The Republic of the Marshall Islands is a sovereign nation previously under the administrative control of the United States. Since 1986, the Compact of Free Association (COFA) between the Republic of the Marshall Islands and the United States allows Republic of the Marshall Islands citizens to freely enter, lawfully reside, and work in the United States and provides the United States exclusive military control of the region. When the COFA was signed, COFA migrants were eligible for Medicaid and other safety net programs. However, these migrants were excluded from these benefits as a consequence of the Personal Responsibility and Work Opportunity Reconciliation Act. Currently, COFA migrants have limited access to health care benefits in the United States, which perpetuates health inequalities.

Vaccination is a critical means for mitigating the worst effects of the COVID-19 pandemic in the United States (US). However, the initial high demand for COVID-19 vaccines has not persisted, and the rate of vaccination slowed significantly in the summer of 2021. This study seeks to understand the motivations to receive the COVID-19 vaccine among hesitant adopters. Hesitant adopters are individuals who express some level of hesitancy about the vaccine but have also received at least one dose of the vaccine. Using a qualitative descriptive design, three loci for motivation emerged during analysis: extrinsic motivators, intrinsic motivators, and structural motivators. Extrinsic motivations, such as protecting one’s community, family, and friends, were reported as driving vaccination behavior. Among intrinsic motivators, the desire to protect themselves from COVID-19 was the most frequently reported. Structural motivators were also identified, indicating that vaccine mandates also serve to motivate hesitant adopters of the COVID-19 vaccine. These findings have important implications in ongoing efforts to increase COVID-19 vaccine uptake in the US and highlight the multi-dimensional motivations for vaccination among hesitant adopters. Additionally, we provide recommendations for practice based on our findings.