Mixed methods approach to understanding COVID-19 vaccine hesitancy among immigrants in the Chicago

MaryGrace Sharp; Paula Lozano; Alia Southworth; Aven Peters; Helen Lam; Fornessa T Randal; Michael Quinn; Karen E Kim

doi:10.1016/j.vaccine.2023.12.062

Mixed methods approach to understanding COVID-19 vaccine hesitancy among immigrants in the Chicago

Vaccine. 2024 Jan 9:S0264-410X(23)01508-6. doi: 10.1016/j.vaccine.2023.12.062. Online ahead of print.

Authors

MaryGrace Sharp¹, Paula Lozano², Alia Southworth³, Aven Peters², Helen Lam², Fornessa T Randal³, Michael Quinn², Karen E Kim²

Affiliations

¹ Asian Health Coalition, Chicago, IL, United States. Electronic address: marygrace@asianhealth.org.
² University of Chicago Center for Asian Health Equity, Chicago, IL, United States.
³ Asian Health Coalition, Chicago, IL, United States.

PMID: 38199924
DOI: 10.1016/j.vaccine.2023.12.062

Abstract

Background: COVID-19 vaccine hesitancy has been particularly high among immigrant populations, whose experience is shaped by a history of racism and discriminations, and distrust of the healthcare system. In this study we draw from the Theory of Planned Behavior to examine COVID-19 vaccine hesitancy among immigrants in Chicago.

Methods: A mixed-methods approach comprising of both focus groups and a health survey was conducted from February to August 2022. Five focus groups were held (N = 35) among Black, Asian and Arab/Palestine participants to understand attitudes and beliefs around the COVID-19 vaccine. Focus groups were analyzed using a modified template approach to text analysis. Based on these findings and themes, we developed a survey that was conducted among 413 immigrants from the mentioned communities. We used hierarchical ordinal regression analyses to examine the relationship between COVID-19 vaccine hesitancy and vaccination status.

Results: Qualitative analysis suggest that the major factors influencing COVID-19 vaccine hesitancy included fear of adverse reactions, misinformation around COVID-19 and the vaccine, negative social norms around vaccination, and external pressure to get vaccinated. From our quantitative analysis we found that 24% of participants were unvaccinated, 5% were partially vaccinated, 32.3% were vaccinated but not boosted, and 39% were vaccinated and boosted for COVID-19. Hierarchical regression models suggest that immigrants who hold negative attitudes and social norms around the COVID-19 vaccine are less likely to vaccinate.

Conclusions: Understanding vaccine hesitancy among immigrants allows for the creation of culturally and linguistically tailored education that can be utilized to increase vaccine confidence and uptake.

Keywords: COVID-19; Immigrants; Mixed methods; RIM; Theory of planned behavior; Vaccine hesitancy.