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Research on COVID-19 vaccine hesitancy and misinformation endorsement among Spanish-speaking Americans is limited. This cross-sectional study used a Spanish-language survey from May-August 2021 among 483 Spanish speakers living in the US and Puerto Rico. We applied multivariable Poisson regression with robust error variances to assess the association between independent variables and binary outcomes for vaccine acceptance versus hesitance, as well as misinformation endorsement. Vaccine acceptance was associated with COVID-19 risk perception score (PR = 1.7 high vs. low perceived risk), opinion of government transparency (PR = 2.2 very transparent vs. not transparent), and trust in vaccine information (PR = 1.8 high vs. low). There was also an interaction between time spent on social media and social media as a main source of COVID-19 information (p = 0.0484). Misinformation endorsement was associated with opinion about government transparency (PR = 0.5 moderately vs. not transparent), trust in vaccine information (PR = 0.5 high vs. low trust), social media impact on vaccine confidence (PR = 2.1 decreased vs. increased confidence), distrust vaccines (PR = 1.9 distrust vs. trust), using vaccine information from Facebook (PR = 1.4 yes vs. no), and time spent on social media by those using social media as main source of COVID-19 vaccine information (p = 0.0120). Vaccine acceptance in respondents with high misinformation endorsement scores was 0.7 times those with low scores. These findings highlight the importance of effective information dissemination, the positive role of social media, and government transparency in boosting vaccine uptake among Spanish speakers in the US.
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[This corrects the article DOI: 10.3389/fpubh.2023.1195005.].
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Despite the crucial role the COVID-19 vaccine played in curbing the pandemic, a significant portion of Black and African American individuals expressed hesitancy toward being vaccinated. This review aimed to identify the determinants of COVID-19 vaccine hesitancy among Black and African American individuals in the U.S. The literature search was conducted in December 2022 according to the PRISMA criteria focusing on empirical studies. Data extraction methods, critical appraisal, and secondary thematic analysis were conducted on both quantitative and qualitative studies. Sixteen quantitative studies identified the key factors associated with vaccine hesitancy, such as confidence in vaccine effectiveness, safety, and trust in the healthcare system. Fourteen qualitative studies revealed major themes of mistrust, fear, and information needs, including historical mistrust, concerns about the vaccine development process, and contemporary institutional mistrust. The synthesis of quantitative and qualitative findings derived from this review provides a nuanced understanding of the determinants of vaccine hesitancy in Black and African American communities in the U.S., offering a foundation for the development of evidence-based interventions. Mistrust in the healthcare system, fear, and informational gaps on vaccine safety and effectiveness were identified as significant barriers to vaccination, demanding targeted interventions.
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BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic highlighted the challenges of effective emergency risk communication (ERC) to protect public health, including the difficulty in tackling the spread of inaccurate information. This study aimed to understand those challenges and potential solutions by interviewing leading government spokespersons and their advisors from around the world with experience during large scale emergencies. Interviews were conducted with 27 individuals representing governments from 19 countries across five continents. Thematic analysis, using both a deductive and inductive approach, organized and identified salient themes and patterns that emerged from the interview data. RESULTS: The thematic analysis of the interviews' data led to the identification of 9 principles of communication: 1) Timeliness, 2) Transparency, 3) Coordination, 4) Accuracy and Consistency, 5) Accountability and Integrity, 6) Independence from politics, 7) Responsiveness, 8) Equity, 9) Trust and Empathy. We also developed 36 recommendations actionable by government agencies to enhance the practice of the 9 principles. Examples include the need for: proactive communication strategies, permanent communication task forces integrated into preparedness and response efforts, robust processes to enhance open discussion of controversial topics within government agencies, clarification of how various branches of government coordinate to oversee specific aspects of the overall communication, and development of relationships across public and private entities ahead of a crisis. CONCLUSIONS: Our findings suggest key practical recommendations for leaders of government agencies to enhance ERC capabilities going forward. Before a crisis, they must constantly review internal processes and integrate ERC functions into overall communication planning efforts. During a crisis, they must coordinate roles and responsibilities across branches of governments, strive to communicate to a range of populations to uphold equity, maintain transparency by avoiding information voids on controversial issues and build trust by building relationships with a variety of community leaders. After a crisis, government agencies should continue the practice of social listening to hear more about the public's informational needs, strengthen civic participation processes, and understand how an always evolving information environment can best be leveraged during future crises.
