Vaccine Communication Research Articles

Development and evaluation of virtual simulation games to increase the confidence and self-efficacy of healthcare learners in vaccine communication, advocacy, and promotion

BackgroundAlthough healthcare providers (HCPs) are the most trusted source of vaccine information, there is a paucity of easily accessible, multidisciplinary educational tools on vaccine communication for them. Virtual simulation games (VSGs) are innovative yet accessible and effective tools in healthcare education. The objectives of our study were to develop VSGs to increase HCP confidence and self-efficacy in vaccine communication, advocacy, and promotion, and evaluate the VSGs’ effectiveness using a pre-post self-assessment pilot study.MethodsA multidisciplinary team of experts in medicine, nursing, pharmacy, and simulation development created three VSGs for HCP learners focused on addressing conversations with vaccine hesitant individuals. We evaluated the VSGs with 24 nursing students, 30 pharmacy students, and 18 medical residents who completed surveys and 6-point Likert scale pre-post self-assessments to measure changes in their confidence and self-efficacy.ResultsThere were no significant differences in baseline confidence and self-efficacy across the three HCP disciplines, despite varied levels of education. Post-VSG confidence and self-efficacy (median: 5) were significantly higher than pre-VSG (median: 4–5) for all three HCP disciplines (P ≤ 0.0005), highlighting the effectiveness of the VSGs. Medical residents reported significantly lower post-VSG confidence and self-efficacy than nursing and pharmacy learners despite completing the most significant amount of education.ConclusionsFollowing the completion of the VSGs, learners in medicine, nursing, and pharmacy showed significant improvement in their self-assessed confidence and self-efficacy in holding vaccine conversations. The VSGs as an educational tool, in combination with existing clinical immunization training, can be used to increase HCP confidence and engagement in vaccine discussions with patients, which may ultimately lead to increased vaccine confidence among patients.

Interactive Narrative-Based Digital Health Interventions for Vaccine Communication: Protocol for a Scoping Review.

Interactive narrative-based digital health interventions hold promise for effectively addressing the complex determinants of vaccine hesitancy and promoting effective communication across a wide range of settings and vaccine types. Synthesizing evidence related to the implementation and evaluation of these interventions could offer valuable perspectives for shaping future strategies in vaccine communication. Prior systematic and scoping reviews have examined narrative-based vaccine communication interventions but not the inclusion of interactivity in such interventions. The overall objective of the scoping review is to summarize the evidence on the use of interactive narrative-based digital health interventions for vaccine communication. Specific research questions focus on describing the use of interactive narrative-based digital health interventions (RQ1), describing evaluations of the impact of interactive narrative-based digital health interventions on promoting vaccine uptake (RQ2), and factors associated with their implementation (RQ3). A detailed search string will be used to search the following databases for records that are relevant to the review questions: PubMed, Embase, Scopus, Web of Science, CINAHL, and PsycINFO. Two reviewers will independently screen the titles and abstracts of identified records against the predefined eligibility criteria. Subsequently, eligible records will undergo comprehensive full-text screening by 2 independent reviewers to assess their relevance to review questions. A data charting tool will be developed and used to extract relevant information from the included articles. The extracted information will be analyzed following the review questions and presented as a narrative summary. Tabular or graphical representations will be used to display review findings, as relevant. Public health informationists were consulted to develop the detailed search strategy. The final search string comprised terms related to narrative communication, digital health, and vaccines. The search string was customized to each proposed publication database and implemented on April 18, 2023. A total of 4474 unique records were identified using the search strategy and imported into the Covidence (Veritas Health Innovation Ltd) review management software for title and abstract screening. Title and abstract screening of identified records are ongoing as of December 29, 2023. To our knowledge, this will be the first scoping review to investigate the features of interactive narrative-based digital health interventions and their role in vaccine communication. The goal of this study is to provide a comprehensive overview of the current research landscape and identify prevailing gaps in knowledge. The findings will provide insights for future research and development of novel applications of interactive narrative-based digital health vaccine communication interventions. DERR1-10.2196/51137.

Evaluating the usefulness of a wordless picture book for adults with intellectual disabilities about the COVID-19 vaccination programme using co-production: The CAREVIS study.

To explore the usefulness of a co-designed wordless book showing processes of receiving COVID-19 vaccines designed by, and for, adults with intellectual disabilities. A qualitative evaluation of the resource using mixed methods. Semi-structured interviews were conducted with people with intellectual disabilities, carers and health professionals about resource content, and use. This was analysed thematically. A survey was circulated to intellectual disabilities networks to understand resource need, use, sharing and content. Understanding the COVID-19 vaccine was a process, not a single event using one resource. A visual resource had a place in facilitating conversations about vaccines between people with intellectual disabilities and carers. Differing perspectives were expressed regarding personal needs, existing awareness of vaccine programmes and communication preferences. Changes were suggested to improve the suggested storyline and relevance around COVID-19 restrictions changing. A visual resource may help conversations about the COVID-19 vaccine for people with intellectual disabilities.

The Feature Positive Effect Biases Vaccination Information Processing

Evidence-based vaccination communication aims to support people in making informed decisions regarding vaccination. It is therefore important to learn how vaccination information is processed and how it might be biased. One potentially relevant bias that is overlooked in the vaccination literature is the feature positive effect (FPE), the phenomenon that people experience greater difficulty processing nonoccurring events than occurring events, which impacts judgment and decision making. The present study adopts an experimental design with sequential testing rules to examine a potential FPE for vaccination information processing. The results convincingly demonstrate that vaccination-related events described as nonoccurring (e.g., no side effects after vaccination) versus occurring (e.g., side effects after vaccination) indeed result in lower recall and are perceived as less important in evaluating the vaccine. The results regarding processing time remain inconclusive. These findings might help explain the appeal of vaccination-critical information and suggest that emphasizing what does happen as a result of vaccination, rather than what does not, can help debias the processing of evidence-based vaccination information.

Understanding factors associated with COVID-19 vaccination among health care workers using the Diffusion of Innovation Theory

The COVID-19 vaccine was initially offered to frontline health care workers (HCWs), due to the high risk of contracting COVID-19 through occupational exposure to patients. Low HCW vaccine uptake can impact overall community-level vaccine uptake. This study used the Diffusion of Innovation (DOI) Theory to understand factors related to COVID-19 vaccine uptake in HCWs. We surveyed Pennsylvanian HCWs (excluding Philadelphia) from August 2022 to February 2023. Survey questions inquired about demographics, COVID-19 vaccination status, reasons for receiving/declining the COVID-19 vaccine, and sources of information about the vaccine. Participants (n=3,490) were 85% female, 89% White, and 93% (n=3,255) reported receiving at least one dose of a COVID-19 vaccine. HCWs were categorized into adopter categories of the DOI Theory: innovators (56%), early adopters (9%), early majority (11%), late majority (7%), and laggards (17%). The major reason that prompted participants to get the vaccine was to protect them against COVID-19 infection (78%), while the major reason for declining the vaccine was due to concern about possible side effects from the vaccine (78%). We applied the DOI Theory to characterize adopters and identify factors related to COVID-19 vaccine uptake in HCWs. As updated COVID-19 vaccines are approved for the United States market, our findings may be used to improve vaccine education and communication among HCWs to support vaccine uptake.

Vaccinating humanitarian workers against COVID-19.

To describe the United Nations' (UN's) coronavirus disease 2019 (COVID-19) vaccination programme and its efforts to vaccinate frontline humanitarian personnel stationed in locations where access to COVID-19 vaccine was limited or absent. The vaccination programme was structured as a two-level operation: a global vaccine deployment support team and local vaccine deployment teams in each participating country, territory or administrative area. The central group, led by a global vaccine coordinator, oversaw medical, legal, financial, logistical, data, technological and communication aspects. Local vaccine deployment teams were led by coordinators who managed registration, logistics, communication and vaccine administration. The programme used World Health Organization-approved COVID-19 vaccines and developed prioritization criteria for distributing vaccine supplies. The programme ensured that vaccines for the UN personnel were not diverted from the populations they were intended to serve. The programme successfully formed 120 deployment teams across 152 eligible countries, territories and administrative areas, targeting approximately 673 000 individuals. By April 2023, 72 countries, territories and administrative areas had received over 470 000 doses, of which 337 072 doses were administered. Almost half of the doses administered (167 616) were to individuals in five UN hardship countries. Ninety-five severe adverse events were reported, but none led to any reported medical evacuation, permanent disability or death. The programme demonstrated effective global coordination and local implementation, adapting to diverse contexts and operational challenges. The model can serve as a guide for global actors for future health emergencies, or for deploying health aid at a regional or global scale.

Primary Care and Community-Based Partnerships to Enhance HPV Vaccine Delivery.

With growing vaccination misinformation and mistrust, strategies to improve vaccination communication across community-based settings are needed. The Rural Adolescent Vaccine Enterprise (RAVE), a 5-year (2018-2022) stepped-wedge cluster randomized study, tested a clinic-based practice facilitation intervention designed to improve HPV vaccination. An exploratory aim sought to explore the use of partnerships between primary care clinics and a community partner of their choosing, to implement a social marketing campaign related to HPV immunization. We assessed perceptions about the value and success of the partnership, and barriers and facilitators to its implementation using a 29-item community partner survey, key informant interviews, and field notes from practice facilitators. Of the initial 45 clinics participating in RAVE, 9 were unable to either start or complete the study, and 36 participants (80.0%) were actively engaged. Of these, 16/36 clinics (44.4%) reported establishing successful partnerships, 10 reported attempting to develop partnerships (27.8%), and another 10 reported not developing a partnership (27.8%), which were often caused by the COVID-19 pandemic. The most common partnership was with public health departments at 27.3%. Other partnerships involved libraries, school districts, and local businesses. More than half (63.7%) reported that creating messages regarding getting HPV vaccination was moderately to very challenging. Just under half reported (45.5%) that messaging was hard because of a lack of understanding about the seriousness of diseases caused by HPV, parents being against vaccines because of safety concerns, and religious values that result in a lack of openness to HPV vaccines. Community partners' health priorities changed as a result of RAVE, with 80% prioritizing childhood immunizations as a result of the RAVE partnership. Community groups want to partner with primary care organizations to serve their patients and populations. More research is needed on how best to bring these groups together.

COVID-19 Vaccine Communications on Instagram and Vaccine Uptake in Young Adults: A Content Assessment and Public Engagement Analysis

In Canada, during the pandemic, young adults (18–29 year-olds) represented one of the least-vaccinated age groups against COVID-19. These low vaccination rates, and high infection rates, left young people vulnerable to severe infections and created a risk for transmission to immunocompromised populations. Given young adults’ unique characteristics, to encourage vaccination among this demographic, public health and government officials must adopt an audience-centred approach to communication. We sought to understand if the vaccine messages from 8 Canadian federal government Instagram accounts met the needs of young adults based two frameworks: Guiding Principles for Crisis Communication (compassion and empathy, conversational tone, transparency, clarity, call to action and correction of misinformation), and the 5C Model for Vaccine Hesitancy (confidence, complacency, constraints, collective responsibility, and risk calculation). Across 159 posts that mentioned COVID-19 vaccines, there was limited incorporation of best practices, suggesting the government’s communication strategy did not meet the needs of young people.

Addressing COVID-19 vaccine hesitancy in rural community pharmacies: a protocol for a stepped wedge randomized clinical trial

BackgroundUptake of COVID-19 vaccines remains problematically low in the USA, especially in rural areas. COVID-19 vaccine hesitancy is associated with lower uptake, which translates to higher susceptibility to SARS-CoV-2 variants in communities where vaccination coverage is low. Because community pharmacists are among the most accessible and trusted health professionals in rural areas, this randomized clinical trial will examine implementation strategies to support rural pharmacists in delivering an adapted evidence-based intervention to reduce COVID-19 vaccine hesitancy.MethodsWe will use an incomplete stepped wedge trial design in which we will randomize 30 rural pharmacies (unit of analysis) to determine the effectiveness and incremental cost-effectiveness of a standard implementation approach (consisting of online training that describes the vaccine hesitancy intervention, live webinar, and resource website) compared to adding on a virtual facilitation approach (provided by a trained facilitator in support of the delivery of the vaccine hesitancy counseling intervention by pharmacists). The intervention (ASORT) has been adapted from an evidence-based vaccine communication intervention for HPV vaccines through a partnership with rural pharmacies in a practice-based research network in seven southern US states. ASORT teaches pharmacists how to identify persons eligible for COVID-19 vaccination (including a booster), solicit and address vaccine concerns in a non-confrontational way, recommend the vaccine, and repeat the steps later if needed. The primary trial outcome is fidelity to the ASORT intervention, which will be determined through ratings of recordings of pharmacists delivering the intervention. The secondary outcome is the effectiveness of the intervention, determined by rates of patients who agree to be vaccinated after receiving the intervention. Other secondary outcomes include feasibility, acceptability, adoption, reach, and cost. Cost-effectiveness and budget impact analyses will be conducted to maximize the potential for future dissemination and sustainability. Mixed methods will provide triangulation, expansion, and explanation of quantitative findings.DiscussionThis trial contributes to a growing evidence base on vaccine hesitancy interventions and virtual-only facilitation of evidenced-based practices in community health settings. The trial will provide the first estimate of the relative value of different implementation strategies in pharmacy settings.Trial registrationNCT05926544 (clinicaltrials.gov); 07/03/2023.

How can early COVID-19 vaccine campaigns in the US-affiliated Pacific Islands inform future vaccine efforts: a cross-sectional analysis

IntroductionThe US-affiliated Pacific Islands (USAPI) are six geographically isolated and culturally distinct Pacific Island jurisdictions with special relationships with the USA; the USAPI were included in the US COVID-19 vaccination...

Behavioural and social drivers of COVID-19 vaccination in Vietnam: a scoping review

BackgroundUnderstanding of the behavioural and social drivers (BeSD) of vaccination is key to addressing vaccine hesitancy and accessibility issues. Vietnam’s national COVID-19 vaccination programme resulted in high uptake of primary...

Safety of Janssen Ad26.COV.S and Astra Zeneca AZD1222 COVID-19 Vaccines among Mobile Phone Users in Malawi: Findings from a National Mobile-Based Syndromic Surveillance Survey, July 2021 to December 2021

The safety profiles of the Ad26.COV2.S and AZD1222 COVID-19 vaccines have not been described in the general population in Malawi. We present self-reported adverse events (AE) following the receipt of these vaccines in Malawi as part of a national syndromic surveillance survey. We conducted phone-based syndromic surveillance surveys among adults (≥18 years) with verbal consent. We used secure tablets through random digit dialing to select mobile phone numbers and collected data electronically. Survey questions included whether the respondent had received the COVID-19 vaccines, whether they had experienced any AE following vaccination, and the severity of the AE. We used multivariable analysis to identify factors associated with self-reported AE post-COVID-19 vaccination. A total of 11,924 (36.0%) out of 33,150 respondents reported receiving at least one dose of either Ad26.COV2.S or AZD1222 between July–December 2021; of those, 65.1% were female. About 49.2% of the vaccine recipients reported at least one AE, 90.6% of which were mild, and 2.6% were severe. Higher education level and concern about the safety of COVID-19 vaccines were associated with AE self-report (Adjusted Odds Ratio [AOR] 2.63 [95% CI 1.96–3.53] and 1.44, [95% CI 1.30–1.61], respectively), while male gender and older age were associated with reduced likelihood of AE self-report (AORs 0.81, [95% CI 0.75–0.88], 0.62 [95% CI 0.50–0.77], respectively). Ad26.COV2.S and AZD1222 vaccines are well-tolerated, with primarily mild and few severe AE among adults living in Malawi. Self-reporting of AE following COVID-19 vaccination is associated with gender, age, education, and concern about the safety of the vaccines. Recognizing these associations is key when designing and implementing COVID-19 vaccination communication messages to increase vaccination coverage.

Unfolding COVID-19 vaccine communication campaigns in China's neighborhoods: a qualitative study of stakeholders' narratives.

The Chinese state has recently implemented the COVID-19 Vaccine Communication Campaign (CVCC) to counter vaccine hesitancy. Nonetheless, the extant literature that examines COVID-19 vaccine acceptance has less represented COVID-19 vaccine communication efforts. To address this lacuna, we qualitatively explored how CVCCs were organized in Chinese communities by investigating 54 Chinese stakeholders. This study indicates that the CVCC was sustained by top-down political pressure. CVCCs' components involve ideological education among politically affiliated health workers, expanding health worker networks, training health workers, implementing media promotion, communicating with residents using persuasive and explanatory techniques, encouraging multistakeholder partnerships, and using public opinion-steered and coercive approaches. While CVCCs significantly enhanced COVID-19 vaccine acceptance, lacking open communication, stigmatizing vaccine refusers, insufficient stakeholder collaboration, and low trust in the COVID-19 vaccination program (CVP) eroded the validity of CVCCs. To promote the continuity of CVCCs in China, CVCC performers are expected to conduct open and inclusive communication with residents. Furthermore, CVP planers should create robust partnerships among health workers by ensuring their agreements on strategies for implementing CVCCs and optimize COVID-19 immunization service provision to depoliticize CVPs. Our study will not only deepen global audiences' understanding of CVCCs in authoritarian China but also offer potential neighborhood-level solutions for implementing local and global public health communication efforts.

Optimizing Vaccine Delivery Among Pediatric Allogeneic Hematopoietic Cell Transplant Recipients: A Quality Improvement Initiative

Abstract Background Pediatric allogeneic hematopoietic cell transplantation (HCT) recipients are at risk for vaccine-preventable infections (VPI). Although evidence-based guidelines recommend starting vaccination efforts between 3-6 months post-HCT, most children remain sub-optimally vaccinated and at-risk for VPI. Our prior work demonstrated that early vaccination starting at 4-6 months post HCT was safe and immunogenic. To reduce potential patient harm from vaccine-preventable infections (VPI), we created a quality improvement (QI) initiative to increase vaccination rates among eligible pediatric allo-HCT recipients, beginning early post-HCT by implementing a best practice immunization strategy at our institution. Methods This QI initiative applied a quasi-experimental design and multiple bundled interventions in Plan-Do-Study-Act (PDSA) cycles to implement and sustain an early immunization strategy among allogeneic HCT recipients in our ambulatory HCT clinic from November 2018-May 2022. The study aimed to increase vaccination rates in eligible patients by providing a core vaccine bundle (pneumococcal conjugate [PCV13], Haemophilus influenzae type b [Hib], inactivated polio [IPV], diphtheria, tetanus, acellular pertussis [DTaP], and hepatitis B vaccines [HBV]) beginning at 6 months [Day+168 to 180] post-HCT, allowing a 30-day grace period for clinic scheduling. The number of subjects who completed a full vaccine series (4 PCV13, 3 DTaP/HBV/IPV and Hib) within the expected time post HCT were recorded. Subjects were ineligible for early vaccination if the indication for HCT was a primary immunodeficiency, and if at screening or vaccination, subjects had relapsed primary disease, graft failure, died, received anti-CD20 therapies in the preceding 6 months and had no evidence of B cell recovery, or were receiving augmented immunosuppression (prednisone-equivalent of ≥ 2 mg/kg/day). The process measure was the proportion of patients screened for vaccine eligibility vs all eligible allo-HCT recipients at 4 months post-HCT. The outcome measure included the proportion of eligible allo-HCT recipients who received the first doses of core vaccines at 6 months (+30 days) among the total number of eligible patients dur for early vaccination. PDSA interventions included creating and implementing a standardized vaccine clinical practice guideline, stakeholder engagement and communication, pre-clinic screening at 4 months post-HCT, creation of a vaccine order set per time post-HCT, and patient-individualized vaccine decision support recommendations. Results Among 72 children who underwent allo-HCT, 37 (51%) were deemed eligible for early vaccination. Review of institutional baseline data revealed that only 43% of eligible allo-HCT received the core vaccines beginning at 6 mos post-HCT. After the first two PDSA cycles, the proportion of eligible patients receiving core vaccines beginning early post-HCT increased from a baseline of 43% to 62%. After implementation of a patient-individualized vaccine decision support recommendation, early immunization rates increased to 92% and were sustained for over 2 years. In total, 33 (90%) patients, predominantly males (55%) with a median age of 9 y [range 0.33-19], received core vaccines at a median of 175 days [range 168-210] post-HCT during the study period. Among children who received early vaccination post-HCT, 82% remained eligible to continue their recommended vaccine roadmap and completed the full vaccine series by the expected 14-16 months post-HCT. Conclusions A multidisciplinary approach applying QI methodology and individualized vaccine decision support allowed for improved and sustained early vaccination after pediatric allo-HCT and completion of vaccine series, thereby reducing potential VPI-associated patient harm. Figure 1. Statistical Process Control Chart (p-chart) of Quality Improvement Initiative to Improve Vaccination Delivery Starting at 6 months After Pediatric Allogeneic Hematopoietic Cell Transplantation (HCT)

