Tu Abùs Isbabanal Jia-Chi, Chang Ray-E, O'Neill Liam, Chen Ting-Hung, Lee Po-Han, Ou Tsan-Teng
Namasia District Public Health Center, Department of Health, Kaohsiung City Government, Kaohsiung, Taiwan.
Department of Family Medicine, Saint Paul's Hospital, Taoyuan, Taiwan.
JMIR Public Health Surveill. 2025 Sep 10;11:e75278. doi: 10.2196/75278.
The COVID-19 pandemic has devastated economies and strained health care systems worldwide. Vaccination is crucial for outbreak control, but disparities persist between and within countries. In Taiwan, certain indigenous regions show lower vaccination rates, prompting comprehensive inquiries.
This study aims to identify predictors for COVID-19 vaccination and develop strategies for indigenous communities.
This cross-sectional study, conducted from May 13 to July 18, 2022, surveyed indigenous community members older than 55 years residing in a mountain area in southern Taiwan. Based on the health belief model, the questionnaire covered sociodemographic factors, health-related issues, and trust in physicians. The analysis included bivariate analysis, logistic regression, and mediation analysis.
Most participants (N=203) were aged 55-64 years (102/203, 50.2%), female (129/203, 63.5%), married (104/203, 51.2%), with low education (165/203, 81.3%), and engaged in agriculture (79/203, 38.9%) or were unemployed (104/203, 51.2%). Logistic regression revealed that unvaccinated individuals were significantly more likely to perceive lower COVID-19 threats (P=.03), fewer vaccination benefits (P=.04), higher barriers to vaccination (P=.02), and weaker responses to external cues to action (P<.001), while no significant differences were observed in trust in physicians. Mediation analyses further indicated that trust in physicians influenced vaccine uptake indirectly through perceived barriers. The indirect effect was statistically significant (95% bootstrap CI 0.013 to 0.437), suggesting a full mediation effect.
Effective pandemic prevention strategies for indigenous communities should be grounded in a nuanced understanding of local needs and incorporate bottom-up approaches to avoid cultural saturation and the exacerbation of existing health disparities. Ensuring the accuracy and clarity of vaccine-related information received by indigenous older adults is essential. Local health authorities should consider deploying health care professionals to engage directly with indigenous older adults and their caregivers, delivering culturally appropriate and evidence-based information to address concerns regarding vaccine safety and perceived risks. Such efforts are critical to strengthening vaccine confidence and increasing vaccination uptake in these communities.
新冠疫情对全球经济造成了严重破坏，使医疗保健系统不堪重负。疫苗接种对于疫情控制至关重要，但国家之间和国家内部的差异依然存在。在台湾，某些原住民地区的疫苗接种率较低，这引发了全面调查。
本研究旨在确定新冠疫苗接种的预测因素，并为原住民社区制定策略。
这项横断面研究于2022年5月13日至7月18日进行，调查了居住在台湾南部山区的55岁以上原住民社区成员。基于健康信念模型，问卷涵盖了社会人口学因素、健康相关问题以及对医生的信任。分析包括双变量分析、逻辑回归和中介分析。
大多数参与者（N = 203）年龄在55 - 64岁之间（102/203，50.2%），女性（129/203，63.5%），已婚（104/203，51.2%），教育程度低（165/203，81.3%），从事农业（79/203，38.9%）或失业（104/203，51.2%）。逻辑回归显示，未接种疫苗的个体更有可能认为新冠威胁较低（P = 0.03）、疫苗接种益处较少（P = 0.04）、疫苗接种障碍较高（P = 0.02）以及对外部行动提示的反应较弱（P < 0.001），而在对医生的信任方面未观察到显著差异。中介分析进一步表明对医生的信任通过感知到的障碍间接影响疫苗接种。间接效应具有统计学意义（95%自抽样置信区间为0.013至0.437），表明存在完全中介效应。
针对原住民社区的有效疫情防控策略应基于对当地需求的细致理解，并采用自下而上的方法，以避免文化饱和以及加剧现有的健康差距。确保原住民老年人获得的疫苗相关信息准确清晰至关重要。地方卫生当局应考虑派遣医疗保健专业人员直接与原住民老年人及其照顾者接触，提供符合文化背景且基于证据的信息，以解决对疫苗安全性和感知风险的担忧。这些努力对于增强这些社区的疫苗信心和提高疫苗接种率至关重要。
