Strategies and resources used by public health units to encourage COVID-19 vaccination among priority groups: a behavioural science-informed review of three urban centres in Canada

Abstract

Background: Ensuring widespread COVID-19 vaccine uptake is a public health priority in Canada and globally, particularly within communities that exhibit lower uptake rates and are at a higher risk of infection. Public health units (PHUs) have leveraged many resources to promote the uptake of recommended COVID-19 vaccine doses. Understanding barriers and enablers to vaccine uptake, and which strategies/resources have been used to address them to date, may help identify areas where further support could be provided. We sought to identify the strategies/resources used by PHUs to promote the uptake of the first and third doses of the COVID-19 vaccine among priority groups in their jurisdictions. We examined the alignment of these existing strategies/resources with behavioral science principles, to inform potential complementary strategies/resources. Methods: We reviewed the online and in-person strategies/resources used by three PHUs in Ontario, Canada to promote COVID-19 vaccine uptake among priority groups (Black and Eastern European populations, and/or neighbourhoods with low vaccine uptake or socioeconomic status). Strategies/resources were identified from PHU websites, social media, and member-checking. We used the Behaviour Change Techniques (BCT) Taxonomy – which describes 93 different ways of supporting behaviour change – to categorise the types of strategies/resources used, and the Theoretical Domains Framework – which synthesises 14 factors that can be barriers or enablers to decisions and actions – to categorise the barriers and enablers addressed by each strategy/resource. Results: PHUs operationalised 21 out of 93 BCTs, ranging from 15–20 BCTs per PHU. The most frequently operationalised BCTs were found in PHU strategies/resources that provided information about COVID-19 infection and vaccines, increased access to COVID-19 vaccination, and integrated social supports such as community ambassadors and engagement sessions with healthcare professionals. Identified BCTs aligned most frequently with addressing barriers and enablers related to Knowledge, Environmental context and resources, and Beliefs about consequences domains. Conclusion: PHUs have used several BCTs to address different barriers and enablers to COVID-19 vaccine uptake for priority groups. Opportunities should be pursued to broaden the scope of BCTs used in strategies/resources and barriers/enablers addressed in general and for prioritised populations to support ongoing and future efforts supporting uptake of COVID-19 vaccine doses.

One size doesn’t fit all: methodological reflections in conducting community-based behavioural science research to tailor COVID-19 vaccination initiatives for public health priority populations

“…In parallel, we conducted a detailed environmental scan to identify how the three PHUs promoted COVID-19 vaccination amongst key populations, classify existing strategies/resources used by these PHUs and identify the barriers and enablers to vaccination that these strategies are designed to address. This behavioural science-informed scan is reported in a separate paper [58].…”