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

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

UC 4-H youth spread the facts — not the disease — during COVID-19

The onset of the COVID-19 pandemic highlighted the need for education in disease transmission and prevention. In response, the University of California 4-H Youth Development Program implemented a virtual epidemiology project, based on resources developed by the Centers for Disease Control and Prevention (CDC) and collaborating agencies. The teenage participants were actively engaged in group lessons focused on epidemiology, immunology, vaccination, zoology, prevention strategies, related careers, and health communication. Surveys administered before and after the program showed an increase in knowledge about vaccinations and disease transmission and improved attitudes toward, and intentions to adopt, practices that reduce the spread of disease. They also showed increased self-efficacy and positive health behaviors (hand washing and mask use, and the intention to share what they learned in their communities). These findings contribute to the development of public health and epidemiological education programs for adolescents and programming that elevates youth as messengers of health information.

Leveraging a Peer-to-Peer Approach to Mitigate Vaccine Misinformation and Improve Vaccine Communication During a Pandemic: Experiences From the Development of a Massive Open Online Course.

The COVID-19 pandemic has not only led to massive global mortality and morbidity, but it has also fueled an infodemic of false and misleading information about COVID-19 and vaccines. The spread of misinformation and disinformation on vaccine safety and efficacy has contributed to vaccine hesitancy and distrust of public health institutions and has undermined the public health response to the COVID-19 pandemic. Because communication plays a monumental role in pandemic preparedness, a promising approach to countering the COVID-19 infodemic is empowering peers to serve as trusted messengers to provide accurate information using evidence-based communication approaches. With this in mind, we developed a massive open online course (MOOC) to provide the general public with the knowledge, skills, and resources to effectively navigate potentially contentious vaccine conversations with their peers, with a specific focus on parents. Within the first year of the course launch, 29,000 people had enrolled. Learners appreciated the information related to vaccine development, communication tips and techniques, and identifying and responding to vaccine misinformation. Over 1,000 learners who completed the course participated in an online evaluation survey. To address public distrust in healthcare providers, government, and science, our survey results indicate that peer-to-peer approaches to addressing vaccine hesitancy can empower community members to educate others and promote vaccine acceptance at scale.

Participatory transferability analysis of vaccination interventions with underserved communities

