemination included personal storytelling with an iterative and empathetic approach, while recognizing the importance of protecting community leader well-being.

CONCLUSION

To increase vaccine uptake among Black individuals with rheumatic conditions, strategies should acknowledge and respond to racial/ethnic and socioeconomic injustices that engender vaccine hesitancy. Messaging should be compassionate, individually tailored, and recognize heterogeneity in experiences and opinions. Results from these analyses will inform a planned community-based intervention in Boston and Chicago.

Role of leadership and incentive-based programs in addressing vaccine hesitancy in India

The current study goes beyond the popular 5Cs model of vaccine hesitancy to explore perceived social norms, role of leadership and the role of incentive-based intervention for improving the likelihood of vaccination, in a population-representative sample of adults in India (N = 1129). We investigated differences in socio-demographic status, perceived descriptive norms like vaccine behaviours, beliefs, experience and perceived injunctive norms like community and political leadership within the context of the COVID-19 pandemic are related to vaccination. Further, we examined the role of incentive-based intervention as a potentially salient predictor of adults' vaccine uptake. The study is based on a cross-sectional survey conducted in July-November 2021, which included questions about impacts of pandemic collected by phone call interview from adults' beneficiaries of Government free food schemes, across 11 states in India. The data include 81 % vaccinated and 19 % vaccine hesitant participants, with a higher proportion of business or self-employed (53.1 %) as vaccine hesitant. We performed the t-test to assess the variation between vaccinated and vaccine hesitant adults, and Exploratory Factor Analysis to uncover the underlying dimension of vaccine hesitancy. Subsequently, Binary Logistic Regression model probed the factors associated with likelihood of vaccination uptake. In contrast to the prevailing evidence, results demonstrated community and political leadership has significant negative impact on vaccination (p-value < 0.06, 95 % CI, 0.57-1.01). Incentive-based intervention offer a vital leverage to enhance positive attitude towards vaccination (p-value < 0.05, 95 % CI, 1.01-1.80). The results thus broadly highlight the limited role of political and community leaders in leveraging their influence on vaccination, the role of timely, accurate information, applications of telemedicine as an important tool to provide healthcare and the need for optimal design of incentive-based vaccination programs recommended by trusted sources.

Avoidance of Interpersonal Discussions About the COVID-19 Vaccination: Applying the Theory of Motivated Information Management

Using a stratified sample of German non-vaccinated residents (N = 1,328), we examined the effectiveness of the Theory of Motivated Information Management (TMIM) in explaining avoidant information management among family and friends, in the context of the COVID-19 vaccination. Our results generally supported the TMIM's utility as a theoretical framework for understanding avoidant information management, as the model fitted the data well. The study contributes to the theoretical development of the TMIM, by proving that anxiety and hope operate jointly and contribute to decisions for avoiding interpersonal discussions. Further, our findings indicate that avoidance efficacy is a valuable supplement to the considered types of efficacy assessments. As a practical implication, our findings indicate that interventions encouraging individuals to talk to their family and friends should focus on raising levels of communication and target efficacy, to overcome barriers to interpersonal discussions. This is significant in motivating individuals to get vaccinated.

Calculation, knowledge, and identity: Dimensions of trust when making COVID-19 vaccination choices in China

Vaccine hesitancy threatens the response to the COVID-19 pandemic and to other infectious disease outbreaks globally. Fostering trust has been highlighted as a critical factor in addressing vaccine hesitancy and expanding vaccine coverage, but qualitative exploration of trust in the context of vaccination remains limited. We contribute to filling this gap by providing a comprehensive qualitative analysis of trust in the context of COVID-19 vaccination in China. We conducted 40 in-depth interviews with Chinese adults in December 2020. During data collection, trust emerged as a highly salient topic. Interviews were audio-recorded, transcribed verbatim, translated into English, and analyzed with a combination of inductive and deductive coding. Following established trust literature, we differentiate between three types of trust - calculation-based trust, knowledge-based trust, and identity-based trust - which we grouped across components of the health system, as informed by the WHO's building blocks. Our results highlight how participants attributed their level of trust in COVID-19 vaccines to their trust in the medical technology itself (based on assessing risks and benefits or previous vaccination experiences), the service delivery and health workforce (informed by past experiences with health providers and their role throughout the pandemic), and leadership and governance (drawing on notions of government performance and patriotism). Reducing negative impact from past vaccine controversies, increasing the credibility of pharmaceutical companies, and fostering clear communication are identified as important channels for facilitating trust. Our findings emphasize a strong need for comprehensive information on COVID-19 vaccines and increased promotion of vaccination by credible figures.

