Motivators and Barriers to COVID-19 Vaccination Intentions Across U.S. County-Level Barriers in the COVID-19 Vaccine Coverage Index

Overview

Journal J Racial Ethn Health Disparities

Specialties Public Health
Social Sciences

Date 2024 Aug 2

PMID 39093376

Authors

Jessica R Fernandez

Jennifer Richmond

Paula D Strassle

Jennifer Cunningham-Erves

Allana T Forde

Affiliations

Soon will be listed here.

Abstract

Background: County-level barriers (sociodemographic barriers, limited healthcare system resources, healthcare accessibility barriers, irregular healthcare seeking behaviors, low vaccination history) may impact individuals' reasons for receiving the COVID-19 vaccine.

Methods: This study linked data from REACH-US (Race-Related Experiences Associated with COVID-19 and Health in the United States), a nationally representative, online survey of 5475 adults living in the U.S (January-March 2021) to county-level barriers in the COVID-19 Vaccine Coverage Index. County-level vaccination barriers were measured using the COVID-19 Vaccine Coverage Index. Participants reported why they would or would not receive the COVID-19 vaccine in an open-ended item and their responses were coded using thematic analysis. Descriptive statistics and chi-square tests assessed whether reasons for COVID-19 vaccination intentions varied by county-level barriers and whether these distributions varied across racial/ethnic groups.

Results: Thematic analysis revealed twelve themes in participants' reasons why they would or would not receive the COVID-19 vaccine. Themes of societal responsibility (9.8% versus 7.7%), desire to return to normal (8.1% versus 4.7%), and trust in science/healthcare/government (7.7% versus 5.1%) were more frequently reported in counties with low/medium barriers (versus high/very high) (p-values < 0.05). Concerns of COVID-19 vaccine side effects/safety/development (25.3% versus 27.9%) and concerns of access/costs/availability/convenience (1.9% versus 3.6%) were less frequently reported in counties with low/medium barriers (versus high/very high) (p-values < 0.05). Trends in the prevalence of these themes varied across racial/ethnic groups (p-values < 0.05).

Conclusions: Future pandemic responses should consider potential ways county-level barriers shape reasons for COVID-19 vaccination.

References

Nguyen K, Anneser E, Toppo A, Allen J, Scott Parott J, Corlin L . Disparities in national and state estimates of COVID-19 vaccination receipt and intent to vaccinate by race/ethnicity, income, and age group among adults ≥ 18 years, United States. Vaccine. 2021; 40(1):107-113. PMC: 8598948. DOI: 10.1016/j.vaccine.2021.11.040. View

Pena J, Schwartz M, Hernandez-Vallant A, Sanchez G . Social and structural determinants of COVID-19 vaccine uptake among racial and ethnic groups. J Behav Med. 2023; 46(1-2):129-139. PMC: 9846662. DOI: 10.1007/s10865-023-00393-y. View

Chen J, Shiu C . Race, ethnicity and COVID-19 vaccine concerns: A latent class analysis of data during early phase of vaccination. SSM Popul Health. 2022; 18:101073. PMC: 8928703. DOI: 10.1016/j.ssmph.2022.101073. View

Clark U, Hurd Y . Addressing racism and disparities in the biomedical sciences. Nat Hum Behav. 2020; 4(8):774-777. DOI: 10.1038/s41562-020-0917-7. View

Tewarson H, Greene K, Fraser M . State Strategies for Addressing Barriers During the Early US COVID-19 Vaccination Campaign. Am J Public Health. 2021; 111(6):1073-1077. PMC: 8101562. DOI: 10.2105/AJPH.2021.306241. View

Carson S, Casillas A, Castellon-Lopez Y, Mansfield L, Morris D, Barron J . COVID-19 Vaccine Decision-making Factors in Racial and Ethnic Minority Communities in Los Angeles, California. JAMA Netw Open. 2021; 4(9):e2127582. PMC: 8485164. DOI: 10.1001/jamanetworkopen.2021.27582. View

