COVID-19 vaccine uptake and barriers among Indigenous language speakers in Mexico: Results from a nationally representative survey.

Mexico faced a significant burden from the COVID-19 pandemic. Since the pandemic's onset in 2020, numerous studies have underscored the substantial risk of COVID-19 death among Indigenous individuals. This study aims to assess COVID-19 vaccine uptake among Indigenous language speakers in Mexico, focusing on understanding the barriers they face in obtaining access to vaccines. We used Encuesta Nacional de Salud y Nutrición Continua (ENSANUT) 2022, a nationally representative health survey in Mexico to analyze data on self-reported COVID-19 vaccine status, reasons for not getting vaccinated, and other relevant covariates. We employed logistic regression to estimate odds ratios (ORs) for vaccine uptake and uptake barriers, all models were adjusted for potential confounders. Among 34,051 participants, 1793 individuals (5.23%) reported speaking an Indigenous language. Indigenous language speakers were found to have a lower vaccination rate (63%) compared to non-Indigenous language speakers (81%) (p <0.005). They were also 59% less likely to be vaccinated against COVID-19 (OR 0.41, 95% CI 0.27-0.62), even when adjusted for confounders. Among unvaccinated individuals, Indigenous language speakers were more likely to cite negative beliefs about the vaccine or fear as reasons for not being vaccinated (OR 1.82, 95% CI 1.11-3.00) while being less likely to report access barriers (OR 0.62, CI 95% 0.42-0.91). This study highlights disparities in COVID-19 vaccine uptake among Indigenous language speakers in Mexico. The findings underscore the urgent need for targeted, culturally appropriate public health interventions and the consideration of social and ethnic vulnerability in prioritizing vaccinations.

A Co-Created Tool to Help Counter Health Misinformation for Spanish-Speaking Communities in the San Francisco Bay Area.

BACKGROUND: Health misinformation, which was particularly prevalent during the COVID-19 pandemic, hampers public health initiatives. Spanish-speaking communities in the San Francisco Bay Area may be especially affected due to low digital health literacy and skepticism towards science and healthcare experts. Our study aims to develop a checklist to counter misinformation, grounded in community insights. METHODS: We adopted a multistage approach to understanding barriers to COVID-19 vaccine uptake in Spanish-speaking populations in Alameda and San Francisco counties. Initial work included key informant and community interviews. Partnering with a community-based organization (CBO), we organized co-design workshops in July 2022 to develop a practical tool for identifying misinformation. Template analysis identified key themes for actionable steps, such as source evaluation and content assessment. From this, we developed a Spanish-language checklist. FINDINGS: During formative interviews, misinformation was identified as a major obstacle to vaccine uptake. Three co-design workshops with 15 Spanish-speaking women resulted in a 10-step checklist for tackling health misinformation. Participants highlighted the need for scrutinizing sources and assessing messenger credibility, and cues in visual content that could instill fear. The checklist offers a pragmatic approach to source verification and information assessment, supplemented by resources from local CBOs. CONCLUSION: We have co-created a targeted checklist for Spanish-speaking communities to identify and counter health misinformation. Such specialized tools are essential for populations that are more susceptible to misinformation, enabling them to differentiate between credible and non-credible information.

Barriers to COVID-19 vaccine acceptance to improve messages for vaccine uptake in indigenous populations in the central highlands of Guatemala: a participatory qualitative study.

INTRODUCTION: As of July 2022, a little over one-third of Guatemalans were fully vaccinated. While COVID-19 vaccination rates are not officially reported nationally by racial/ethnic groups, non-governmental organisations and reporters have observed that COVID-19 vaccination rates are especially low among high-risk Indigenous populations. We conducted one of the first studies on COVID-19 vaccine acceptance in Indigenous populations in the Central Highlands of Guatemala, which aimed to better understand the barriers to COVID-19 vaccine uptake and how to improve vaccine promotional campaigns. METHODS: In November 2021, we conducted eight focus group discussions (FGDs) with 42 Indigenous men and women and 16 in-depth interviews (IDIs) with community health workers, nurses and physicians in Chimaltenango and Sololá. Using a participatory design approach, our qualitative analysis used constant comparative methods to understand the inductive and deductive themes from the FGD and IDI transcripts. RESULTS: We found three major overarching barriers to vaccination within the sampled population: (1) a lack of available easily understandable, linguistically appropriate and culturally sensitive COVID-19 vaccine information; (2) vaccine access and supply issues that prevented people from being vaccinated efficiently and quickly; and (3) widespread misinformation and disinformation that prey on people's fears of the unknown and mistrust of the medical establishment and government. CONCLUSION: When developing COVID-19 vaccine messages, content should be culturally relevant, appropriate for low-literacy populations and in the languages that people prefer to speak. Promotional materials should be in multiple modalities (print, radio and social media) and also have specific Maya cultural references (dress, food and concepts of disease) to ensure messaging connects with intended targets. This study supports the need for more robust research into best practices for communicating about COVID-19 vaccines to marginalised communities globally and suggests that policy makers should invest in targeted local solutions to increase vaccine uptake.