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COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Comunicação , Saúde Pública , Política , GovernoRESUMO
Introduction: Human trafficking (HT) awareness campaigns can educate the public and specific professional figures about this crime and ways to prevent it. However, there currently remains a gap in terms of how to best frame such campaigns without stigmatizing groups of individuals or portraying victims in unrealistic ways. Methods: We conducted four focus groups with 22 experts in HT to explore their perspectives and opinions on current challenges in the framing of HT awareness campaigns in the United States. Focus groups were conducted via Zoom and transcribed verbatim. Two independent reviewers analyzed the transcripts to identify themes using an inductive approach. The results of the focus groups analysis were used to structure the guiding questions of a brainstorming technique named Nominal Group Technique (NGT). Fifteen of 22 experts that participated in the focus groups joined the in-person NGT with the intent of generating ideas and achieving consensus on target audiences, goals, and content of human trafficking awareness campaigns. At the end of the NGT participants ranked priority for actions in the development of HT awareness efforts in the United States. Results: During the NGT the experts provided a number of recommendations to improve HT awareness and to empower victims to reach for help. They pointed to the need for: awareness efforts that describe HT on a spectrum of human abuse and exploitation; training for professional figures about trauma-informed care and communication; and efforts that empower trafficked victims to seek support. They also pointed to the need to develop awareness efforts tailored to local needs in close collaborations with the community-based organizations that can champion their dissemination and be the primary point of access for victims seeking help.
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Objetivos , Tráfico de Pessoas , Humanos , Tráfico de Pessoas/prevenção & controle , Comunicação , Consenso , Grupos FocaisRESUMO
Understanding the size and composition of the state and local governmental public health workforce in the United States is critical for promoting and protecting the health of the public. Using pandemic-era data from the Public Health Workforce Interests and Needs Survey fielded in 2017 and 2021, this study compared intent to leave or retire in 2017 with actual separations through 2021 among state and local public health agency staff. We also examined how employee age, region, and intent to leave correlated with separations and considered the effect on the workforce if trends were to continue. In our analytic sample, nearly half of all employees in state and local public health agencies left between 2017 and 2021, a proportion that rose to three-quarters for those ages thirty-five and younger or with shorter tenures. If separation trends continue, by 2025 this would represent more than 100,000 staff leaving their organizations, or as much as half of the governmental public health workforce in total. Given the likelihood of increasing outbreaks and future global pandemics, strategies to improve recruitment and retention must be prioritized.
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COVID-19 , Saúde Pública , Humanos , Pirantel , Surtos de Doenças , Governo LocalRESUMO
OBJECTIVE: To share the experiences of stakeholders in a school district's response to the COVID-19 pandemic, especially related to supporting the district in the reopening process and sharing key decision points, challenges, facilitators, and overall lessons learned that may be applied to future emergencies. DESIGN: A descriptive study of participants' experience that included (1) a content analysis of policy documents and recommendations that were developed and published by key stakeholders and (2) interviews with stakeholders in the school system that were coded to identify patterns and themes. SETTING: Remote interviews conducted over Zoom. Participants live or work in Brookline, Massachusetts. PARTICIPANTS: Fifteen qualitative interviews were conducted with school committee members, principals, members of school leadership, school nurses, school staff, parents, advisory panel members, and physicians collaborating with the school district. MAIN OUTCOME MEASURES: Whether patterns and themes related to challenges, solutions, and recommendations for future management of public health emergencies in the district could be identified. RESULTS: Challenges experienced during a school district's response included staffing burdens, changing scopes of services, the difficulty of successfully enforcing social distancing, addressing staff and family fears, meeting informational needs, and limited resources. Multiple interviewees shared that they felt there should have been a greater emphasis on mental health in the district's response. Successes of the response included the creation and implementation of a consistent communications system, recruiting volunteers and mobilizing the community to address critical needs, and effective technology expansion and usage in schools. CONCLUSIONS: Leadership and community collaboration were essential to the response to the COVID-19 pandemic in addition to strategies used to enhance coordination and communication and relay information across the community.
