Exploring key informants' perceptions of Covid-19 vaccine hesitancy in a disadvantaged urban community in Ireland: Emergence of a '4Cs' model

Barriers and enablers of addiction recovery amongst people experiencing homelessness in Dublin, Ireland: A proposed conceptual framework adapted from the REC-CAP

BACKGROUND

Worsening health disparities amongst individuals experiencing co-occurring homelessness and addiction underline a need to examine potential pathways towards recovery. This study consists of a secondary analysis to identify barriers and enablers of addiction recovery amongst people experiencing homelessness (PEH) in Dublin, Ireland, and to propose a conceptual framework adapted from the Recovery Capital Assessment & Recovery Planning Tool (REC-CAP).

METHODS

The analysis drew on two data sources collected between September 2022 and April 2023 as part of a qualitative, community health needs assessment: in-depth interviews with 19 providers working with PEH in Dublin, and ethnographic fieldwork conducted with 40 homeless clients attending a primary care and addiction services clinic in the city.

RESULTS

In addition to widely reported barriers to recovery such as limited access to housing, clients' recovery progress was blocked by unaddressed physical and psychological health conditions, and by harmful attitudes and beliefs about themselves, their substance use, and their treatment options. Societal stigma perpetuated those harmful beliefs and unfair access to recovery resources. Despite these barriers, once an individual found sufficient motivation to recover and reached a minimum threshold of physiological health and stability in their substance use, key elements of personal, social and community capital intersected and built upon each other to aid in recovery.

CONCLUSION

Key elements of recovery capital for PEH include a combination of self-confidence and self-efficacy, autonomy and freedom of choice, meaningful activities, social support, and access to satisfactory mental health, addiction, family, primary care, and housing supports. Though not essential for starting recovery, a safe and stable home is crucial for sustaining it.

Determinants of COVID-19 vaccination acceptance based on the novel Omale INDEPT FORCIS Framework and recommendations for subsequent pandemics: a qualitative study among community members in Ebonyi state, Nigeria

BACKGROUND

The unprecedented COVID-19 pandemic has become an endemic disease of global public health importance. Mass COVID-19 vaccination has been an essential global control strategy amidst challenges of limited acceptance. Because of globalization, COVID-19/similar diseases vaccination acceptance and the determinants in any particular setting are important global public health issues. Using a novel and pragmatic framework, this study explored determinants of COVID-19 vaccination acceptance among community members during the pandemic in Ebonyi state, Nigeria, and made policy-relevant recommendations on how to increase vaccination acceptance in subsequent outbreaks/pandemics.

METHODS

This qualitative study was based on the novel and pragmatic Individual Experiences and Perceptions and Complacency, Confidence, Convenience, and Compulsion (Four 'Cis') Determinants of Vaccination Acceptance Conceptual Framework - Omale INDEPT FORCIS Framework. On April 26 and 27, 2022, 20 semi-structured face-to-face focus group discussions were conducted in local language and pidgin English with 100 purposively selected consenting/assenting community members aged 15 years and above who had resided in the community for at least one year. Data was analysed using deductive (with some inductive) thematic analytic approach.

RESULTS

The many, diverse, and significant determinants of COVID-19 vaccination acceptance found were factors that were individual-related (individual experiences and perceptions and knowledge about COVID-19, COVID-19 vaccine/vaccination, and the vaccination process/system, sociodemographic, individual's condition (e.g. pregnancy)); COVID-19-related (factuality, transmissibility, frequency, severity, fatality); COVID-19 vaccine/vaccination-related (safety/side-effects, effectiveness, speedy production); COVID-19 vaccination process/system-related (real availability/accessibility); family, group, and other individual-related (experiences and perceptions and actions); and broader local, national, international, and global (LONING) context-related (socio-political, economic, historic, health system factors). The broader LONING contextual factors included the unprecedented disinformation/conspiracy theories, non-sustained COVID-19 risk/behaviour change communication, enforcement and non-enforcement or termination of peculiar control policies/measures (lockdowns, social/physical distancing, use of face mask etc.), mandatory COVID-19 vaccination policies, provision of incentives, past experiences regarding the Ebola viral disease outbreak, (un)trustworthiness of the Nigerian health system and her international/global partners, and the (un)trustworthiness of the governments in Nigeria and bad/good governance, inclusive of the failure of the Ebonyi state government to distribute the COVID-19 palliatives to the people during the lockdowns.

CONCLUSION

The evidence illuminates complex and interrelated, specific underlying, and peculiar policy-relevant LONING determinants of COVID-19 vaccination acceptance and emphasizes the need for concerted and comprehensive LONING strategies (involving all the relevant LONING stakeholders/policy makers) in addressing these determinants to increase vaccination acceptance among community members in subsequent outbreaks/pandemics in Ebonyi state/Nigeria and similar settings.

'Is It Safe? Is it not?' A Youth-Led Photovoice Study of Youth Perspectives of COVID-19 Vaccine Confidence

BACKGROUND

Youth have been uniquely affected by the COVID-19 pandemic. Despite high rates of COVID-19 infection, youth had one of the lowest vaccine uptake rates. Certain characteristics can affect vaccine uptake, such as mental health and substance use, but it is important to understand uptake for an effective response to pandemics.

OBJECTIVE

This study examined the perspectives of youth with mental health or substance use concerns on COVID-19 vaccine confidence, hesitancy and overall COVID-19 vaccine perspectives.

METHODS

Using photovoice, a community-based participatory research method, a sample of 27 youth aged 14-24 years participated in a series of photography workshops and focus groups. Participants submitted final photographs for discussion. Focus groups were recorded, transcribed and thematically analysed.

RESULTS

Four themes were generated: (1) Youth deciphered the vaccine discourse in a changing information landscape; (2) mixed perspectives of families, friends and loved ones influenced the vaccine journey; (3) complex societal influences affected views and decisions around the COVID-19 vaccine; and (4) youth navigated their vaccine journeys through first- and second-hand experiences. The four themes and subthemes highlight the evolution of youth's journeys with the COVID-19 vaccine over the course of the pandemic and into the late-pandemic period.

CONCLUSIONS

Youth with mental health or substance use challenges navigated a complex environment during the COVID-19 pandemic. The wide variety of factors influencing vaccine perspectives should be taken into account in public health messaging and future research on youth vaccine uptake. Youth-led and youth-engaged research can help solicit rich and meaningful perspectives of young people on important public health issues.

PATIENT OR PUBLIC CONTRIBUTION

This was a youth-led study. A youth research analyst conducted the study activities together with the support of a youth advisory group, an adult photographer with lived experience, and a scientific team.

The impact of targeted local outreach clinics to improve COVID-19 vaccine uptake: controlled interrupted time series in South West England

BACKGROUND

Outreach clinics were part of efforts to maximise uptake in COVID-19 vaccination.

METHODS

We used controlled interrupted time series, matching on age, sex, deprivation and vaccination eligibility date, to determine the effect of outreach clinics on time to first COVID-19 vaccine, using a population-based electronic health record database of 914,478 people, from December 2020 to December 2021; people living within 1 mile of each outreach clinics were exposed.

RESULTS

50% of 288,473 exposed citizens were white British, and 71% were aged 0-49 years. There was no evidence for an overall statistically significant increase in cumulative percentage vaccinated due to the outreach clinic at 6 weeks, with an overall pooled effect estimate of -0.07% (95% CI: -1.15%, 1.02%). The pooled estimate for increased cumulative vaccine uptake varied slightly depending on how the analysis was stratified; by ethnic group it was - 0.12% (95% CI: -0.90%, 0.66%); by age group it was - 0.06% (95% CI: -0.41%, 0.28%); and by deprivation it was 0.03% (95% CI: -0.74%, 0.79%).

CONCLUSIONS

Living within a mile of an outreach clinic was not associated with higher vaccine uptake. Evaluation of future outreach clinics should consider the relative importance of travel amongst other barriers to accessing vaccines.

"Just a knife wound this week, nothing too painful": An ethnographic exploration of how primary care patients experiencing homelessness view their own health and healthcare

