Identifying barriers to vaccination intention at walk-in vaccination facilities in deprived neighbourhoods: A cross-sectional survey.

OBJECTIVES: Low COVID-19 vaccination adherence in deprived neighbourhoods is problematic since the prevalence of chronic diseases associated with mortality rates due to COVID-19 is higher in these populations. The aim of this study is to provide an insight about beliefs and considerations relating to vaccination intention among inhabitants of deprived neighbourhoods in the Netherlands. DESIGN: Cross-sectional survey. SETTING: Easily accessible vaccination facilities at markets in deprived neighbourhoods in the Netherlands. PARTICIPANTS: Participants were recruited at three vaccination facilities that were set up at markets in deprived neighbourhoods in Rotterdam. A total of 124 surveys were retained for analysis. MAIN OUTCOME MEASURE: Intention to get vaccinated against COVID-19. RESULTS: The survey was filled out by 124 respondents; 62 % had - prior to visiting the easily accessible locations - intended to get a COVID-19 vaccine and 38 % were hesitant (22.3 % had doubts and 15.7 % did not plan to get vaccinated). Many people mentioned the convenience of an easily accessible location nearby. At the bivariate level, the influence of information from the family was associated with vaccination intention (p < 0.01). In a logistic regression model, both fear of vaccination and fear of side-effects were significantly associated with vaccination intention (ORs 0.56 (CI 0.35-0.89) and 0.47 (CI 0.30-0.73)). CONCLUSION: The accessibility of a vaccination facility, family influence and fear are relevant factors for the intention to get vaccinated against COVID-19 in people living in deprived neighbourhoods. Interventions should address these factors in order to increase vaccination uptake.

The role of socio-demographic and health factors during COVID-19 in remote access to GP care in low-income neighbourhoods: a cross-sectional survey of GP patients.

OBJECTIVES: Remote consultations were common in general practice during the COVID-19 pandemic. This approach may have affected access to GP care for people with low socio-economic status: this group has a high prevalence of chronic conditions and a higher mortality rate due to COVID-19. This study explores the association of sociodemographic and health factors with the decision to contact a GP practice, and care utilisation, among patients in low-income neighbourhoods in the Netherlands. DESIGN: Cross-sectional survey study. SETTING: General practice in low-income neighbourhoods in the Netherlands. PARTICIPANTS: Patients from low-income neighbourhoods were selected from fourteen general practices on the basis of ethnic background, chronic disease or health literacy. Participants were stratified according to categories of these background characteristics to obtain equal numbers per category. A total of 213 surveys were retained for analysis. MAIN OUTCOME MEASURES: Need for GP contact, decision to contact a GP practice, and GP service utilisation. RESULTS: Forty-five percent (N = 88) of the participants experienced health problems for which they wished to consult their GP at the start of the outbreak of COVID-19. A majority of them (81%) had contact with a GP service. The need to contact the GP was significantly associated with financial difficulties (OR 2.20 CI (1.10 to 4.39)). An interaction effect was found of health literacy with concerns about COVID-19 with in respondents with low health literacy a significant association between concerns about COVID-19 and a need for a GP appointment (OR 5.33 CI (2.09 to 13.59)) and absence of a significant association in the higher health literacy group (OR 1.14 CI (0.51 to 2.56)) . Moreover, 56% (N = 74) of the participants received remote care at least one time during the first wave of COVID-19. Female participants used remote care more often (OR 3.22 CI (1.57 to 6.59)) and participants aged 50 and over used remote care less often (OR 0.46 CI (0.21 to 0.97)). CONCLUSION: Many patients in low-income neighbourhoods were able to consult a GP, often remotely. However from the equity perspective, access to GP care should be safeguarded for patients with health problems, financial difficulties and low health literacy because of their greater need to consult a GP during times of crisis.

Interest in participation in a peer-led senior health education program.

A study was made of the characteristics of older adults showing an interest in participating in a health education course given by peers. Determining the degree of interest in health education is important for assessing the impact on the target-population and evaluating the dissemination strategy. In the course 'Successful Aging' groups of older adults came together to discuss health related issues. The course was given by senior health educators aged 55 years and over from the peer group. To determine interest in the course answer cards were sent with a letter of invitation to all independently living inhabitants aged between 55 an 79 in a Dutch community. The rate of expressed interest in the course was 5.8%. Interest was highest among females in the 55-64 age group, the unmarried and those with low wellbeing. Males in the age group 65-79, females aged 75-79, those with a lower socio-economic status and the inactive were comparatively less interested. Subscription to the course was distinguished from mere interest in the course. From those who expressed interest, more people of low socio-economic status, with a reduced level of wellbeing, many physical limitations and poor self-efficacy actually subscribed. It is concluded that the health education program will be continued and that special attention will be paid to groups that showed lower levels of uptake. Involving intermediates from these groups in the course development is recommended.

Effects of a peer-led senior health education program.

The effect of a health education course guided by peers aged 55 and over was evaluated. The aim of the course was to empower older adults to participate in society and to promote their wellbeing. Evaluation included determining the effect on attitude toward aging, self-efficacy, perception of the societal opinion regarding the place of the elderly in society (social influence), social participation, perceived social support, and wellbeing of the participants aged 55 to 79 years. A quasi-experimental approach was used. The effect on the experimental group of course participants was studied compared to a control group of older adults on the waiting list. The respondents filled out postal questionnaires at three time points (before starting the course (t0), immediately after termination (t1) and three months later (t2)). Using a multivariate analysis procedure, a significant interaction effect between time of measurement and group membership was found with respect to the outcome of social influence. At t1 an effect was absent, but at t2, the current idea that elderly occupy a marginal position in society, found less favour with the experimental group than the control group. Moreover perceived social support and subjective health improved significantly at t1 and t2 among the course members, when compared to the control group. No effect was found on attitude, self-efficacy, social participation and wellbeing in the short time span of a three months follow-up.

[Psychosocial problems in the elderly in Rotterdam and point of departure for prevention]. / Psychosociale problemen van ouderen in Rotterdam en aanknopingspunten voor preventie.

The aim of this study is to examine the prevalence of psycho-social problems among the elderly in order to plan prevention-programs. A questionnaire was sent in 1990 to a sample of 1989 inhabitants of the city of Rotterdam aged 65-79 years living on their own, drawn at random from the municipal registrar's office (response 58%). The results show that one third of the respondents experiences psycho-social problems. Groups at risk are: women, men who live alone, those with a low socio-economic status, people who live on their own but receive limited support from institutions. These socio-demographic variables explain only 5% of the variance in psycho-social well-being. Risk-indicators for psycho-social problems are problems in the performance of activities of daily living (ADL) and household-activities (HHA) as well as decreased social support. The relationship between satisfaction with living environment and psycho-social problems is affected by these risk-indicators. Elderly experiencing only psycho-social problems and those experiencing only ADL/HHA-problems visited their general practitioner during the last three months just frequently. Elderly experiencing both psycho-social and ADL/HHA-problems most frequently visited their GP. More elderly in Rotterdam compared to elderly in some other Dutch cities and to normscores seem to have psycho-social problems.