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COVID-19 , Humanos , COVID-19/epidemiologia , Pandemias , Emergências , Recursos Comunitários , EstudantesRESUMO
Both traditional and social media information sources have disseminated information on the COVID-19 pandemic. The content shared may influence public opinion on different mitigation strategies, including vaccination. Misinformation can alter risk perception and increase vaccine hesitancy. This study aimed to explore the impact of using social media as the primary information source about the COVID-19 vaccine on COVID-19 vaccine hesitancy among people living in Canada. Secondary objectives identified other predictors of vaccine hesitancy and distinguished the effects of using traditional and social media sources. We used quota sampling of adults in Canada [N = 985] to conduct an online survey on the Pollfish survey platform between 21st and 28th May 2021. We then used bivariate chi-squared tests and multivariable logistic regression modeling to explore the associations between using social media as one's primary source of information about the COVID-19 vaccine and vaccine hesitancy. We further analyzed the association between specific types of channels of information and vaccine hesitancy. After controlling for covariates such as age, sex, race, and ethnicity, individuals reporting social media as their primary source of COVID-19 vaccine information versus those who had not used social media as their primary source of COVID-19 vaccine information had 50% higher odds of vaccine hesitancy. Among different channels of information, we found that information from television was associated with a 40% lower odds ratio for vaccine hesitancy. Since social media platforms play an essential role in influencing hesitancy in taking the COVID-19 vaccination, it is necessary to improve the quality of social media information sources and raise people's trust in information. Meanwhile, traditional media channels, such as television, are still crucial for promoting vaccination programs.
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Despite the availability of effective vaccines that lower mortality and morbidity associated with COVID-19, many countries including Italy have adopted strict vaccination policies and mandates to increase the uptake of the COVID-19 vaccine. Such mandates have sparked debates on the freedom to choose whether or not to get vaccinated. In this study, we examined the people's belief in vaccine choice as a predictor of willingness to get vaccinated among a sample of unvaccinated individuals in Italy. An online cross-sectional survey was conducted in Italy in May 2021. The survey collected data on respondents' demographics and region of residence, socioeconomic factors, belief in the freedom to choose to be vaccinated or not, risk perception of contracting and transmitting the disease, previous vaccine refusal, opinion on adequacy of government measures to address the pandemic, experience in requesting and being denied government aid during the pandemic, and intent to accept COVID-19 vaccination. The analysis employed binary logistic regression models using a hierarchical model building approach to assess the association between intent to accept vaccination and belief in the freedom to choose to vaccinate, while adjusting for other variables of interest. 984 unvaccinated individuals were included in the study. Respondents who agreed that people should be free to decide whether or not to vaccinate with no restrictions on their personal life had 85% lower odds of vaccine acceptance (OR = 0.15; 95% CI, 0.09,0.23) after adjusting for demographic and socioeconomic factors and their risk perception of contracting and transmitting COVID-19. Belief in the freedom to choose whether or not to accept vaccinations was a major predictor of COVID-19 vaccine acceptance among a sample of unvaccinated individuals in Italy in May 2021. This understanding of how individuals prioritize personal freedoms and the perceived benefits and risks of vaccines, when making health care decisions can inform the development of public health outreach, educational programs, and messaging.
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Vaccine hesitancy is a key contributor to reduced COVID-19 vaccine uptake and remains a threat to COVID-19 mitigation strategies as many countries are rolling out the campaign for booster shots. The goal of our study is to identify and compare the top vaccine concerns in four countries: Canada, Italy, Sweden, and the USA and how these concerns relate to vaccine hesitancy. While most individuals in these countries are now vaccinated, we expect our results to be helpful in guiding vaccination efforts for additional doses, and more in general for other vaccines in the future. We sought to empirically test whether vaccine related concerns followed similar thematic issues in the four countries included in this study, and then to see how these themes related to vaccine hesitancy using data from a cross-sectional survey conducted in May 2021. We applied CFA and created vaccine concern scales for analysis. We then utilized these results in regression-based modeling to determine how concerns related to vaccine hesitancy and whether there were similar or different concerns by country. The results quantitatively highlight that the same vaccine related concerns permeated multiple countries at the same point in time. This implies that COVID-19 vaccination communications could benefit from global collaboration.
