Vaccine Trust Gauge: Mixed methods research to measure and understand vaccine trust.

INTRODUCTION: While trust in vaccination is one factor in the ecosystem that surrounds vaccine decision-making and acceptance, understanding its role may provide insights into effective and tailored approaches to help build individual-level vaccine confidence. The authors developed the Vaccine Trust Gauge (VTG), a scale used to measure trust in vaccines, and conducted mixed methods research to provide an in-depth understanding of the various factors shaping vaccine trust in the United States. MATERIALS AND METHODS: The VTG instrument was developed from previous and scoping research of questionnaires (Larson et al., 2018; Palmedo et al., 2021) and fielded in the US to n = 3026 adults ages ≥18. Based on survey responses, participants were segmented by vaccine trust level (low, medium, or high) through an aggregated scoring system constructed from the VTG. 65 respondents were recruited to participate in in-depth interviews or focus groups conducted by phone or video conference. A conceptual definition of vaccine trust was developed using components of the VTG scale. RESULTS: Multivariate regressions found that higher levels of vaccine trust measured by the VTG are closely associated with trust in healthcare providers and trust in government. College or higher degree, Democrats, and those aged 55+ were more likely to have higher trust in vaccines compared to Black/African Americans, and those experiencing discrimination in the healthcare system. The qualitative analysis allowed the authors to add diverse, contextual elements to the vaccine trust levels summarized here. DISCUSSION: These mixed methods findings suggest future implications for research and practice. Ideas for potential communication, policy, and public health strategies are offered to build vaccine confidence and advance uptake for COVID-19 and other vaccines. CONCLUSIONS: There are diverse underlying factors that influence an individual's trust in vaccines, which means trust categories and demographic characteristics cannot be used as monolithic identifiers. Assessing vaccine trust provides insights into a foundation for engagement to promote individual-level vaccine acceptance. The authors present recommendations for the use of the VTG, future implications for research and practice, and potential strategies to build vaccine confidence.

Supporting US healthcare providers for successful vaccine communication.

BACKGROUND: While many healthcare providers (HCPs) have navigated patients' vaccine concerns and questions prior to the rollout of the COVID-19 vaccines, sentiments surrounding the COVID-19 vaccines have presented new and distinct challenges. OBJECTIVE: To understand the provider experience of counseling patients about COVID-19 vaccinations, aspects of the pandemic environment that impacted vaccine trust, and communication strategies providers found supportive of patient vaccine education. METHODS: 7 focus groups of healthcare providers were conducted and recorded during December 2021 and January 2022, at the height of the Omicron wave in the United States. Recordings were transcribed, and iterative coding and analysis was applied. RESULTS: 44 focus group participants representing 24 US states with the majority (80%) fully vaccinated at the time of data collection. Most participants were doctors (34%) or physician's assistants and nurse practitioners (34%). The negative impact of COVID-19 misinformation on patient-provider communication at both intrapersonal and interpersonal levels as well as barriers and facilitators to patient vaccine uptake are reported. People or sources that play a role in health communication ("messengers") and persuasive messages that impact behavior or attitudes towards vaccination ("messages") are described. Providers expressed frustration in the need to continuously address vaccine misinformation in clinical appointments among patients who remained unvaccinated. Many providers found value in resources that provided up-to-date and evidence-based information as COVID-19 guidelines continued to change. Additionally, providers indicated that patient-facing materials designed to support vaccination education were not frequently available, but they were the most valuable to providers in a changing information environment. CONCLUSIONS: While vaccine decision-making is complex and hinges on diverse factors such as health care access (i.e., convenience, expense) and individual knowledge, providers can play a major role in navigating these factors with their patients. But to strengthen provider vaccine communication and promote vaccine uptake, a comprehensive communication infrastructure must be sustained to support the patient-provider dyad. The findings provide recommendations to maintain an environment that facilitates effective provider-patient communication at the community, organizational and policy levels. There is a need for a unified multisectoral response to reinforce the recommendations in patient settings.