Addressing Barriers to COVID-19 Vaccination Among Older U.S. Veterans

Abstract

Efforts are being made to ensure that COVID-19 vaccination among older adults is as complete as possible. Dialogue-based interventions tailored to patients’ specific concerns have shown potential for effectiveness in promoting vaccination. We implemented a quality improvement project intended to help patients in an outpatient geriatrics clinic overcome barriers to COVID-19 vaccination. We offered tailored conversations by telephone in which we discussed the barriers to vaccination that the patients were facing and offered to provide relevant information and/or logistical assistance. Of the 184 patients reached by phone, 125 (68%) endorsed having already been vaccinated and 59 (32%) did not. About one third of the unvaccinated patients were willing to participate in tailored conversations (20 patients = 34% of the unvaccinated). In follow-up calls 30 days after the intervention we found that four of these 20 patients had received COVID-19 vaccination, one patient was scheduled for vaccination, 10 continued to be deciding about vaccination, four had decided against it and one could not be reached. Dialogue-based interventions that are conducted by telephone and are tailored to the specific barriers to vaccination being faced by older adults may have some effectiveness in encouraging vaccination against COVID-19. The effectiveness of such interventions may be decreased in populations that already have high vaccination rates and in which many patients have already formed strong opinions regarding vaccination against COVID-19. Completion of Plan-Do-Study-Act cycles is a feasible way to design, implement and work to optimize quality improvement efforts related to COVID-19 vaccination.

Vaccine hesitancy and the willingness to recommend the COVID-19 vaccine to children in a rural country on the United States-Mexico border

“…The strong association between adult vaccination status and vaccine hesitancy is consistent with previous studies that found the vaccination status of parents as the greatest predictor of willingness to vaccinate their children ( 18 , 19 , 38 , 62 – 65 ). Multi-component and dialog-based interventions, targeted to increase knowledge and awareness, were found to be most effective in improving vaccination intentions ( 66 , 67 ); focusing on vaccination intentions is consistent with the TPB, as intention is the immediate antecedent to the behavior of getting a vaccine ( 27 ). These public health communication strategies tailored to emphasize the health risks and public health consequences of not vaccinating against COVID-19 improved vaccination intentions among adults ( 66 , 67 ).…”

“…Multi-component and dialog-based interventions, targeted to increase knowledge and awareness, were found to be most effective in improving vaccination intentions ( 66 , 67 ); focusing on vaccination intentions is consistent with the TPB, as intention is the immediate antecedent to the behavior of getting a vaccine ( 27 ). These public health communication strategies tailored to emphasize the health risks and public health consequences of not vaccinating against COVID-19 improved vaccination intentions among adults ( 66 , 67 ). Our findings reaffirm the importance of a multi-sectoral approach to vaccination campaigns and public health messaging with stakeholder collaboration that stresses the importance of vaccine safety and efficacy, debunking myths, illustrating adverse health effects of COVID-19 infection in children to change perceptions of COVID-19 vaccination to improve vaccination intention ( 68 – 70 ).…”

Use of Information and Communication Technology Strategies to Increase Vaccination Coverage in Older Adults: A Systematic Review

“…The majority of the studies (n = 15) were conducted in the United States [ 19 , 32 , 35 , 36 , 37 , 38 , 39 , 41 , 43 , 45 , 46 , 47 , 48 , 49 , 50 ], three around Europe (Spain [ 42 ], the UK [ 34 ], France/Monaco [ 44 ]), two in the Middle East (Lebanon [ 33 ] and Turkey [ 31 ]), one in Canada [ 40 ], and one in Australia [ 18 ].…”

“…In terms of the study designs, most interventions (n = 15) were Randomized Controlled Trials (RCT) [ 18 , 19 , 34 , 35 , 37 , 38 , 39 , 41 , 43 , 44 , 45 , 46 , 48 , 49 ], while the others either had a quasi-experimental design [ 31 , 36 , 42 ] or were before-and-after trials [ 32 , 40 , 47 , 50 ].…”

“…Of the 22 included studies, 11 promoted the influenza vaccine [ 18 , 34 , 35 , 36 , 39 , 40 , 42 , 43 , 45 , 46 , 50 ], four promoted both the influenza and the pneumococcus vaccines [ 37 , 38 , 44 , 48 ], three the pneumococcus vaccine [ 31 , 33 , 41 ], one the COVID-19 vaccine [ 32 ], two the herpes zoster vaccine [ 19 , 47 ] and one both the pneumococcal and the herpes zoster vaccines [ 49 ].…”