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The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on individuals' mental health. This study aimed to investigate how negative emotions toward the COVID-19 pandemic, including feeling anxious, depressed, upset, and stressed, were associated with COVID-19 vaccine acceptance in Sweden. The study is a cross-sectional online survey conducted between 21-28 May 2021, using three nested hierarchical logistic regression models to assess the association. The study included 965 unvaccinated individuals, 51.2% (n = 494) of whom reported their intention to get vaccinated. We observed graded positive associations between reported negative emotions and vaccine acceptance. Individuals who experienced economic stress had lower odds of vaccine acceptance while having a positive opinion of the government's response to COVID-19 was associated with higher odds of being vaccine-acceptant. In conclusion, unvaccinated individuals experiencing negative emotions about the pandemic were more willing to get the vaccine. On the contrary, those with a negative opinion about the government's response, and those that had experienced economic stress were less likely to accept the immunization.
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The COVID-19 pandemic has highlighted the adverse consequences created by an infodemic, specifically bringing attention to compliance with public health guidance and vaccine uptake. COVID-19 vaccine hesitancy is a complex construct that is related to health beliefs, misinformation exposure, and perceptions of governmental institutions. This study draws on theoretical models and current data on the COVID-19 infodemic to explore the association between the perceived risk of COVID-19, level of misinformation endorsement, and opinions about the government response on vaccine uptake. We surveyed a sample of 2697 respondents from the US, Canada, and Italy using a mobile platform between 21-28 May 2021. Using multivariate regression, we found that country of residence, risk perception of contracting and spreading COVID-19, perception of government response and transparency, and misinformation endorsement were associated with the odds of vaccine hesitancy. Higher perceived risk was associated with lower odds of hesitancy, while lower perceptions of government response and higher misinformation endorsement were associated with higher hesitancy.
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BACKGROUND: Over the course of the COVID-19 pandemic, a variety of COVID-19-related misinformation has spread and been amplified online. The spread of misinformation can influence COVID-19 beliefs and protective actions, including vaccine hesitancy. Belief in vaccine misinformation is associated with lower vaccination rates and higher vaccine resistance. Attitudinal inoculation is a preventative approach to combating misinformation and disinformation, which leverages the power of narrative, rhetoric, values, and emotion. OBJECTIVE: This study seeks to test inoculation messages in the form of short video messages to promote resistance against persuasion by COVID-19 vaccine misinformation. METHODS: We designed a series of 30-second inoculation videos and conducted a quasi-experimental study to test the use of attitudinal inoculation in a population of individuals who were unvaccinated (N=1991). The 3 intervention videos were distinguished by their script design, with intervention video 1 focusing on narrative/rhetorical ("Narrative") presentation of information, intervention video 2 focusing on delivering a fact-based information ("Fact"), and intervention video 3 using a hybrid design ("Hybrid"). Analysis of covariance (ANCOVA) models were used to compare the main effect of the intervention on the 3 outcome variables: ability to recognize misinformation tactics ("Recognize"), willingness to share misinformation ("Share"), and willingness to take the COVID-19 vaccine ("Willingness"). RESULTS: There were significant effects across all 3 outcome variables comparing inoculation intervention groups to controls. For the Recognize outcome, the ability to recognize rhetorical strategies, there was a significant intervention group effect (P<.001). For the Share outcome, support for sharing the mis- and disinformation, the intervention group main effect was statistically significant (P=.02). For the Willingness outcome, there was a significant intervention group effect; intervention groups were more willing to get the COVID-19 vaccine compared to controls (P=.01). CONCLUSIONS: Across all intervention groups, inoculated individuals showed greater resistance to misinformation than their noninoculated counterparts. Relative to those who were not inoculated, inoculated participants showed significantly greater ability to recognize and identify rhetorical strategies used in misinformation, were less likely to share false information, and had greater willingness to get the COVID-19 vaccine. Attitudinal inoculation delivered through short video messages should be tested in public health messaging campaigns to counter mis- and disinformation.
