Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Front Public Health. 2023 Feb 9;11:1046515. doi: 10.3389/fpubh.2023.1046515. eCollection 2023.
Despite the use of interventions (e.g., monetary incentives, educational campaigns, on-site workplace vaccination) to increase COVID-19 vaccination, differences in uptake persist by poverty level, insurance status, geography, race, and ethnicity, suggesting that these interventions may not be adequately addressing the barriers faced by these populations. Among a sample of resource-limited individuals with chronic illnesses, we (1) described the prevalence of different types of barriers to the COVID-19 vaccination and (2) identified associations between patients' sociodemographic characteristics and barriers to vaccination.
We surveyed a national sample of patients with chronic illness and demonstrated healthcare affordability and/or access challenges about barriers to COVID-19 vaccination in July 2021. We categorized participant responses into cost, transportation, informational, and attitudinal barrier domains and assessed the prevalence of each domain, both overall and by self-reported vaccination status. Using logistic regression models, we examined unadjusted and adjusted associations between respondent characteristics (sociodemographic, geographic, and healthcare access) and self-reported barriers to vaccination.
Of 1,342 respondents in the analytic sample, 20% (264/1,342) reported informational barriers and 9% (126/1,342) reported attitudinal barriers to COVID-19 vaccination. Transportation and cost barriers were reported much less commonly, by only 1.1% (15/1,342) and 0.7% (10/1,342) of the sample, respectively. Controlling for all other characteristics, respondents with either a specialist as their usual source of care or no usual source of care had an 8.4 (95% CI: 1.7-15.1) and 18.1 (95% CI: 4.3-32.0) percentage point higher predicted probability, respectively, of reporting informational barriers to care. Compared to females, males had an 8.4% point (95% CI: 5.5-11.4) lower predicted probability of reporting attitudinal barriers. Only attitudinal barriers were associated with COVID-19 vaccine uptake.
Among a sample of adults with chronic illnesses who had received financial assistance and case management services from a national non-profit, informational and attitudinal barriers were more commonly reported than logistical or structural access barriers (i.e., transportation and cost barriers). Interventions should target attitudinal barriers among patients with chronic illness, who may have particular concerns about the interaction of the vaccine with ongoing medical care. Additionally, interventions targeting informational barriers are particularly needed among individuals without a usual source of care.
尽管采取了干预措施（例如，经济激励、教育宣传、现场接种疫苗）来提高 COVID-19 疫苗接种率，但贫困水平、保险状况、地理位置、种族和族裔的接种率仍存在差异，这表明这些干预措施可能无法充分解决这些人群所面临的障碍。在一组患有慢性病的资源有限的个体中，我们 (1) 描述了 COVID-19 疫苗接种的不同类型障碍的流行情况，以及 (2) 确定了患者社会人口特征与疫苗接种障碍之间的关联。
我们调查了患有慢性病的全国性样本，展示了 2021 年 7 月与 COVID-19 疫苗接种相关的医疗保健负担能力和/或可及性挑战。我们将参与者的回答分为成本、交通、信息和态度障碍领域，并评估了每个领域的流行程度，包括总体和自我报告的疫苗接种状况。使用逻辑回归模型，我们检查了受访者特征（社会人口统计学、地理位置和医疗保健可及性）与自我报告的疫苗接种障碍之间的未调整和调整关联。
在分析样本的 1342 名受访者中，20%（264/1342）报告了 COVID-19 疫苗接种的信息障碍，9%（126/1342）报告了态度障碍。交通和成本障碍的报告则要少得多，只有 1.1%（15/1342）和 0.7%（10/1342）的样本报告了这两种障碍。在控制了所有其他特征后，有专科医生作为常规医疗服务提供者或没有常规医疗服务提供者的受访者，报告信息障碍的预测概率分别高出 8.4 个百分点（95%CI：1.7-15.1）和 18.1 个百分点（95%CI：4.3-32.0）。与女性相比，男性报告态度障碍的预测概率低 8.4 个百分点（95%CI：5.5-11.4）。只有态度障碍与 COVID-19 疫苗接种率有关。
在一组接受了国家非营利组织的经济援助和病例管理服务的慢性病成年人中，与物流或结构可及性障碍（即交通和成本障碍）相比，信息和态度障碍报告更为常见。干预措施应针对慢性病患者的态度障碍，因为他们可能对疫苗与正在进行的医疗护理的相互作用特别关注。此外，在没有常规医疗服务提供者的个体中，特别需要针对信息障碍的干预措施。
