COVID-19 Vaccine Hesitancy: Disadvantaged Groups’ Experience with Perceived Barriers, Cues to Action, and Attitudes

• Published in: American journal of health promotion Vol. 37; no. 4; pp. 488 - 498
• Main Authors: Coman, Ioana A, Xu, Shan, Yamamoto, Masahiro
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.05.2023; American Journal of Health Promotion
• Subjects: Action; Attitudes; Barriers; Black people; Communication; Coronaviruses; COVID-19; COVID-19 - prevention & control; COVID-19 Vaccines; Cross-Sectional Studies; Cues; Disadvantaged; Factor analysis; Health belief model; Health beliefs; Health promotion; Humans; Immunization; Quantitative Research; Religion; Spirituality; Vaccination; Vaccine hesitancy; United States > US; vaccine promotion; COVID-19 vaccine hesitancy; HBM; health disparities; barriers; cues to action; disadvantaged groups; underserved populations
• ISSN: 0890-1171; 2168-6602; 2168-6602
• DOI: 10.1177/08901171221136113

Purpose Drawing from the Health Belief Model, we explored how disadvantaged groups in the U.S., including Black, Hispanic, less educated and wealthy individuals, experienced perceived barriers and cues to action in the context of the COVID-19 vaccination. Design A cross-sectional survey administered in March 2021. Setting USA Subjects A national sample of U.S. residents (n = 795) recruited from Prolific. Measures Perceived barriers (clinical, access, trust, religion/spiritual), cues to action (authorities, social circles), attitudes toward COVID-19 vaccination. Analysis Factor analysis and Structural Equation Model (SEM) were performed in STATA 16. Results Black and less educated individuals experienced higher clinical barriers (CI [.012, .33]; CI [.027, .10]), trust barriers (CI [.49, .92]; CI [.057, .16]), and religious/spiritual barriers (CI [.28, .66]; CI [.026, .11]). Hispanics experienced lower levels of clinical barriers (CI [-.42, .0001]). Clinical, trust, and religious/spiritual barriers were negatively related to attitudes toward vaccination (CI [-.45, −.15]; CI [-.79, −.51]; CI [-.43, −.13]). Black and less educated individuals experienced fewer cues to action by authority (CI [-.47, −.083]; CI [-.093, −.002]) and social ties (CI [-.75, −.33]; CI [-.18, −.080]). Lower-income individuals experienced fewer cues to action by social ties (CI [-.097, −.032]). Cues from social ties were positively associated with vaccination attitudes (CI [.065, .26]). Conclusion Communication should be personalized to address perceived barriers disadvantaged groups differentially experience and use sources who exert influences on these groups.