Influence of health beliefs on COVID-19 vaccination among patients with cancer and other comorbidities in Puerto Rico

ABSTRACT

Background: Ethnic minority populations are more likely to suffer from chronic comorbidities, making them more susceptible to the poor health outcomes associated with COVID-19 infection. Ensuring COVID-19 vaccination among vulnerable populations, such as cancer patients, is of utmost importance. Thus, we aimed to investigate health behaviors and perceptions related to COVID-19 vaccination among adults with cancer and other chronic comorbidities in Puerto Rico (PR). Methods: This secondary analysis used data from 1,911 participants who completed an online survey from December 2020 to February 2021. The Health Belief Model (HBM) was used to measure perceptions surrounding COVID-19 vaccination among individuals diagnosed with cancer, adults with other chronic comorbidities, and healthy adults. Multivariate logistic regression analyses assessed the associations of disease status (healthy, cancer diagnosis, other chronic conditions/comorbidities [excluding cancer]) with individual HBM constructs and vaccine intent, while adjusting for age, sex, education, income, employment status, influenza vaccine, health literacy, and religiosity. Results: Among study participants, 76% were female, 34% greater than or equal to 50 years old, 5% had a cancer diagnosis, and 70% had other chronic conditions/comorbidities. Participants with a cancer diagnosis had significantly higher odds of getting vaccinated when the vaccine was made available to them compared to healthy individuals (OR 2.08 95%CI 1.00-4.30). Compared to healthy participants, those diagnosed with cancer and those with other chronic conditions other than cancer had higher odds of perceiving their chance of getting COVID-19 as high (OR 1.63 95%CI 1.01-1.62;OR 1.39 95%CI 1.11-1.73), believed getting COVID-19 was a possibility for them (OR 1.94 95%CI 1.16-3.25;OR 1.56 95%CI 1.24-1.97), perceived they would get very sick if infected with COVID-19 (OR 4.18 95%CI 2.30-7.58;OR 1.83 95%CI 1.47-2.28), and were afraid of COVID-19 (OR 2.51 95%CI 1.18-5.35;OR 1.67 95%CI 1.25-2.22). Individuals with other chronic comorbidities also had increased odds of perceiving that COVID-19 side effects would interfere with their usual activities (OR 1.32 95%CI 1.06-1.64), worrying about their likelihood of getting COVID-19 (OR 1.63 95%CI 1.09- 2.44), and taking the vaccine regardless of the information provided (OR 1.42 95%CI 1.14-1.77). COVID-19 vaccine safety was the main reason for vaccine hesitancy among all participants. Discussion: Understanding vaccine hesitancy and willingness is essential in creating effective vaccine promotion programs and informing health policy. Our findings elucidate the effect of disease status on health-related decision making and isolate what steps can be taken to increase vaccine uptake among vulnerable ethnic minority populations. Acknowledgements This work was supported by Award Grant R25CA240120 and RCMI grant U54-MD007600.