RESUMO
Hispanic/Latino communities have suffered a disproportionate burden of the COVID-19 pandemic. Although Puerto Rico has one of the highest COVID-19 primary series vaccination rates nationwide, this estimate contrasts with the reported booster doses' low uptake. This study aimed to assess health belief correlates of COVID-19 vaccine booster uptake. Using a convenience sampling approach, the Puerto Rico-Community Engagement Alliance (PR-CEAL) conducted a cross-sectional study where 787 participants were recruited using online and in-person strategies between December 2021 and February 2022. Participants were adults 18 years or older, Spanish-speaking, and residents of Puerto Rico. The Health Belief Model was used to evaluate attitudes and beliefs. A total of 784 participants were used in this analysis. Adjusted Poisson regression models were used to estimate prevalence ratios (PR) and 95% confidence intervals (CI) of booster refusal. Overall, 22% of participants refused the vaccine booster or had not gotten it yet. Adjusted models showed that (i) participants who disagreed that getting the booster dose either made them feel less worried about COVID-19 or (ii) felt that the vaccine decreased their chances of getting COVID-19 presented higher booster-refusal prevalence ratios (PR = 4.20, 95% CI: 3.00, 5.90; PR = 3.70, 95% CI: 2.64, 5.18). Moreover, participants that (iii) reported having concerns for booster side effects [PR = 2.47; 95% CI = 1.73, 3.51], (iv) booster efficacy [PR = 2.50; 95% CI = 1.75, 3.58], and (v) booster safety [PR = 2.80; 95% CI = 1.96, 3.99] were significantly more likely to refuse the booster. In conclusion, booster vaccination refusal was associated with lower perceived vaccine benefits and greater barriers among adults in Puerto Rico. These results informed the development of PR-CEAL's targeted community outreach strategies and public health campaigns to increase booster vaccine uptake.
RESUMO
Background: Widespread vaccination against COVID-19 is essential to control the pandemic. Estimates of unwillingness and uncertainty toward COVID-19 vaccination and factors associated with it remain unclear among adults in Puerto Rico (PR).Objective: To examine factors associated with uncertainty and unwillingness of COVID-19 vaccination among adults in PR.Methods: The Health Belief Model was used to develop an online survey. Analyses included adjusted logistic regressions (aOR). A total of 1,911 adults completed the survey from December 2020 to February 2021.Results: Overall, 76.2% were females, 33.7% were aged 50 or older, and 82.7% reported an intent to get vaccinated. Individuals who did not perceive that their chances of getting COVID-19 were high (aOR = 2.94; 95%CI = 2.24-3.86), that getting COVID-19 was not a possibility for them (aOR = 2.86; 95%CI = 2.19-3.74), or unafraid of getting COVID-19 (aOR = 3.80; 95%CI = 2.76-5.23) had higher odds of uncertainty and unwillingness to get vaccinated against COVID-19. Participants who perceived that COVID-19 complications were not serious also had higher odds of uncertainty and unwillingness (aOR = 7.50; 95%CI = 3.94-14.3), whereas those who did not perceive that they would get very sick with COVID-19 had 89% increased odds. Those who agreed that they would only take the vaccine if many individuals took it had higher odds of uncertainty and unwillingness (aOR = 3.32; 95%CI = 2.49-4.43). The most reported reasons for uncertainty and unwillingness toward COVID-19 vaccination were vaccine safety (63.8%), efficacy (49.4%), and novelty (45.5%).Discussion: Although COVID-19 vaccination intent was high, the study highlights concern over vaccine safety and efficacy that should be addressed by public health campaigns and interventions to enhance vaccine uptake.