ABSTRACT
COVID-19 vaccines mitigate severe disease, yet uptake remains low among people experiencing homelessness (PEH) despite the risk of transmission in congregate settings like homeless shelters. This study evaluated retrospective COVID-19 vaccination intent and decision-making between March 2020-October 2021 to identify modifiable factors to improve vaccine acceptance among PEH. We conducted 31 semi-structured interviews and eight focus group discussions across six homeless shelters in Seattle-King County, Washington. Residents and staff aged >= 18 years were recruited through purposive sampling for interviews and convenience sampling for focus groups. Thematic analysis was conducted. Participants reported that too much contradictory and changing information about COVID-19 vaccines led to confusion. Information deemed trustworthy contributed to individual's knowledge and in some cases changed their vaccination intent. While many intended to get vaccinated without external motivators, others were motivated by incentives and requirements. Despite intention to vaccinate, participants reported barriers to COVID-19 vaccine access including availability of vaccine doses, timely eligibility for vaccination, and availability of appointments. Participants presented recommendations to improve COVID-19 information content and dissemination, access, and use of incentives in shelter settings. Future research should test recommended vaccination strategies rooted in the voices and experiences of PEH to determine feasibility and effectiveness in shelter settings.
ABSTRACT
Background. COVID-19 vaccines are important to mitigate severe disease in congregate settings, yet uptake remains lower among people experiencing homelessness (PEH) than in the general population. This study aimed to explain changes in COVID-19 vaccination intent over time and identify modifiable factors to improve vaccine acceptance among PEH. Methods. We utilized the Health Belief Model and 3Cs Model of Vaccine Hesitancy to develop a conceptual framework to explore factors that may influence COVID-19 vaccination intent among PEH. Between July 27 - October 15, 2021, we conducted semi-structured interviews (SSIs) and focus group discussions (FGDs) across six homeless shelters in Seattle-King County, Washington. Residents and staff aged 18 years and older were recruited through purposive sampling for SSIs and convenience sampling for FGDs. We captured retrospective information about perceptions of and intent to receive COVID-19 vaccines between March 2020 - August 2021. Thematic analysis was conducted using Dedoose. Results. We conducted 31 SSIs (25 residents and six staff) and eight FGDs with 43 residents. Participants reported that too much contradictory and changing information about COVID-19 vaccines led to confusion. Information deemed trustworthy (i.e., objective, honest, professional, and recommended by others) contributed to individual's knowledge and in some cases changed their vaccination intent. Despite intention to vaccinate, participants reported barriers to COVID-19 vaccine access including availability, eligibility, appointments, and timeliness. While many intended to get vaccinated on their own, others were motivated by incentives and requirements. Participants presented recommendations to improve COVID-19 information content and dissemination, access, and incentives in shelter settings (Table 1). Table 1. Recommendations for Interventions to Increase COVID-19 Vaccine Uptake in Shelter Settings Conclusion. COVID-19 vaccination strategies that are rooted in the voices and experiences of PEH are presented and can inform improved vaccine implementation among key stakeholders. Future research should test recommended strategies to determine feasibility and effectiveness in shelter settings.