Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA.
Division of Health Services Management and Policy, The Ohio State University College of Public Health, 202 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA.
BMC Prim Care. 2024 Jan 12;25(1):24. doi: 10.1186/s12875-023-02251-x.
Compared to the general population, individuals experiencing homelessness are at greater risk of excess morbidity and mortality from COVID-19 but have been vaccinated at lower rates. The U.S. Department of Veterans Affairs (VA)'s Homeless Patient Aligned Care Team (HPACT) program integrates health care and social services for Veterans experiencing homelessness to improve access to and utilization of care.
This study explores the vaccination uptake behavior and attitudes through a qualitative comparative case study of two HPACT clinics, one in California (CA) and one in North Dakota (ND). Semi-structured telephone interviews were conducted with Veterans enrolled in the two VA HPACT clinics from August to December 2021 with 20 Veterans (10 at each clinic).
Four themes emerged from the interviews: (1) Vaccination uptake and timing- While half of the Veterans interviewed were vaccinated, ND Veterans were more likely to be vaccinated and got vaccinated earlier than CA Veterans; (2) Housing- Unsheltered or precariously housed Veterans were less likely to be vaccinated; (3) Health Care- Veterans reporting positive experiences with VA health care and those who trusted health providers were more likely to vaccinate than those with negative or nuanced satisfaction with health care; (4) Refusers' Conspiracy Theories and Objectivity Claims- Veterans refusing the vaccine frequently mentioned belief in conspiracy theories while simultaneously asserting their search for objective information from unbiased sources.
These findings amplify the importance of improving access to population-tailored care for individuals experiencing homelessness by reducing patient loads, expanding housing program enrollment, and increasing the provider workforce to ensure personalized care. Health care providers, and housing providers, social workers, and peers, who offer information without discrediting or criticizing Veterans' beliefs, are also key to effectively delivering vaccine messaging to this population.
与一般人群相比，无家可归者感染 COVID-19 导致发病率和死亡率过高的风险更大，但接种疫苗的比例较低。美国退伍军人事务部（VA）的无家可归患者关怀团队（HPACT）计划整合了无家可归退伍军人的医疗保健和社会服务，以改善他们获得和利用医疗服务的机会。
本研究通过对加利福尼亚州（CA）和北达科他州（ND）的两个 HPACT 诊所的定性比较案例研究，探讨了疫苗接种率和态度。2021 年 8 月至 12 月，对两家 VA HPACT 诊所的退伍军人进行了半结构式电话访谈，每个诊所各有 10 名退伍军人参加。
访谈中出现了四个主题：（1）疫苗接种率和时间——虽然接受采访的退伍军人中有一半已经接种了疫苗，但 ND 的退伍军人比 CA 的退伍军人更有可能接种疫苗，而且接种时间更早；（2）住房——无家可归或住房不稳定的退伍军人接种疫苗的可能性较低；（3）医疗保健——报告对 VA 医疗保健有积极体验的退伍军人，以及那些信任医疗服务提供者的退伍军人，比那些对医疗保健满意度为负面或模棱两可的退伍军人更有可能接种疫苗；（4）拒绝者的阴谋论和客观主张——拒绝接种疫苗的退伍军人经常提到对阴谋论的信仰，同时坚称他们从无偏见的来源寻找客观信息。
这些发现强调了通过减少患者负担、扩大住房项目的参与度以及增加服务人员的数量来改善无家可归者的个性化护理，从而提高无家可归者获得人群定制护理的重要性。医疗保健提供者、住房提供者、社会工作者和同龄人，在向这一人群传递疫苗信息时，提供信息而不诋毁或批评退伍军人的信仰，也是至关重要的。
