Investigating vaccine hesitancy and factors that build vaccine confidence among refugees in Rhode Island, U.S.

The Problem

Vaccine hesitancy was a major concern through the COVID-19 pandemic. Organizations working with immigrants and refugees indicated that vaccine hesitancy was especially concerning within these populations. However, there is little research that investigates immigrant or refugee vaccination rates and vaccine hesitancy. In this study, Keller and colleagues aimed to:

• investigate COVID-19-related knowledge, attitudes, and belief among refugees,

• identify perceived barriers to COVID-19 vaccination,

• examine COVID-19 health literacy, and

• identify factors associated with increased vaccine confidence and decreased vaccine hesitancy.

The Approach

The research team conducted a community-engaged, sequential mixed-methods study, collecting data from refugees and healthcare providers in Rhode Island.

Phase 1 included eight exploratory focus group discussions with 60 refugees from Central America, Africa, and the Middle East and eight interviews with healthcare professionals who treat refugee patients. The focus groups discussed COVID-19 experience and knowledge, vaccine attitudes and beliefs, sources of health information, and ideas for change. Healthcare providers were asked about barriers to care and vaccination, organizational support for refugees, and health literacy challenges.

The Findings

Four themes emerged from the focus groups regarding COVID-19, vaccines, and vaccine hesitancy.

The first theme was that the COVID-19 pandemic was a stressful, difficult, fear-inducing experience in a variety of ways. Sub-themes related to a sense of loss, feelings of fear of the virus and the unknown, and beliefs around the religious significance or symbolism of COVID-19 and the COVID-19 vaccines.

The second theme was feelings of mistrust and/or beliefs of malicious intent surrounding the COVID-19 virus and vaccine. Related sub-themes included beliefs that the virus is not legitimate or is a fake virus and that the virus and vaccine had racist underpinnings. Another sub-theme was viewing the COVID-19 vaccine as a business rather than a tool to protect public health.

The third theme identified is the beliefs that COVID-19 vaccines are unsafe or not completely effective. Sub-themes include concerns about the vaccines’ quick development, fear of negative effects from the vaccine, and the belief that home remedies were just as effective as the vaccine.

The final theme identified included positive attitudes toward the COVID vaccine. Participants expressed their beliefs that the vaccine helped prevent or minimize symptoms, and that it was important to obtain, with some participants even reporting feeling a personal responsibility to get the vaccine.

Preliminary analysis shows that providers generally did not see a lot of vaccine hesitancy from their patients, and found that parents especially chose to vaccinate their children. They also noted that system barriers, including language barriers, impeded the flow of information or reassurance between providers and patients.