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COVID-19 , Vacinas , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Humanos , Pandemias , Inquéritos e Questionários , Vacinação/psicologiaRESUMO
The COVID-19 pandemic has resulted in over 5.2 million deaths. Vaccine hesitancy remains a public health challenge, especially in Eastern Europe. Our study used a sample of essential workers living in the Republic of North Macedonia to: (1) Describe rates of vaccine hesitancy and risk perception of COVID-19; (2) Explore predictors of vaccine hesitancy; and (3) Describe the informational needs of hesitant and non-hesitant workers. A phone survey was administered in North Macedonia from 4−16 May 2021. Logistic regression explored associations of COVID-19 vaccine hesitancy with sociodemographic characteristics, non-COVID-19 vaccine hesitancy, previous diagnosis of COVID-19, and individual risk perception of contracting COVID-19. Chi-squared analyses compared differences in informational needs by hesitancy status. Of 1003 individuals, 44% were very likely to get the vaccine, and 56% reported some level of hesitancy. Older age, Albanian ethnicity, increased education, previous COVID-19 diagnosis, acceptance of other vaccines, and increased risk perception of COVID-19 infection were negatively associated with vaccine hesitancy. Results indicated significant differences in top informational needs by hesitancy status. The top informational needs of the hesitant were the freedom to choose to be vaccinated without consequences (57% vs. 42%, p < 0.01) and that all main international agencies recommended the vaccine (35% vs. 24%, p < 0.01).
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OBJECTIVE: Public health and emergency management agencies play a critical role in addressing the needs of vulnerable populations in preparation for and in response to emergencies. Identifying and leveraging community assets is a way to address such needs. This study focuses on the development of a process and tools to engage community leaders in sharing their knowledge about their community characteristics and assets useful for emergency planning. METHODS: We conducted interviews with community leaders across five study sites with the goal of understanding what type of local knowledge community leaders are able to share in regard to emergency preparedness. Based on the interview results we developed and tested a mobile application as a mobile friendly directory of community assets. RESULTS: We identified two main types of local knowledge about community assets for emergency preparedness: communication-based and trust-based local knowledge. We created an application to facilitate the sharing of such knowledge. Community leaders were able to share local knowledge across four areas: communication-based assets, trust-based assets, spatial-based assets and personal-preparedness assets. CONCLUSION: Community leaders' engagement in preparedness efforts is important to identify community assets that can be leveraged to address the needs of the most vulnerable segments of a community.
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Defesa Civil , Planejamento em Desastres , Humanos , Planejamento em Desastres/métodos , Populações Vulneráveis , Confiança , ComunicaçãoRESUMO
This study presents the results of a survey of 1591 hesitant U.S. essential workers, conducted over Pollfish in December 2020 when they were the only group eligible for the vaccine, aiming to describe their concerns regarding COVID-19 vaccine safety, effectiveness and distribution policies. We computed frequencies using the SAS software for each answer, using chi-squared statistics and Cochran-Armitage trend tests to determine how informational needs differ by age, gender, level of education, race, source of COVID-19 information and levels of vaccine acceptance. The results of this study show that freedom of choice, equal access to the vaccine and being able to live a life with no restrictions once vaccinated were important concerns since the early days of the distribution campaign, with 53% (836/1591), 42% (669/1591) and 35% (559/1591) of hesitant respondents, respectively, indicating they would be more likely to receive the COVID-19 vaccine if they felt these issues were satisfactorily addressed. Early risk communication and immunization campaign strategies should address not only the reported efficacy and safety of new vaccines, but, as equally important, the population's perceptions and beliefs regarding personal choice, effectiveness and adverse consequences.