Flanagan B, Hallisey E, Adams E, Lavery A . Measuring Community Vulnerability to Natural and Anthropogenic Hazards: The Centers for Disease Control and Prevention's Social Vulnerability Index. J Environ Health. 2020; 80(10):34-36. PMC: 7179070. View

Zhang Y, Fisk R . Barriers to vaccination for coronavirus disease 2019 (COVID-19) control: experience from the United States. Glob Health J. 2021; 5(1):51-55. PMC: 7871809. DOI: 10.1016/j.glohj.2021.02.005. View

Chu H, Liu S . Integrating health behavior theories to predict American's intention to receive a COVID-19 vaccine. Patient Educ Couns. 2021; 104(8):1878-1886. PMC: 7889032. DOI: 10.1016/j.pec.2021.02.031. View

10.

Fernandez J, Strassle P, Richmond J, Mays V, Forde A . County-level barriers in the COVID-19 vaccine coverage index and their associations with willingness to receive the COVID-19 vaccine across racial/ethnic groups in the U.S. Front Public Health. 2023; 11:1192748. PMC: 10602638. DOI: 10.3389/fpubh.2023.1192748. View

11.

Ma K, Bacong A, Kwon S, Yi S, oan L . The Impact of Structural Inequities on Older Asian Americans During COVID-19. Front Public Health. 2021; 9:690014. PMC: 8417937. DOI: 10.3389/fpubh.2021.690014. View

12.

Kricorian K, Turner K . COVID-19 Vaccine Acceptance and Beliefs among Black and Hispanic Americans. PLoS One. 2021; 16(8):e0256122. PMC: 8384224. DOI: 10.1371/journal.pone.0256122. View

13.

Willis D, Montgomery B, Selig J, Andersen J, Shah S, Li J . COVID-19 vaccine hesitancy and racial discrimination among US adults. Prev Med Rep. 2022; 31:102074. PMC: 9703864. DOI: 10.1016/j.pmedr.2022.102074. View

14.

Landis J, Koch G . The measurement of observer agreement for categorical data. Biometrics. 1977; 33(1):159-74. View

15.

Li F . Disconnected in a pandemic: COVID-19 outcomes and the digital divide in the United States. Health Place. 2022; 77:102867. PMC: 9283607. DOI: 10.1016/j.healthplace.2022.102867. View

16.

Kelly B, Southwell B, McCormack L, Bann C, MacDonald P, Frasier A . Predictors of willingness to get a COVID-19 vaccine in the U.S. BMC Infect Dis. 2021; 21(1):338. PMC: 8039496. DOI: 10.1186/s12879-021-06023-9. View

17.

Eiden A, Barratt J, Nyaku M . Drivers of and barriers to routine adult vaccination: A systematic literature review. Hum Vaccin Immunother. 2022; 18(6):2127290. PMC: 9746483. DOI: 10.1080/21645515.2022.2127290. View

18.

Fisher K, Bloomstone S, Walder J, Crawford S, Fouayzi H, Mazor K . Attitudes Toward a Potential SARS-CoV-2 Vaccine : A Survey of U.S. Adults. Ann Intern Med. 2020; 173(12):964-973. PMC: 7505019. DOI: 10.7326/M20-3569. View

19.

Hooper M, Napoles A, Perez-Stable E . No Populations Left Behind: Vaccine Hesitancy and Equitable Diffusion of Effective COVID-19 Vaccines. J Gen Intern Med. 2021; 36(7):2130-2133. PMC: 7985226. DOI: 10.1007/s11606-021-06698-5. View

20.

Raskind I, Shelton R, Comeau D, Cooper H, Griffith D, Kegler M . A Review of Qualitative Data Analysis Practices in Health Education and Health Behavior Research. Health Educ Behav. 2018; 46(1):32-39. PMC: 6386595. DOI: 10.1177/1090198118795019. View