COVID-19 Vaccine Booster Hesitancy among Hispanic Adults: A Cross-Sectional Study from the Puerto Rico Community Engagement Alliance against COVID-19 Disparities (PR-CEAL)

Abstract

Hispanic/Latino communities have suffered a disproportionate burden of the COVID-19 pandemic. Although Puerto Rico has one of the highest COVID-19 primary series vaccination rates nationwide, this estimate contrasts with the reported booster doses’ low uptake. This study aimed to assess health belief correlates of COVID-19 vaccine booster uptake. Using a convenience sampling approach, the Puerto Rico-Community Engagement Alliance (PR-CEAL) conducted a cross-sectional study where 787 participants were recruited using online and in-person strategies between December 2021 and February 2022. Participants were adults 18 years or older, Spanish-speaking, and residents of Puerto Rico. The Health Belief Model was used to evaluate attitudes and beliefs. A total of 784 participants were used in this analysis. Adjusted Poisson regression models were used to estimate prevalence ratios (PR) and 95% confidence intervals (CI) of booster refusal. Overall, 22% of participants refused the vaccine booster or had not gotten it yet. Adjusted models showed that (i) participants who disagreed that getting the booster dose either made them feel less worried about COVID-19 or (ii) felt that the vaccine decreased their chances of getting COVID-19 presented higher booster-refusal prevalence ratios (PR = 4.20, 95% CI: 3.00, 5.90; PR = 3.70, 95% CI: 2.64, 5.18). Moreover, participants that (iii) reported having concerns for booster side effects [PR = 2.47; 95% CI = 1.73, 3.51], (iv) booster efficacy [PR = 2.50; 95% CI = 1.75, 3.58], and (v) booster safety [PR = 2.80; 95% CI = 1.96, 3.99] were significantly more likely to refuse the booster. In conclusion, booster vaccination refusal was associated with lower perceived vaccine benefits and greater barriers among adults in Puerto Rico. These results informed the development of PR-CEAL’s targeted community outreach strategies and public health campaigns to increase booster vaccine uptake.

The Puerto Rico community engagement alliance (PR-CEAL) against COVID-19 disparities: outreach and research engagement efforts in disproportionately affected communities

“…The project also aimed to understand perceived barriers and enablers of vaccination, testing behaviors, and various modules related to health behaviors and their impact on mental health outcomes during the pandemic. Adopting a cross-sectional design, the study recruited 784 participants in Puerto Rico through online and in-person channels between December 2021 and January 2022 ( 9 ).…”

“…An analysis of the HBM constructs revealed that 83% of these constructs exhibited significant associations with booster refusal. Notably, participants who disagreed with the notion that receiving the booster dose made them feel less worried about COVID-19 or believed that the vaccine decreased their chances of contracting COVID-19 demonstrated higher prevalence ratios for booster refusal ( 9 ). Participants who expressed concerns about booster side effects, efficacy, and safety were significantly more likely to refuse the booster.…”

“…Puerto Rico CEAL (PR-CEAL) emerged as part of the second cohort of consortiums awarded ( 6 , 7 ). This nationwide initiative aimed to raise awareness, foster educational research, and address outreach and engagement in communities disproportionately affected by the pandemic ( 7 – 9 ).…”