A Qualitative Study of Home Health Aides’ Perspectives towards COVID-19 Vaccination

Abstract

Home health aides provide care to homebound older adults and those with chronic conditions. Aides were less likely to receive COVID-19 vaccines when they became available. We examined aides’ perspectives towards COVID-19 vaccination. Qualitative interviews were conducted with 56 home health aides at a large not-for-profit home care agency in New York City. Results suggested that aides’ vaccination decisions were shaped by (1) information sources, beliefs, their health, and experiences providing care during COVID-19; (2) perceived susceptibility and severity of COVID-19; (3) perceived benefits of vaccination including protection from COVID-19, respect from colleagues and patients, and fulfillment of work-related requirements; (4) perceived barriers to vaccination including concerns about safety, efficacy, and side effects; and (5) cues to action including access to vaccination sites/appointments, vaccination mandates, question and answer sessions from trusted sources, and testimonials. Providing tailored information with support to address vaccination barriers could lead to improved vaccine uptake.

Assessing COVID-19 Vaccine Hesitancy and Trust in Home Health Workers in New York City: A Pilot Study

“…9,34 Recognizing this cultural context could potentially play a role in how financial incentives are viewed, which is supported by prior research. 9 In addition to financial incentives, prior research on vaccine hesitancy in HHAs also found workers expressed skepticism toward vaccine mandates. 9 Given that the HHW workforce is largely women of color, monetary incentives and mandates may paradoxically raise red flags and decrease trust in this population.…”

“…While some HHWs voiced appreciation of the $100 incentive offered by NYC, hesitant workers in our study group overall felt skepticism toward a government-funded incentive. It is important to note the historical context of unethical experimentation and exploitation in the United States of people who identify as Black, indigenous, and people of color, such as with the Tuskegee Study, as well as personal encounters with the health care system, which may contribute to mistrust in the medical system 9,34 . Recognizing this cultural context could potentially play a role in how financial incentives are viewed, which is supported by prior research 9 .…”

“…9 In addition to financial incentives, prior research on vaccine hesitancy in HHAs also found workers expressed skepticism toward vaccine mandates. 9 Given that the HHW workforce is largely women of color, monetary incentives and mandates may paradoxically raise red flags and decrease trust in this population. Therefore, they may not be the best strategies to improve confidence in vaccine safety and efficacy in this specific portion of the healthcare workforce.…”

“…This also correlates with prior research examining COVID-19 vaccine hesitancy in HHAs, which found that aides preferred delivery of tailored information by trusted sources. 9 Finally, future interventions could consider the use of vaccine ambassadors within a home health agency or union to help set a culture around vaccination acceptance. Workers who experienced a "lifechanging event" such as contracting a severe COVID-19 infection or knowing someone who experienced a negative health outcome from COVID-19 had a greater perceived risk of the virus and were more likely to be vaccinated.…”

“…58 Despite the unique risks that HHWs, particularly HHAs, encountered during the COVID-19 pandemic, their vaccination rates largely lagged behind those of other healthcare workers, especially early in vaccine rollout. 9 According to a Kaiser Family Foundation survey, only 34% of HHWs reported being vaccinated for COVID-19 in March 2021, compared with 80% of hospital health workers. 10 Given the considerable risks of COVID-19 to HHWs, it is important that we learn more about the reasons behind vaccine hesitancy.…”