Barriers and Enablers to COVID-19 Vaccination in San Francisco's Spanish-Speaking Population.

Populations at high risk for COVID-19- including Spanish speakers-may face additional barriers to obtaining COVID-19 vaccinations; by understanding their challenges, we can create more equitable vaccine interventions. In this study, we used interviews to identify barriers and enablers to COVID-19 vaccine uptake among participants in the San Francisco Department of Public Health contact tracing program. Data analysis employed Capability, Opportunity, Motivation Behavior model (COM-B) and the Behavior Change Wheel framework as guides to target barriers with interventions and supporting policies. This paper presents data from interviews focused on COVID-19 vaccine uptake that was part of a project to improve COVID-19 preventive behaviors in San Francisco. We completed seventeen interviews between February and May 2021; six (35%) were completed in English and 11 (65%) in Spanish. Barriers to vaccine uptake included an unprepared health system, fear of side effects, limited knowledge, and conflicting information. Behavioral factors influencing vaccine uptake were mainly related to physical opportunity, automatic motivation, and psychological capability. Interventions that could address the most significant number of barriers included education, enablement, and environmental restructuring. Finally, communication and marketing policies that use diverse multi-lingual social media and environmental planning that includes accessible vaccine sites for people with disabilities, literacy barriers, and limited English proficiency could significantly increase vaccination. Public health departments should tailor interventions to high-risk populations by understanding the specific barriers they face. This exploratory study suggests how implementation science can provide frameworks to achieve this.

Evaluating the impact of a linguistically and culturally tailored social media ad campaign on COVID-19 vaccine uptake among indigenous populations in Guatemala: a pre/post design intervention study.

OBJECTIVES: To evaluate the impact of culturally and linguistically tailored informational videos delivered via social media campaigns on COVID-19 vaccine uptake in Indigenous Maya communities in Guatemala. METHODS: Our team designed a series of videos utilising community input and evaluated the impact using a pre-post intervention design. In-person preintervention surveys were collected from a sample of respondents in four rural municipalities in Guatemala in March 2022. Facebook, Instagram and browser ads were flooded with COVID-19 vaccine informational videos in Spanish, Kaqchikel and Kiche for 3 weeks. Postintervention surveys were conducted by telephone among the same participants in April 2022. Logistic regression models were used to estimate the OR of COVID-19 vaccine uptake following exposure to the intervention videos. RESULTS: Preintervention and postintervention surveys were collected from 1572 participants. The median age was 28 years; 63% (N=998) identified as women, and 36% spoke an Indigenous Mayan language. Twenty-one per cent of participants (N=327) reported watching the intervention content on social media. At baseline, 89% (N=1402) of participants reported having at least one COVID-19 vaccine, compared with 97% (N=1507) in the follow-up. Those who reported watching the videos had 1.78 times the odds (95% CI 1.14 to 2.77) of getting vaccinated after watching the videos compared with those who did not see the videos when adjusted by age, community, sex and language. CONCLUSION: Our findings suggest that culturally and linguistically tailored videos addressing COVID-19 vaccine misinformation deployed over social media can increase vaccinations in a rural, indigenous population in Guatemala, implying that social media content can influence vaccination uptake. Providing accurate, culturally sensitive information in local languages from trusted sources may help increase vaccine uptake in historically marginalised populations.

The yield of tuberculosis contact investigation in low- and middle-income settings: a systematic review and meta-analysis.

BACKGROUND: Contact investigation, the systematic evaluation of individuals in close contact with an infectious tuberculosis (TB) patient, is a key active case-finding strategy for global TB control. Better estimates of the yield of contact investigation can guide strategies to reduce the number of underreported and underdiagnosed TB cases, approximately three million cases per year globally. A systematic review (Prospero ID # CRD42019133380) and meta-analysis was conducted to update and enhance the estimates of the yield of TB contact investigation in low- and middle-income countries (LMIC). Pubmed, Web of Science, Embase and the WHO Global Index Medicus were searched for peer-reviewed studies (published between January 2006-April 2019); studies reporting the number of active TB or latent tuberculosis infection (LTBI) found through contact investigation were included. Pooled data were meta-analyzed using a random effects model and risk of bias was assessed. RESULTS: Of 1,644 unique citations obtained from database searches, 110 studies met eligibility criteria for descriptive data synthesis and 95 for meta-analysis. The pooled yields of contact investigation activities for different outcomes were: secondary cases of all active TB (defined as those bacteriologically confirmed or clinically diagnosed) 2.87% (2.61-3.14, I2 97.79%), bacteriologically confirmed active TB 2.04% (1.77-2.31, I2 98.06%), and LTBI 43.83% (38.11-49.55, I2 99.36%). Yields are interpreted as the percent of contacts screened who are diagnosed with active TB as a result of TB contact investigation activities. Pooled estimates were substantially heterogenous (I2 ≥ 75%). CONCLUSIONS: This study provides methodologically rigorous and up-to-date estimates for the yield of TB contact investigation activities in low- and middle-income countries (LMIC). While the data are heterogenous, these findings can inform strategic and programmatic planning for scale up of TB contact investigation activities.