COVID-19 Vaccine Hesitancy Research and Findings

To inform communications strategies aimed at increasing COVID-19 vaccination rates in Los Angeles County and in L.A. Care Health Plan’s membership

Goal

Increase COVID-19 vaccination across L.A. County and help L.A. Care Health Plan meet and exceed target vaccination rates set by regulating agencies for high-risk and underserved member groups, while promoting health equity in vaccine access, comprehension, and administration.

Outcomes

Findings from this research informed the organization-wide strategy for the roll-out of the COVID-19 vaccine, including FAQs for the health plan’s call center, website content, member portal content, call hold recordings, social media content, influencer partnerships, grant-funding allocations, on-site programming at Community Resource Centers, and sponsorship and gift-giving priorities and awards. The health plan exceeded regulatorily-mandated increases in vaccination rates and secured over $16,000,000 in financial incentives from regulating agencies.

Strategy

The member survey prompted participants on the following key areas of interest to our health plan, regarding COVID-19 vaccination:

  • Demotivators

  • Information sources

  • Intent to vaccinate

  • Vaccination locations

  • Trusted subject-matter experts

  • How long they planned to wait to vaccinate

As a result of these areas of inquiry and the variety of salient demographic groupings of survey participants, I conducted 46 separate analyzes of the data to make as informed as possible recommendations to company leadership for organization-wide COVID-19 vaccination strategy.

Survey Administration

  • Online survey made available with access to telephonic assistance for completion

  • 115 participants completed the survey

  • Responses were structured in a 1 to 5 Likert scale

    • 1= Strongly disagree

    • 5= Strongly agree

  • Opportunity for open-ended feedback at the end of survey

Key Research Findings

Top Concerns

  • “I want to wait and see how the vaccine affects others first”

  • “The vaccine will hurt my arm”

  • “The speed at which the vaccine was created means it’s not clear or safe”

Top Information Sources

  • Doctors

  • Public health agencies

  • L.A. Care website

  • L.A. Care social media

Trusted Subject-Matter Experts

  • Least likely to agree with:

    • “I will take the vaccine if government agencies or government representatives recommend it”

  • Most likely to agree with:

    • “I will take the vaccine if my health plan recommends it”

      • More than “if my doctor recommends it”

Vaccination Location

  • Most preferred vaccination location:

    • “My doctor’s office”

  • Second most preferred location:

    • “At an L.A. Care Community Resource Center”

  • Mentioned by participants as open-ended feedback:

    • At religious centers

    • At a school

    • Outside of or in a store

    • In their neighborhood

Planned Wait Time to Vaccinate

  • Almost 50% of all respondents plan to get vaccinated as soon as the vaccine is available to them.

  • About 15% of respondents plan on waiting over a year.

  • About 15% of respondents plan on never getting the vaccine.

Demographic-Specific Findings

  • Participants aged 55+ showed the highest intent to vaccinate immediately out of all age groups.

  • Non-English-speaking Asian participants were more likely than English-speaking to never want to be vaccinated.

  • Black participants were more likely than any other ethnic group included in the survey to want to wait and see how the vaccine affects others first and to be concerned the vaccine would be full of toxic heavy metals.

  • Black participants generally had lower trust overall in prompted-on information sources.

  • Black participants had the lowest intent to get vaccinated out of all ethnic groups included in the survey.

  • English-speaking Latinx participants had significantly lower trust in subject-matter experts than did Spanish-speaking Latinx participants.

  • English-speaking Latinx participants were more likely to want to wait at least 3 months to over a year to be vaccinated, whereas Spanish-speaking participants were much more likely to want to be vaccinated immediately.

  • White participants were more likely to rely on elected representatives than any other ethnic group included in the survey for information on the vaccine, and least likely to rely on friends and family.

  • White participants were the only group that indicated higher trust in government agencies/representatives as subject-matter experts, than in their doctor.

  • Female participants showed higher trust than male participants in prompted-on subject-matter experts.

Open-Ended Participant Feedback

  • Comments indicating intent to vaccinate were motivated by feelings of trust and/or altruism.

  • Comments indicating hesitation to vaccinate were motivated by confusion with available information perceived as inconsistent, unclear, and/or insufficient.

  • Comments indicating refusal to vaccinate were motivated by wanting to wait and see how side effects will play out for several months to a year, and/or believing the vaccine is ineffective and/or unsafe.

  • Comments offering advice on the vaccine’s rollout called on the health plan to focus on transparency by sharing information on vaccine contents and potential adverse side effects, to monitor vaccine distribution to ensure those who need it most can get it, to share easy-to-understand current information, to ensure vaccines are administered by professional medical staff, and to use real people in their communities to promote vaccination.

  • Participants also used the open-ended feedback section to submit questions, as follows:

    • What is the vaccine made of?

    • What are the pros and cons of getting the vaccine?

    • What are the vaccine’s side effects?

    • What are the long-term side effects of the vaccine?

    • What vaccine brand does L.A. Care recommend?

    • What vaccine brand is most effective?

    • How does the vaccine affect you if you have other health problems, like high blood pressure or diabetes?

    • If I have a severe adverse reaction to the vaccine, who will cover my medical care expenses?

    • When will it be our turn to get the vaccine?

    • Will children also get the COVID-19 vaccine?

    • When will people with disabilities be able to get the COVID-19 vaccine?

    • How will the vaccine affect my DNA?

    • Is it true that a company is producing a vaccine that is not effective?

    • If I’ve already had COVID-19, should I get the vaccine?

    • What type of allergic reactions can people get after taking the vaccine?

Recommendations

Bridging the Trust Gap in the Black Community

  • Acknowledge history of racially-motivated mistreatment and unethical health care research studies when discussing vaccine hesitancy.

  • Feature black health experts, community members, and influencers in vaccine-related content.

  • Explore partnership with grassroots organization(s) to host Tele Town Halls to help bridge the digital divide.

  • Partner with the health plan’s Community Advisory Council members to serve as vaccine ambassadors in their communities.

  • Sponsorship and grant funding for vaccination events and education initiatives at community health centers.

General Outreach

  • Address top concerns and dispel vaccine myths through a variety of channels.

  • Advocate for equity in vaccine access.

  • Emphasize that medical experts and scientists have fully vetted the vaccine.

  • Host vaccination events at the health plan’s Community Resource Centers.

  • Partner with public health agencies to inform the public about the vaccine.

  • Promote vaccination for an extended period to ensure that those who are following the “wait and see” approach get vaccinated.

  • Promote the L.A. Care website and L.A. Care social media channels as key sources of truth.

  • Train our health plan-contracted providers to address vaccine hesitancy.

  • Partner with community members from L.A. Care’s Community Advisory Councils who have been vaccinated to promote vaccination (flier distribution, selfie campaign).

  • Communicate with transparency by sharing vaccine side effects and ingredients.

  • Appeal to people’s altruism.

  • Make sure that we are providing the same information consistently, across all threshold languages.

  • Use terminology that is clear and easy to understand.

  • Brainstorm responses to concerns about long-term effects.

  • Update FAQs according to questions submitted via the survey.

  • Reassure individuals that vaccines are administered by qualified professionals even if not administered by their doctor.

Findings from this research informed the communications strategies below, including information content, imagery, and campaign partners: