Insights Into Veterans' Motivations and Hesitancies for COVID-19 Vaccine Uptake: A Mixed-Methods Analysis

Abstract

Background: Despite the morbidity and mortality associated with COVID-19 infection, vaccine hesitancy remains a barrier to uptake. This article assessed whether unique clusters can be identified based on COVID-19-related thoughts and feelings and whether cluster membership is associated with COVID-19 vaccination. We also explored how individuals' thoughts, beliefs, and trust shape motivations and hesitancies for vaccine use.

Methods: This mixed-methods quality improvement project was conducted from July 2021 through May 2022 in Primary Care at the Veterans Affairs Pittsburgh Healthcare System. The primary outcome was self-reported COVID-19 vaccination. K-means analysis were used to identify clusters based on questionnaire responses, and multivariable logistic regression were used to assess the association between cluster membership and vaccination. We conducted qualitative interviews with patients in the 2 clusters with the lowest vaccination rates to explore vaccination motivations and hesitancies.

Results: Among 1208 respondents, 1034 (85.6%) were vaccinated. Four unique clusters were identified with vaccination rates of 29.9%, 93.3%, 93.5%, and 98.9%. Cluster membership was independently associated with vaccination, with adjusted odds ratios in the 3 most frequently vaccinated clusters of 12.1 (95% CI, 6.1-23.8), 13.0 (95% CI, 6.9-24.5), and 48.6 (95% CI, 15.5-152.0). Thematic analyses of 47 qualitative interviews found that protecting oneself and protecting others were the most common motivators for vaccination. The most common concerns were the rapid development of the vaccines and adverse effects, both more frequently endorsed in the cluster with the lowest vaccination rate.

Conclusions: Unique patient clusters based on infection- and vaccine-related thoughts and feelings are independently associated with COVID-19 vaccination. Identifiable themes regarding vaccine uptake and hesitancy vary among these clusters. These themes can be used to tailor strategies to diminish vaccine hesitancy and augment vaccination uptake among veterans.

FIGURE

COVID-19 vaccination status by cluster membership. The frequency of COVID-19 vaccination varied more than 3-fold, from 29.9% among Unconcerned Disbelievers to 98.9% among Concerned Believers (P < .001).