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2023 HSR&D/QUERI National Conference Abstract

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4093 — Understanding Veteran Motivations and Hesitancies for COVID-19 Vaccination by Clusters Derived from COVID-19 Thoughts and Beliefs

Lead/Presenter: Alexis Barrett,  COIN - Pittsburgh/Philadelphia
All Authors: Barrett AK (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, VA Center for Medication Safety), Beyer NM (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System) Hruska KL (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System) Rodriguez KL (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System) Lovelace EZ (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System) Hoffman BL (University of Pittsburgh School of Public Health) Wolynn R (University of Pittsburgh School of Public Health) Sidani JE (University of Pittsburgh School of Public Health) Pellathy T (Highmark Health; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System) Burkitt KH (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System) Mor MK (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System; University of Pittsburgh School of Public Health) Switzer G (Division of General Internal Medicine, University of Pittsburgh School of Medicine) Sonel AF (VA Pittsburgh Healthcare System) Fine MJ (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System; Division of General Internal Medicine, University of Pittsburgh School of Medicine)

Objectives:
Understanding the typologies or clusters of Veterans based on COVID-19 (C-19) related thoughts and feelings and understanding individual motivations/hesitancies for C-19 vaccination across such clusters could inform interventions promoting Vaccine uptake, but such knowledge does not exist. We aimed to qualitatively assess individual motivations and hesitancies to receive C-19 vaccination within empirically defined clusters of Veterans independently associated with receipt of C-19 vaccination.

Methods:
In this partnered quality-improvement (QI) project conducted with senior clinical leaders at the VA Pittsburgh Healthcare System (VAPHS), we invited Veterans engaged in primary care to complete a 60-item questionnaire reflecting World Health Organization domains (e.g., thoughts and feelings, social factors) associated with C-19 vaccine uptake. We used k-means cluster analysis to determine Veteran typologies, using 6 questionnaire items on thoughts and feelings about C-19 infection risk and severity, vaccine effectiveness and safety. Identified clusters guided purposive sampling of semi-structured Veteran telephone interviews (03/2022-05/2022) to qualitatively assess motivations and hesitancies for C-19 vaccination. We performed rapid thematic analyses by cluster membership and participant-reported C-19 vaccination status from audio-recorded, transcribed open-ended interviews.

Results:
Among 1,182 questionnaire respondents, we contacted 208 of 293 that assented to participate and completed 49 semi-structured interviews for 29 (59.2%) participants in a Guarded Yet Optimistic (GYO) cluster, 18 (36.7%) in a Skeptical And Indifferent (SAI) cluster, and 2 (4.1%) in a Carefree And Confident cluster. In the GYO cluster, 27 (93.1%) participants reported prior C-19 vaccination, with personal C-19 protection (n = 25) and C-19 protection for others (n = 7) as common motivational themes. Hesitation-related themes for the 27 vaccinated GYO participants included concerns about vaccine side effects (n = 11) and lack of vaccine information (n = 11). In the SAI cluster, only 8 (44.4%) participants reported prior C-19 vaccination, with vaccine mandates (n = 3) and requirements for employment (n = 4) and/or travel (n = 3) as common motivational themes. The SAI vaccinated and unvaccinated participants expressed similar concerns regarding lack of vaccine information (n = 7 vaccinated vs. n = 8 unvaccinated), limited vaccine efficacy (n = 3 vs. n = 5), and excessive side effects (n = 3 vs. n = 4). Of the 25 previously vaccinated participants in GYO who were eligible for a C-19 booster vaccine, 24 (96.0%) received one, with a desire for continued C-19 protection, recommendations from a trusted source, and emerging variant strains as motivational themes; 23 (92.0%) also favored receiving yearly C-19 vaccines, if recommended. Of the 7 booster eligible SAI participants, 6 (85.7%) chose not to receive one, with decisions motivated by finding it unnecessary, concerning side effects, and wanting more information; none favored receiving yearly C-19 vaccines, if recommended.

Implications:
Identifiable themes regarding uptake of C-19 vaccination and vaccine boosters vary by empirically defined cluster group membership. Targeted interventions to reinforce motivations and counteract hesitancies represent an evidence-based strategy to augment uptake of C-19 vaccination among identifiable Veteran subgroups defined by cluster membership.

Impacts:
These results will be shared with clinical and operational stakeholders from VAPHS and VISN4 to develop evidence-based interventions to counteract vaccine hesitancy and to identify the Veteran subgroups most appropriate for such interventions.