Abstract Background The Horizon 2020 project RIVER-EU will remove health system barriers to childhood vaccination in the migrant community in Greece, the Turkish and Moroccan communities in the Netherlands, the Ukrainian minority in Poland, and the marginalized Roma community in Slovakia. In order to identify transferable vaccination interventions for HPV and MMR, our aim was to establish a collaboration with various stakeholders from these communities. Methods For the transferability analysis, we used the participatory action approach (PAR) to stimulate meaningful participation of different key stakeholder groups in discussing evidence-based interventions and the specific contextual conditions of the underserved communities. Based on the PIET-T models, we collaboratively explored characteristics of the populations (P), interventions (I), environments (E) as well as options for intervention transfer (T) to understand transferability (T), need for intervention adaptations or new interventions. Results Six interventions were pre-selected for decision-making. These addressed elements of involving community members to support vaccination, education in schools, providers’ vaccine communication, and educational videos. All partners co-created knowledge through their expertise: Community members contributed through their experiences with vaccination services, provided valuable arguments for or against interventions, as well as ideas for improvement. Country coordinators in each context were mediators for knowledge-co-creation between all partners involved. Transferability researchers guided the process and analysed the results of discussions through workshops, interviews and focus groups. Conclusions Establishing trust between partners was a key issue in all contexts. Participatory transferability analysis required the consideration of a complex interplay between understanding content of interventions, context, and the specific characteristics and contributions of stakeholders.

Drivers of vaccine hesitancy among vulnerable populations in India: a cross-sectional multi-state study.

India's Covid-19 vaccination campaign engaged frontline workers (FLWs) to encourage vaccination among vulnerable segments of society. The FLWs report encountering a variety of barriers to vaccination and are often unsuccessful despite multiple visits to the same person. This cross-sectional study aims to pinpoint which of these barriers drive vaccine hesitancy among these segments, to help streamline vaccine communication, including FLW training, to better safeguard the population. Trained field enumerators contacted 893 individuals from five states across India and collected self-reported assessments of fifteen vaccination barriers (identified through discussions with FLWs), current vaccination status and future vaccination intentions, and covariates (demographics/comorbidities). Factor analysis of the fifteen barriers yielded two factors, one relating to fear of vaccine adverse effects and a second focused on peripheral concerns regarding the vaccine. The covariates significantly associated with current vaccination status were combined under a latent class regime to yield three cluster types (health access, financial strength, and demographics). The primary analysis examined the effect of the two barrier factors, the covariate clusters, and comorbidity, on current vaccination status and future vaccine intentions. Fear of vaccine adverse effects was the primary driver of vaccine hesitancy; peripheral concerns frequently mentioned by the FLWs had no impact. Although cluster membership and the presence of comorbidities predicted vaccine uptake, neither of them materially altered the effect of fear of vaccine adverse effects with the following exception: fear of adverse effects was not associated with vaccination status among young Muslim men. Subject to limitations, these results indicate that interventions to decrease vaccine hesitancy should focus primarily on fear associated with vaccines rather than spend resources trying to address peripheral concerns.

Community organization perspectives on COVID-19 vaccine hesitancy and how they increased COVID-19 vaccine confidence: a Canadian Immunization Research Network, social sciences and humanities network study.

COVID-19 vaccines play a critical role in reducing the morbidity and mortality associated with SARS-CoV-2 infection and despite vaccine availability, disparities in COVID-19 vaccine uptake among Canadian subgroups exist. Community organizations are uniquely situated to relay important vaccine messaging around all vaccines, understand components of vaccine hesitancy, and facilitate vaccine uptake within the communities they serve. The objective of this research was to solicit community organizations perspectives specific to COVID-19 vaccines and explore strategies of increasing vaccine uptake within their communities. A qualitative focus group study was held in the spring of 2021 with 40 community organizations from across the country. Discussions focused on COVID-19 vaccine communication and awareness within their communities, vaccine misinformation, and strategies to increase vaccine acceptance and access. Data were analyzed utilizing thematic and inductive techniques. Vaccine hesitancy was identified among staff and clients. Vaccine confidence, complacency, convenience, and mistrust in government and authorities were identified as contributors to vaccine hesitancy. Community organizations utilized innovative and novel methods to encourage vaccine uptake and increase vaccine confidence. Leveraging established trusting relationships was key to successful messaging within communities. Community organizations used innovative methods, built on established trust, to increase vaccine confidence within their communities and among their staff. Community agencies played an important role in COVID-19 vaccine uptake within subgroups of the Canadian population. Community organizations are key public health partners and play a critical role in increasing COVID-19 vaccine confidence.