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COVID-19 , Vacinas , Vacinas contra COVID-19 , Comunicação , Humanos , SARS-CoV-2 , Estados UnidosRESUMO
Background: During the initial phase of the COVID-19 pandemic, the University of Bologna Medical School surveyed medical students to learn more about their preparation to confront challenges posed by the pandemic and whether it affects perceptions of viral infection risk. This information could help design risk-reduction interventions with training to mitigate possible viral exposure. Method: A cross-sectional online survey examining students' characteristics, volunteer status, adoption of evidence-based preventive measures, trust in information sources used, infectious disease training, and knowledge of PPE usage in relation to perceived risk of infection from SARS-CoV-2 in daily living, academic, and healthcare activities. A multivariate path model estimated the simultaneous influences of all exogenous factors on perceived risk. A Poisson regression model assessed the same multivariate effects on knowledge of PPE usage. Results: The analysis sample included 537 respondents. Perceived risk of infection was highest in hospital activities. On average, students were able to use only four out of seven types of PPE albeit they adopted most of the evidence-based preventive measures. Adoption of preventive measures was positively associated with perceived risk of COVID infection. Conversely, training on PPE usage and volunteer work were associated with lower perceived risk in healthcare setting and higher PPE knowledge. Conclusion: Implementing early safety-based educational programs remedy students' lack of knowledge in infectious disease prevention and mitigate their risk of infection. Voluntary work should be encouraged with potential benefit for both their continued medical training and strengthening the healthcare system's response to public health emergencies.
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COVID-19 , Estudantes de Medicina , Estudos Transversais , Humanos , Itália/epidemiologia , Pandemias , Equipamento de Proteção Individual , SARS-CoV-2 , Confiança , VoluntáriosRESUMO
Despite the effectiveness of the COVID-19 vaccine, global vaccination distribution efforts have thus far had varying levels of success. Vaccine hesitancy remains a threat to vaccine uptake. This study has four objectives: (1) describe and compare vaccine hesitancy proportions by country; (2) categorize vaccine-related concerns; (3) rank vaccine-related concerns; and (4) compare vaccine-related concerns by country and hesitancy status in four countries-the United States, Canada, Sweden, and Italy. Using the Pollfish survey platform, we sampled 1000 respondents in Canada, Sweden, and Italy and 750 respondents in the United States between 21-28 May 2021. Results showed vaccine-related concerns varied across three topical areas-vaccine safety and government control, vaccine effectiveness and population control, and freedom. For each thematic area, the top concern was statistically significantly different in each country and among the hesitant and non-hesitant subsamples within each county. Concerns related to freedom were the most universal. Understanding the specific concerns among individuals when it comes to the COVID-19 vaccine can help to inform public communications and identify which, if any, salient narratives are global.
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The goal of this study is to explore predictors of COVID-19 vaccine hesitancy, including socio-demographic factors, comorbidity, risk perception, and experience of discrimination, in a sample of the U.S. population. We used a cross-sectional online survey study design, implemented between 13-23 December 2020. The survey was limited to respondents residing in the USA, belonging to priority groups for vaccine distribution. Responses were received from 2650 individuals (response rate 84%) from all 50 states and Puerto Rico, American Samoa, and Guam. The five most represented states were California (13%), New York (10%), Texas (7%), Florida (6%), and Pennsylvania (4%). The majority of respondents were in the age category 25-44 years (66%), male (53%), and working in the healthcare sector (61%). Most were White and non-Hispanic (66%), followed by Black and non-Hispanic (14%) and Hispanic (8%) respondents. Experience with racial discrimination was a predictor of vaccine hesitancy. Those reporting racial discrimination had 21% increased odds of being at a higher level of hesitancy compared to those who did not report such experience (OR = 1.21, 95% C.I. 1.01-1.45). Communication and logistical aspects during the COVID-19 vaccination campaign need to be sensitive to individuals' past-experience of racial discrimination in order to increase vaccine coverage.
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Vaccine hesitancy (delay in obtaining a vaccine, despite availability) represents a significant hurdle to managing the COVID-19 pandemic. Vaccine hesitancy is in part related to the prevalence of anti-vaccine misinformation and disinformation, which are spread through social media and user-generated content platforms. This study uses qualitative coding methodology to identify salient narratives and rhetorical styles common to anti-vaccine and COVID-denialist media. It organizes these narratives and rhetorics according to theme, imagined antagonist, and frequency. Most frequent were narratives centered on "corrupt elites" and rhetorics appealing to the vulnerability of children. The identification of these narratives and rhetorics may assist in developing effective public health messaging campaigns, since narrative and emotion have demonstrated persuasive effectiveness in other public health communication settings.