Factors influencing H1N1 vaccine behavior among Manitoba Metis in Canada: a qualitative study

Abstract

BackgroundDuring the first wave of the H1N1 influenza pandemic in 2009, Aboriginal populations in Canada experienced disproportionate rates of infection, particularly in the province of Manitoba. To protect those thought to be most at-risk, health authorities in Manitoba listed all Aboriginal people, including Metis, among those able to receive priority access to the novel vaccine when it first became available. Currently, no studies exist that have investigated the attitudes, influences, and vaccine behaviors among Aboriginal communities in Canada. This paper is the first to systematically connect vaccine behavior with the attitudes and beliefs that influenced Metis study participants’ H1N1 vaccine decision-making.MethodsResearchers held focus groups (n = 17) with Metis participants in urban, rural, and remote locations of Manitoba following the conclusion of the H1N1 pandemic. Participants were asked about their vaccination decisions and about the factors that influenced their decisions. Following data collection, responses were coded into the broad categories of a social-ecological model, nuanced by categories stemming from earlier research. Responses were then quantified to show the most influential factors in positively or negatively affecting the vaccine decision.ResultsMedia reporting, the influence of peer groups, and prioritization all had positive and negative influential effects on decision making. Whether vaccinated or not, the most negatively influential factors cited by participants were a lack of knowledge about the vaccine and the pandemic as well as concerns about vaccine safety. Risk of contracting H1N1 influenza was the biggest factor in positively influencing a vaccine decision, which in many cases trumped any co-existing negative influencers.ConclusionsMetis experiences of colonialism in Canada deeply affected their perceptions of the vaccine and pandemic, a context that health systems need to take into account when planning response activities in the future. Participants felt under-informed about most aspects of the vaccine and the pandemic, and many vaccine related misconceptions and fears existed. Recommendations include leveraging doctor-patient interactions as a site for sharing vaccine-related knowledge, as well as targeted, culturally-appropriate, and empowering public information strategies to supply reliable vaccine and pandemic information to potentially at-risk Aboriginal populations.

Health Systems and Services During COVID-19: Lessons and Evidence From Previous Crises: A Rapid Scoping Review to Inform the United Nations Research Roadmap for the COVID-19 Recovery

“…Knowledge deficits about the vaccine and the pandemic, concerns about vaccine safety, targeted testing within their communities (rooted by colonial legacy), and feeling like a “guinea pig” were stated as having deterred vaccine uptake. Doctor–patient trust, usually helpful to promote uptake, is more complicated in this setting with historically negative interactions 134 (#23, Level IV). This likely translates to LMIC contexts given the colonial nature of some global health vaccination campaigns in the past.…”

HPV vaccine: uptake and understanding among global Indigenous communities – a qualitative systematic review

“…Interpersonal communication with practitioners is the foundation of quality care, however it is often one of the largest barriers for Indigenous peoples [40,42]. While mistrust in healthcare is common for Indigenous communities, participants both in this qualitative review [29,30,32] and elsewhere [37,43,44] have discussed the centrality of practitioner-patient relationships and health professional guidance in promoting vaccine acceptance. Health practitioners have an ethical obligation to respectfully engage in honest conversations with Indigenous peoples about vaccines that prioritises oral forms of education [30,31] and increases understanding for patients.…”

“…The findings align with previous explorations of Indigenous understandings and uptake of vaccinations. Intergenerational impacts of colonisation, historic maltreatment and continuing marginalisation and oppression have significantly impacted Indigenous trust in health-related services, communications, and professionals [37][38][39][40]. Synthesised findings from the included studies highlight a commonality of mistrust in healthcare systems and vaccines [30][31][32][33], with participants describing feeling like a 'guinea pig' when considering vaccination [33].…”

L’expérimentation médicale et les causes de la réticence à la vaccination contre la COVID-19 chez les peuples autochtones du Canada

“…La pandémie du virus de la grippe A (H1N1) est un exemple révélateur de la réticence à la vaccination chez les peuples autochtones. Comme le démontrent les études, l'expérience du colonialisme canadien par les peuples autochtones avait « profondément altéré leurs perceptions du vaccin [anti-H1N1] et de la pandémie » et a accru leur hésitation face au vaccin 8 , sentiments que des messages et des interventions pro blématiques en matière de santé publique ont ensuite exacerbés.…”