Students' COVID-19 vaccine behaviors, intentions, and beliefs at a US Native American-Serving Nontribal Institution (NASNTI)

Spatial multilevel analysis of individual, household, and community factors associated with COVID-19 vaccine hesitancy in the Dominican Republic

Vaccine hesitancy or refusal poses a significant public health challenge resulting in the resurgence of preventable diseases and undermining the effectiveness of national and global health initiatives. This study investigates multilevel determinants of COVID-19 vaccine hesitancy in the Dominican Republic (DR) shortly after the launch of the national COVID-19 vaccination campaign in February 2021. Participants aged 18 years and older were enrolled through a national multistage cluster survey conducted from June-October 2021. The Health Belief Model guided the selection of potential factors contributing to vaccine hesitancy. Hierarchical mixed-effect logistic regression models were used to examine individual, household, and community factors associated with vaccine hesitancy. COVID-19 vaccine hesitancy was observed in 12.6% (95% CI: 11.7-13.5%) of participants (n = 5,566), with spatial variations at the cluster level. Individual factors associated with lower odds of vaccine hesitancy included older age, higher education levels, mulatto ethnicity, and perceiving vaccination as crucial for health. In contrast, factors significantly associated with hesitancy included being born in the DR and concerns about COVID-19 vaccine side effects. For factors at the household level, differential trust in health information sources significantly influenced vaccine hesitancy, with certain sources correlating with increased hesitancy and others with reduced vaccine hesitancy. Better access to healthcare, as indicated by a higher number of hospitals per population, was paradoxically associated with increased vaccine hesitancy. Future strategies to reduce vaccine hesitancy in the DR might consider these multifaceted factors.

College leadership decisions and experiences during the COVID-19 pandemic: an elite interview study

OBJECTIVE

This study at a US Native American-serving Nontribal Institution (NASNTI) deeply analyzed collegiate leadership's responses and experiences during the first year of the COVID-19 pandemic.

PARTICIPANTS

Elite interviews were conducted between April and June 2021 with the college president, provost, dean of student engagement, human resources director, and chief of police. Interviewees were purposively selected due to their positions of authority.

METHODS

Each one-hour interview used a semi-structured guide for standardization and was conducted either virtually or in-person while following COVID-19 protocols. The general inductive method was used to identify nodes and categories within the transcripts.

RESULTS

Six nodes (conceptual domains) and 18 categories were identified. Though there was variability in interviewee emphasis, the respondents described the motivations, drivers, and sentiment behind their decision-making in a transparent way.

CONCLUSIONS

NASNTI leadership reported being able to navigate the pandemic by emphasizing transparency and engaging students, while working alongside the community.

Recognising the heterogeneity of Indigenous Peoples during the COVID-19 pandemic: a scoping review across Canada, Australia, New Zealand and the USA

Objectives

The COVID-19 pandemic has had a disproportionate impact on the health of Indigenous Peoples in Canada, Australia, New Zealand and the USA, as reflected in the growing literature. However, Indigenous Peoples are often homogenised, with key differences often overlooked, failing to capture the complexity of issues and may lead to suboptimal public health policy-making. The objective of this review was to assess the extent to which the heterogeneity of the Indigenous Peoples in Canada, Australia, New Zealand and the USA has been reflected in COVID-19 research.

Design

This study took the form of a scoping review.

Data sources

Medline, Embase, CINAHL and Web of Science were searched for studies investigating COVID-19 pandemic outcomes among Indigenous Peoples in Canada, Australia, New Zealand and the USA. The search dates included January 2019 to January 2024.

Eligibility criteria

All citations yielded by this search were subjected to title and abstract screening, full-text review and data extraction. We included original, peer-reviewed research investigating COVID-19-related outcomes among Indigenous Peoples in Canada, Australia, New Zealand or the USA.

Data extraction and synthesis

Data extraction was conducted as an iterative process, reaching consensus between two of the study authors. All included studies were analysed through a combination of quantitative descriptive summary and qualitative thematic analysis.

Results

Of the 9795 citations found by the initial search, 428 citations were deemed eligible for inclusion. Of these citations: 72.9% compared Indigenous participants to non-Indigenous participants; 10.0% aggregated Indigenous and non-white participants; and 17.1% provided findings for Indigenous participants exclusively.

Conclusions

By overlooking the heterogeneity that exists among Indigenous Peoples in Canada, Australia, New Zealand and the USA, researchers and policy-makers run the risk of masking inequities and the unique needs of groups of Indigenous Peoples. This may lead to inefficient policy recommendations and unintentionally perpetuate health disparities during public health crises.

External relationships as implementation determinants in community-engaged, equity-focused COVID-19 vaccination events

Background

While relationships and connectedness among organizations have been included in implementation theories, models, and frameworks, the increased attention to health equity in implementation science raises the urgency of understanding the role of relationships external to the implementing organization. This paper addresses this gap through an exploration of the role of external relationships in community-based, equity-focused interventions.

Methods

This study focuses on an equity-focused, community-based COVID-19 vaccination intervention in Arkansas, drawing upon long-term community-engaged relationships among University of Arkansas for Medical Sciences and the Hispanic and Marshallese Islander communities. We used an exploratory qualitative descriptive design to examine barriers and facilitators to implementation of COVID-19 vaccination events analyzing in-depth qualitative interviews with implementation team members (n = 17).

Results

All participants described pre-existing relationships among the implementing organization, partner organizations, and communities as a key implementation determinant for this equity-focused program. At the inter-organizational level, external relationships included formal connections and informal relationships among staff (e.g., communication channels from prior partnerships). At the individual level, strong external relationships with the community were facilitators leveraging long-term engagement, community familiarity, and staff from the communities of focus. Strong external relationships facilitated program reach in underserved communities through three mechanisms: (1) reduced time required to establish functional working relationships among partners; (2) accessibility and cultural congruence of health services; and (3) increased trust among community members. Barriers to implementation also existed in external relationships, but had less influence than facilitators.

Conclusions

Achieving health equity in implementation science requires greater understanding of external relationships as implementation determinants. This exploratory study makes a significant contribution to the literature by describing the types of external relationships that facilitate equitable implementation and identifying the mechanisms through which they may work. We argue that approaches to community engagement drawn from community-engaged research approaches may be useful, as these processes require investment in building/maintaining formal and informal organizational and interpersonal relationships. Further research is needed to understand connections among external relationships and other implementation determinants.