Resilience throughout COVID-19: Unmasking the realities of COVID-19 and vaccination facilitators, barriers, and attitudes among Black Canadians.

ABSTRACT

Black communities have suffered disproportionately higher numbers of COVID-19 cases and deaths in Canada. Recognizing the significance of supporting targeted strategies with vulnerable populations extends beyond the COVID-19 pandemic, as it addresses longstanding health disparities and promotes equitable access to healthcare. The present study investigated 1) experiences with COVID-19, 2) COVID-19's impact, and 3) factors that have influenced COVID-19 vaccine acceptance and uptake among stakeholders and partners from the Federation of Black Canadians' (FBC). We conducted semi-structured interviews with 130 individuals and four focus groups with FBC, including stakeholders and partners, between November 2021 and June 2022. The semi-structured interviews and focus group discussions were conducted virtually over Zoom and lasted about 45 minutes each. Conversations from interviews and focus groups were transcribed and coded professionally using team-based methods. Themes were developed using an inductive-deductive approach and defined through consensus. The deductive approach was based on Consolidated Framework for Implementation Research (CFIR) domains and constructs. First, regarding experiences with COVID-19, 36 codes were identified and mapped onto 13 themes. Prominent themes included 39 participants who experienced highly severe COVID-19 infections, 25 who experienced stigma, and 18 who reported long recovery times. Second, COVID-19 elicited lifestyle changes, with 23 themes emerging from 62 codes. As many as 97 participants expressed feelings of isolation, while 63 reported restricted mobility. Finally, participants discussed determinants that influenced their vaccination decisions, in which 46 barriers and four facilitators were identified and mapped onto nine overarching themes. Themes around the CFIR domains Individuals, Inner Setting, and Outer Setting were most prominent concerning vaccine adoption. As for barriers associated with the constructs limited available resources and low motivation, 55 (41%) and 46 (34%) of participants, respectively, mentioned them most frequently. Other frequently mentioned barriers to COVID-19 vaccines fell under the construct policies & laws, e.g., vaccine mandates as a condition of employment. Overall, these findings provide a comprehensive and contextually rich understanding of pandemic experiences and impact, along with determinants that have influenced participants' vaccination decisions. Furthermore, the data revealed diverse experiences within Black communities, including severe infections, stigma, and vaccine-related challenges, highlighting the importance of targeted interventions, support, and consideration of social determinants of health in addressing these effects.