Elwy A Rani, Clayman Marla L, LoBrutto Lara, Miano Danielle, Ann Petrakis Beth, Javier Sarah, Erhardt Taryn, Midboe Amanda M, Carbonaro Richard, Jasuja Guneet K, Maguire Elizabeth M, Kyrish Angela, Asch Steven M, Gifford Allen L, McInnes D Keith
Bridge QUERI Program, Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA.
Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI 02912, USA.
Vaccine X. 2021 Dec;9:100116. doi: 10.1016/j.jvacx.2021.100116. Epub 2021 Sep 22.
Although COVID-19 vaccines have been available to many U.S. Veterans Affairs (VA) healthcare system employees and Veteran patients since early 2021, vaccine receipt data indicates some groups are not receiving them. Our objective was to conduct a rapid qualitative assessment of Veterans' and VA employees' views on COVID-19 vaccination to inform clinical leaders' ongoing efforts to increase vaccine uptake across the VA. We employed semi-structured interviews and a focus group involving employees and Veterans as part of a quality improvement project between January and June 2021 at three VA medical centers. Thirty-one employees and 27 Veterans participated in semi-structured interviews; 5 Veterans from a national stakeholder organization participated in a focus group. Data were analyzed using directed content analysis, involving an coding framework comprised of four domains with subcodes under each: contextual influences, barriers and facilitators, vaccine-specific issues, and VA/military experiences. We then classified initial codes into five categories of hesitancy: vaccine deliberation, dissent, distrust, indifference and skepticism. A subset of Veterans (n = 14) and employees (n = 8) identified as vaccine hesitant. Vaccine hesitancy categories were represented by subcodes of religion, culture, gender or socio-economic factors, perceptions of politics and policies, role of healthcare providers, and historical influences; (contextual influences); knowledge or awareness of vaccines, perceived susceptibility to COVID-19, and beliefs and attitudes about health and illness (barriers and facilitators); vaccine development process (vaccine-specific issues) and military experiences (VA/military factors). Facilitators involved talking with trusted others, ease of vaccine access, and perceptions of family and societal benefits of vaccines. Vaccine hesitancy is multi-faceted and likely requires multiple strategies for engaging in conversations to address Veteran and VA employee concerns. Messages should involve patient-centered communication strategies delivered by trusted healthcare providers and peers and should focus on addressing expected benefits for family, friends, and society.
自2021年初以来，许多美国退伍军人事务部（VA）医疗系统的员工和退伍军人患者都可以接种新冠病毒疫苗，但疫苗接种数据显示，一些群体并未接种。我们的目标是对退伍军人和VA员工对新冠病毒疫苗接种的看法进行快速定性评估，以为临床负责人在VA系统内提高疫苗接种率的持续努力提供信息。作为一项质量改进项目的一部分，我们在2021年1月至6月期间，于三个VA医疗中心开展了半结构化访谈和焦点小组讨论，参与者包括员工和退伍军人。31名员工和27名退伍军人参与了半结构化访谈；来自一个全国性利益相关者组织的5名退伍军人参与了焦点小组讨论。使用定向内容分析法对数据进行分析，该方法涉及一个编码框架，由四个领域组成，每个领域下有子代码：背景影响、障碍和促进因素、疫苗特定问题以及VA/军事经历。然后，我们将初始代码分为五类犹豫情况：疫苗考量、异议、不信任、冷漠和怀疑。一部分退伍军人（n = 14）和员工（n = 8）被确定为对疫苗接种犹豫不决。疫苗犹豫类别由宗教、文化、性别或社会经济因素、对政治和政策的看法、医疗保健提供者的作用以及历史影响等子代码代表（背景影响）；对疫苗的了解或认识、对感染新冠病毒易感性的认知以及对健康和疾病的信念和态度（障碍和促进因素）；疫苗研发过程（疫苗特定问题）以及军事经历（VA/军事因素）。促进因素包括与可信赖的他人交谈、疫苗接种的便利性以及对疫苗对家庭和社会益处的认知。疫苗犹豫是多方面的，可能需要多种策略来进行对话，以解决退伍军人和VA员工的担忧。信息应包括由可信赖的医疗保健提供者和同行采用的以患者为中心的沟通策略，并应侧重于说明对家人、朋友和社会的预期益处。
