Factors Affecting SARS-CoV-2 Vaccination Intent and Decision Making Among African American, Native American, and Hispanic Participants in a Qualitative Study

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.

Trusted Sources of Information and COVID-19 Vaccination Among Black Adults in Chicago

PURPOSE

Examine trust in sources of COVID-19 information and vaccination status.

DESIGN

Cross-sectional.

SETTING

Chicago, Illinois.

SUBJECTS

Convenience sample of 538 Black adults surveyed between September 2021 and March 2022.

MEASURES

Trust in sources of COVID-19 information, COVID-19 vaccination.

ANALYSIS

Using latent class analysis, we identified classes of trust in sources of COVID-19 information. We considered predictors of class membership using multinomial logistic regression and examined unadjusted and adjusted associations between trust class membership and COVID-19 vaccination while accounting for uncertainty in class assignment.

RESULTS

Our analytic sample (n = 522) was predominantly aged 18-34 (52%) and female (71%). Results suggested a four-class solution: (1) low trust, (2) high trust in all sources, (3) high trust in doctor and government, and (4) high trust in doctor, faith leader, and family. Unadjusted odds of vaccination were greater in the high trust in all sources (OR 2.0, 95% CI 1.2-3.2), high trust in doctor and government (OR 2.7, 95% CI 1.4-5.3), and high trust in doctor, faith leader, and family classes (OR 2.1, 95% CI 1.2, 3.9) than the low trust class. However, these associations were not significant after adjustment for sociodemographic and health status factors.

CONCLUSION

Although COVID-19 vaccination varied across trust classes, our adjusted findings do not suggest a direct association between trust and vaccination, reflecting complexities in the vaccine decision-making process.

The Be REAL Framework: Enhancing Relationship-Building Skills for Community Health Workers

Trust plays an integral part in the effective functioning of public health systems. During the COVID-19 pandemic, distrust of public health fueled vaccine hesitancy and created additional barriers to immunization. Although most Americans have received at least one COVID-19 vaccine, the percentage of fully immunized adults remains suboptimal. To reach vaccine-hesitant communities, it is vital that public health be worthy of trust. As trusted members of their communities, community health workers (CHWs) can serve as ideal messengers and conversation partners for vaccination decision-making. We developed the Be REAL framework and training materials to prepare CHWs to work with vaccine-hesitant communities nationwide. Through the four steps of "Relate," "Explore," "Assist," and "Leave (the door open)," CHWs were taught to prioritize relationship building as a primary goal. In this shift from focusing on adherence to public health recommendations (e.g., get vaccinated) to building relationships, the value of vaccine uptake is secondary to the quality of the relationship being formed. The Be REAL framework facilitates CHWs harnessing the power they already possess. The goal of the Be REAL framework is to foster true partnership between CHWs and community members, which in turn can help increase trust in the broader public health system beyond adherence to a specific recommendation.