Black Americans Receiving the COVID-19 Vaccine and Effective Strategies to Overcome Barriers: An Integrative Literature Review

Abstract

Background Black Americans have a greater likelihood of serious morbidity or mortality from contracting the coronavirus and represent the lowest percentage of vaccinated individuals by race. This integrative literature review aims to identify the major barriers to Black Americans receiving the COVID-19 vaccine and proposed solutions to improve vaccination rates among this population. Method Databases CINAHL and LitCovid from the National Library of Medicine were utilized to find the articles included in this review. Results A total of seven articles were identified indicating five barriers preventing Black Americans from being vaccinated against COVID-19 that included (1) mistrust of the medical establishment, (2) uncertainty in vaccine safety, (3) limited access to healthcare, (4) inequitable access to resources, and (5) lower health literacy. The studies also indicated five strategies to increase the desire of Black Americans to be vaccinated including (1) utilizing trusted community leaders, (2) acknowledgment of the history of discrimination and trauma, (3) building more representative clinical trial cohorts, (4) continual investment into community-based organizations, and (5) mobile vaccine clinics. Conclusion The medical establishment in the USA has significant work to do to gain the trust of Black Americans. Many of the strategies to increase vaccine uptake among Black Americans have yet to be implemented which limits the conclusions that can be drawn from them. A future study should examine the outcomes of these proposed solutions to see if they do indeed work as intended and increase vaccination rates among this population.

Vaccine mistrust among Black individuals in Canada: The major role of health literacy, conspiracy theories, and racial discrimination in the healthcare system

“…In terms of conspiracy theories, this is the most important explanatory factor for the COVID‐19 VM in Black communities in Canada. Although the associations between conspiracy theories and COVID‐19 VM are recognized in the scientific literature, 41 systematic reviews conducted on barriers to vaccination and strategies that may encourage Black communities to get vaccinated did not identify conspiracy theories in the included studies 38,42 . This study shows that this is the most important explanatory factor of the COVID‐19 VM and that it should be explored with causal specifications to better understand the underlying mechanisms.…”

“…Although the associations between conspiracy theories and COVID-19 VM are recognized in the scientific literature, 41 systematic reviews conducted on barriers to vaccination and strategies that may encourage Black communities to get vaccinated did not identify conspiracy theories in the included studies. 38,42 This study shows that this is the most important explanatory factor of the COVID-19…”

“…For health literacy, results showed that a higher health literacy score was associated with a lower COVID‐19 VM score. An integrative systematic review found that lower health literacy was among the top five factors identified in studies that may prevent Black Americans from getting vaccinated 38 . These studies also showed that Black individuals had lower health literacy compared to other communities.…”

“…An integrative systematic review found that lower health literacy was among the top five factors identified in studies that may prevent Black Americans from getting vaccinated. 38 These studies also showed that Black individuals had lower health literacy compared to other communities. Health literacy is a protective factor that may play an important role in developing strategies to increase Black communities' confidence in COVID-19 vaccines and vaccines in general.…”

“…However, for health literacy to have its full effect, it requires health environments that are free of racism and this is not currently the case in Canada 19 . To better reach these communities, these programs must also incorporate community leaders, acknowledge the history of discrimination, and complex racial trauma that has guided majority‐minority ethnic group relations, as well as substantially increase investments in community organizations and take cultural aspects into account, as explained in the integrative systematic review conducted among Black American communities 38,42 . In addition, the results demonstrated the need for programs to address COVID‐19 VM issues intersectionally by considering gender, age, vaccination status, and language and racial issues.…”