Knowledge, acceptance, motivators and barriers of booster dose of COVID-19 vaccination among dental patients: A cross-sectional study

Given the lingering threat of COVID infection, questions are being raised if coronavirus disease 2019 (COVID-19) vaccine needs annual or regular boosters to maintain high levels of immunity against both the original virus and variants. This study was designed to evaluate the knowledge, acceptance, motivators and barriers of the booster dose of COVID-19 vaccine among the dental patients of District Lucknow, India. A total of 297 respondents were selected by a convenience sampling method in this cross-sectional study from various dental clinics. An anonymous, self-administered, closed-ended questionnaire was used. Overall 37.7% respondents reported to have taken all 3 doses and 57.9% had taken single/double doses. Correct information about booster doses shows a significant association with the number of doses taken. The majority had information about the availability of the Pfizer booster vaccine (69.0%). About 58% of participants had information about the technology used in booster doses. The hesitancy for booster doses and the development of natural immunity by infection show significant associations with the number of doses taken. Only 18.2% patients had hesitation about the booster dose and most of them 78.8% recommended others to take the booster vaccine as soon as possible. The majority assumed that previous COVID-19 vaccines can help them get immune (21.5%) followed by not much research has been done on the booster vaccines (15.5%) and their chronic diseases warn them against the booster dose administration (12.5%). Nearly 18.2% of respondents had hesitation about booster dose and less than one third of the respondents trusted a government source for information about booster dose of COVID vaccine. Nearly 36 % did not know that the booster dose of COVID vaccine is available at health centers. Dental health professionals and policymakers should implement and support strategies to ensure people are vaccinated for COVID-19 booster doses.

Examining the Dynamics of COVID-19 Misinformation: Social Media Trends, Vaccine Discourse, and Public Sentiment

INTRODUCTION

COVID-19, known as coronavirus disease, has prompted a global reevaluation of societal norms. The World Health Organization (WHO) declared it a worldwide Public Health Emergency on January 30, 2020. Subsequently, governments and pharmaceutical firms developed vaccines, such as mRNA options from Pfizer and Moderna, alongside viral vector alternatives to combat the escalating COVID-19 case tally. Extensive inquiry was directed toward assessing vaccine efficiency. Nonetheless, vaccine discourse has surged across social media, prominently involving the anti-vaxxer community. This faction's hesitancy, rooted in reservations about efficacy, potential side effects, and conspiracy notions, contributes to an ongoing dialogue.

OBJECTIVE

This investigation delves into social media's role in proliferating COVID-19 misinformation, utilizing tools like Python, Excel, and external resources to craft data visuals that elucidate trends influencing misinformation dissemination and its hypothetical ties to elevated COVID-19 cases. Scrutiny of Twitter trends illuminates the prevalence of the hashtag #covidvaccine, although the platform curbs anti-vaccine hashtags.

RESULT

Analysis of sentiment across 207,006 tweets reveals a prevailing positive sentiment toward COVID-19 vaccines, coexisting with lingering skepticism. Google trends reflect increased anti-vaccine ideology queries, notably post-FDA vaccine approval in December 2020, indicating public doubt.

CONCLUSION

While limitations encompass data granularity, geographic origins of false tweets, bot account quantification on Twitter, and comprehensive digital resources, this study pioneers reference for forthcoming investigations. Its objective is to mitigate the diffusion of misinformation.