Community health needs assessments (CHNA) involving qualitative techniques help tailor health services to the specific needs of the population groups for whom they are designed. In light of increasing health disparities amongst people experiencing homelessness (PEH)-and to ensure the integration of their voices into a larger CHNA-this study used an ethnographic approach grounded in a social constructivist research paradigm to explore the perspectives of PEH attending a primary care and addiction service in Ireland on their priority health and healthcare needs. Participant observations and informal interviews were conducted with clients experiencing homelessness attending the service for three hours every Monday morning between October 2022 and April 2023. Field note data from active participant observation and informal conversations were collected, anonymised, and analysed using inductive thematic analysis in accordance with the Declaration of Helsinki and the researchers' institutional Research Ethics Committee. Three main themes emerged from the analysis: self-identified priorities, satisfaction with health services, and migrant health. Clients' priority concerns relate to their mental health and personal safety, strengthening ties with children and families, finding a sense of purpose, and feeling better physically. These challenges differ from those of the general population in terms of their severity observed both prior to and during experiences of homelessness, coupled with disproportionately high levels of loss, fear, pain, fatigue, social stigma and other barriers to accessing satisfactory housing. In terms of services, clients are satisfied with their ability to access primary care and harm reduction in a social environment where positive exchanges with friends and providers take place. Conversely, barriers to accessing mental health and addiction services persist including the internalised belief that one is beyond help, lack of access to information on available services and their entry requirements, and lingering stigma within a health system that treats addiction as separate to health. Moving forward, health practitioners may consider holding more regular and open conversations with clients experiencing homelessness about the care they are receiving, its rationale, and whether or not changes are desired that can be safely made. The health needs of migrants and asylum seekers entering homelessness in Ireland are urgent and should be prioritised in future research.

COVID-19 vaccine hesitancy among adults in India: A primary study based on health behavior theories and 5C psychological antecedents model

Despite the significant success of India's COVID-19 vaccination program, a sizeable proportion of the adult population remains unvaccinated or has received a single dose of the vaccine. Despite the recommendations of the Government of India for the two doses of the COVID-19 vaccine and the precautionary booster dose, many people were still hesitant towards the COVID-19 full vaccination. Hence, this study aimed to identify the primary behavioral and psychological factors contributing to vaccine hesitancy. Cross-sectional data was collected via a multi-stage sampling design by using a scheduled sample survey in the Gorakhpur district of Uttar Pradesh, India, between 15 July 2022 to 30 September 2022. This study has utilized three health behavior models-the Health Belief Model (HBM), the Theory of Planned Behavior (TPB), and the 5C Psychological Antecedents of vaccination, and employed bivariate and multivariable binary logistic regression model to assess the level of vaccine hesitancy and predictive health behavior of the respondents. Results indicate that among the constructs of the HBM and 5C Antecedents models, "perceived benefits", "confidence" and "collective responsibility" showed a lesser likelihood of COVID-19 vaccine hesitancy. However, in the TPB model constructs, a 'negative attitude towards the vaccine' showed a four times higher likelihood of COVID-19 vaccine hesitancy. From the future policy perspective, this study suggested that addressing the issue of 'negative attitudes towards the vaccine' and increasing the trust or confidence for the vaccine through increasing awareness about the benefits of the vaccination in India may reduce vaccine hesitancy.

The emergence of COVID-19 over-concern immediately after the cancelation of the measures adopted by the dynamic zero-COVID policy in China

Background

This study aimed to report the prevalence of COVID-19 over-concern and its associated factors after the relaxation of the health-protective measures in China.

Methods

A team of seven experts in psychiatry and psychology specializing in COVID-19 mental health research from China, Hong Kong, and overseas reached a consensus on the diagnostic criteria for COVID-19 over-concern. Individuals had to meet at least five of the following criteria: (1) at least five physical symptoms; (2) stocking up at least five items related to protecting oneself during the COVID-19 pandemic; (3) obsessive-compulsive symptoms related to the COVID-19 pandemic; (4) illness anxiety related to the COVID-19 pandemic; (5) post-traumatic stress symptoms; (6) depression; (7) anxiety; (8) stress and (9) insomnia. An online survey using snowball sampling collected data on demographics, medical history, views on COVID-19 policies, and symptoms of COVID-19 over-concern. Multivariate linear regression was performed using significant variables from the previous regressions as independent variables against the presence of COVID-19 over-concern as the dependent variable. Breush-Pagan test was used to assess each regression model for heteroskedasticity of residuals.

Results

1,332 respondents from 31 regions in China participated in the study for 2 weeks from December 25 to 27, 2022, after major changes in the zero-COVID policy. After canceling measures associated with the dynamic zero-COVID policy, 21.2% of respondents fulfilled the diagnostic criteria for COVID-19 over-concern. Factors significantly associated with COVID-19 over-concern were poor self-rated health status (β = 0.07, p < 0.001), concerns about family members getting COVID-19 (β = 0.06, p < 0.001), perceived usefulness of COVID-19 vaccine (β = 0.03, p = 0.012), impact on incomes, employment and studies (β = 0.045, p < 0.001) and impact on families (β = 0.03, p = 0.01).

Conclusion

After removing measures associated with the dynamic zero-COVID policy in China, approximately one-fifth of respondents met the diagnostic criteria for COVID-19 over-concern.