COVID-19 vaccination likelihood among federally qualified health center patients: Lessons learned for future health crises

Abstract

Background: To prepare for rollout of a COVID-19 vaccine in fall 2020, there was an urgent need to understand barriers to ensuring equitable access and addressing vaccine skepticism and resistance. This study aimed to understand the association between trusted sources of COVID-19 information and likelihood of vaccination during that time, focusing on lessons learned to prepare for future public health crises.

Methods: From December 2020-March 2021, we surveyed a probability-based, cross-sectional sample of 955 patients across seven federally qualified health centers (FQHCs) serving predominantly low-income, Black and White populations in southeastern Louisiana. Vaccination likelihood was measured on a 7-point scale; "very likely to vaccinate" was defined as score=7. Trust in healthcare provider was measured with a single survey item. High trust in personal contacts, government, and media, respectively, were defined as the highest tertiles of summative scores of trust items. Weighted multivariable logistic regression estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for being very likely to vaccinate.

Results: Participants were 56% Black, 64% women, mean age 44.6 years; 33% were very likely to vaccinate. High trust in healthcare provider (aOR=4.14, 95% CI 2.26-7.57) and government sources (aOR=3.23, 95% CI 1.98-5.28) were associated with being very likely to vaccinate.

Conclusions: During initial COVID-19 vaccination rollout, trust in healthcare providers and government sources of COVID-19 information was associated with likelihood to vaccinate in FQHC patients. To inform public health planning for future crises, we highlight lessons learned for translating community-relevant insights into direct action to reach those most impacted.

Keywords: COVID-19; Federally qualified health centers; Vaccination likelihood.

Figure 1.

Reasons to Vaccinate (top panel) and Not to Vaccinate (bottom panel) by Likelihood to Vaccinate among patients in federally qualified health centers, southeast Louisiana, December 2020-March 2021 Top panel: Percent of respondents endorsing each reason FOR vaccination; survey respondents who were “not at all likely” to vaccinate were not asked to respond to this item; p-values <0.05 reported from Pearson’s chi-squared test of difference between respondents “somewhat” versus “very” likely to vaccinate for each reason. Bottom panel: Percent of respondents endorsing each reason NOT to vaccinate; survey respondents who were “very likely” to vaccinate were not asked to respond to this item; p-values <0.05 reported from Pearson’s chi-squared test of difference between respondents “somewhat” versus “not at all” likely to vaccinate for each reason.