Multilevel determinants of Covid-19 vaccine hesitancy and undervaccination among marginalized populations in the United States: A scoping review

Abstract

Background: Amid persistent disparities in Covid-19 vaccination, we conducted a scoping review to identify multilevel determinants of Covid-19 vaccine hesitancy (VH) and undervaccination among marginalized populations in the U.S. Methods: We utilized the scoping review methodology developed by the Joanna Briggs Institute and report all findings according to PRISMA-ScR guidelines. We developed a search string and explored 7 databases to identify peer-reviewed articles published from January 1, 2020–October 31, 2021, the initial period of U.S. Covid-19 vaccine availability. We combine frequency analysis and narrative synthesis to describe factors influencing Covid-19 vaccination among marginalized populations. Results: The search captured 2,496 non-duplicated records, which were scoped to 50 peer-reviewed articles: 11 (22%) focused on African American/Black people, 9 (18%) people with disabilities, 4 (8%) justice-involved people, and 2 (4%) each on Latinx, people living with HIV/AIDS, people who use drugs, and LGBTQ+ people. Forty-four articles identified structural factors, 36 social/community, 27 individual, and 40 vaccine-specific factors. Structural factors comprised medical mistrust (of healthcare systems, government public health) and access barriers due to unemployment, unstable housing, lack of transportation, no/low paid sick days, low internet/digital technology access, and lack of culturally and linguistically appropriate information. Social/community factors including trust in a personal healthcare provider (HCP), altruism, family influence, and social proofing mitigated VH. At the individual level, low perceived Covid-19 threat and negative vaccine attitudes were associated with VH. Discussion: This review indicates the importance of identifying and disaggregating structural factors underlying Covid-19 undervaccination among marginalized populations, both cross-cutting and population-specific—including multiple logistical and economic barriers in access, and systemic mistrust of healthcare systems and government public health—from individual and social/community factors, including trust in personal HCPs/clinics as reliable sources of vaccine information, altruistic motivations, and family influence, to effectively address individual decisional conflict underlying VH as well as broader determinants of undervaccination.

Acceptability of a future HIV vaccine: A rapid scoping review

“…Important message targeting strategies include (1) translating the message into the languages spoken by different populations, (2) addressing questions and concerns about the vaccine prevalent among their members, (3) disseminating the message through "opinion leaders" these populations consider to be knowledgeable and trustworthy, 35,70,73 and (4) having members of the different populations participate in the design and evaluation of different message versions. 12 Fifth, messages should encourage engagement and shared decision making, by inviting people to ask healthcare providers questions about the vaccine and also recommending that they consult close family and friends when making the decision to vaccinate or not. Sixth, messages should counteract the "reactance" caused by prescriptive advice, which some people perceive as a challenge to their freedom to choose.…”

“…As seen with COVID-19 vaccines, vaccine hesitancy is real and pernicious. [10][11][12] Persuasive health communication can be an effective tool in reducing hesitancy, and thereby maximizing HIV vaccine uptake and coverage. A prerequisite for such communication is exploring factors that influence HIV vaccine decision making, with special attention to attitudes and beliefs toward vaccination among potential recipients.…”