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Report to Washington State Department of Health

Latinx Perceptions and Attitudes Regarding COVID-19 Vaccines and Vaccines in General

A qualitative study of 25 telephone interviews with Latinx adults across Washington state, conducted by the Latino Center for Health, University of Washington.

Published
January 17, 2024
Commissioned By
WA State Dept. of Health
Principal Investigator
Dr. Gino Aisenberg
Study Type
Qualitative — 25 Interviews
Data Collection
Nov. 15 – Dec. 20, 2023
Introduction

About This Report

The Latino Center for Health, an interdisciplinary research center at the University of Washington, conducted and completed a qualitative study of 25 telephone interviews with Latinx individuals across Washington state to ascertain their perceptions and attitudes regarding COVID-19 vaccines. One interview question also asked about their perspectives regarding vaccines in general. This body of work, including this report, was commissioned by the Washington State Department of Health (DOH). Data collection took place from the period of Nov. 15 – Dec. 20, 2023. The sample consisted of Latinx adults ranging in ages from 25 to 54 years old. They lived in diverse regions of the state in Western, Central and Eastern Washington, including rural communities. Fifteen women and 10 men participated, nearly all of whom spoke Spanish.

This report reveals important findings pertaining to Latinx attitudes towards COVID-19 vaccines and their motivations in seeking vaccination. While these findings are not generalizable, they provide critical insights that can help inform the DOH's planned media campaign to the diverse Latinx community in Washington state.

Though the crest of the pandemic has subsided, the need for COVID-19 vaccinations persists, due to the on-going emergence of new variants, relaxed standards of masking, and the elevated health risks that remain. Leading experts posit additional contributing factors, namely, not enough people are accessing treatments or getting vaccinated as well as waning immunity in the overall U.S population.1 Currently, nearly 1500 individuals in the country die per week due to COVID-19.2 This number represents significant mortality signaling the importance of vigilance in taking steps for protection and safety.

Research has identified that Washington state's Latinx communities were disproportionately impacted by the COVID-19 pandemic with Latinx individuals experiencing higher infection, hospitalization and death rates compared with Whites.4

As of January 8, 2024, COVID booster rates among Latinos in WA are the lowest among racial/ethnic groups, with only 5.5% having received the most recent booster, compared to 18.1% of non-Hispanic Whites.5 Recent research conducted by the Latino Center for Health indicates that vaccine hesitancy among Latinos is fueled by persistent concerns regarding vaccine efficacy, safety, and cost.6

This corpus of national and state research provides clear rationale for conducting this survey study of Latinx adults in Washington state.

COVID-19 Vaccination Context in WA

5.5%of WA Latinos had received the most recent COVID booster as of January 8, 2024 — the lowest rate among all racial/ethnic groups in the state
18.1%of non-Hispanic white Washingtonians had received the most recent booster in the same period
25Latinx adults interviewed, ages 25–54, across urban and rural WA communities
Study at a Glance

Key Study Parameters

25 telephone interviews with Latinx adults, November–December 2023.

25
Latinx adults interviewed across WA state
22
Interviews conducted in Spanish
15F 10M
Gender breakdown of participants
25–54
Age range of all participants

Methodology

How the Study Was Conducted

The study's method was to conduct 25 individual interviews in either English or Spanish language by an undergraduate research assistant whose first language is Spanish. The interviews took 20–30 minutes to complete in the language preferred by the respondent.

Prior to commencement of data collection, study researchers obtained approval from the University of Washington's Institutional Review Board Human Subject Division. The application contained recruitment material, consent information, and the survey questions. These were all approved by IRB and the study was deemed low risk of harm to participants. Representatives from the WA State Department of Health and its collaborating partner, C+C, also reviewed the survey questions and provided input and suggested edits to the interview guide before it was finalized. The research assistant translated the interview guide into Spanish and this was reviewed by team members of the Latino Center for Health.

Recruitment efforts consisted of e-mailing community partners, Latino Center for Health Board Members, and select stakeholders with information about the project and a flyer for distribution that contained a phone number to call if interested in learning more about the qualitative study. The flyer was available in English and Spanish languages.

Interviews were conducted over the phone and recorded for transcription purposes. Participants were asked for verbal consent to continue with the recorded interview before any questions were asked. Interviews were later transcribed, and original recordings were deleted. Three of the interviews were conducted in English, while the other twenty-two were conducted in Spanish. Participants were compensated for their time in the form of a $40 gift card sent either electronically or by mail.

Thematic analysis of transcribed responses was then conducted by the Principal Investigator. Major themes were identified and reported. Potential differences based on gender, language and residence in an urban or rural community were examined for each question and reported if significant differences were found. Additionally, two questions — questions four and seven — were quantitative in nature and frequencies of responses were reported.

Interviews
25 individual telephone interviews
Duration
20–30 minutes each
Languages
22 in Spanish, 3 in English
Period
November 15 – December 20, 2023
Analysis
Thematic analysis by PI; quantitative frequencies for Q4 and Q7
Recruitment
LCH community partners, Board Members, and select stakeholders
Compensation
$40 gift card per participant
IRB Approval
UW IRB Human Subject Division — deemed low risk

Results

Key Findings by Interview Question

Q1

What is your opinion about the use and effectiveness of COVID-19 vaccines?

Show findings

Q2

Have you ever received any COVID-19 vaccine? Top reasons for your decision.

Show findings

Q3

What is your primary source of information for staying updated with news overall?

Show findings

Q4

What sources of information do you seek out or use when it comes to staying informed about COVID-19?

Show findings

Q5

What are beliefs and conceptions/perceptions towards COVID-19 vaccines that you have found or heard about in your community?

Show findings

Q6

What message or information would make you more inclined or motivated to get a vaccination?

Show findings

Q7

How strongly do you agree or disagree with statements about vaccines in general?

Show findings

Conclusion

Summary of Findings

This study provides valuable insights into the perspectives of Latinx adults and the sources of information they access to inform them about COVID-19 and vaccines in general. The main themes identified in this study serve as important guideposts to inform the planned media campaign of the Department of Health.

Throughout the pandemic, many Latinx individuals struggled with divergent communication and misinformation regarding the COVID-19 disease and vaccination options and their side effects. Concerns persisted about the effectiveness and side effects of the vaccinations. Similar concerns and fears remain and impact the Latinx community today.

The need to continue to communicate clear and trusted information in English and Spanish. Study findings point to the importance of identifying trustworthy sources of information and then strategically prioritizing them. For example, though promotoras are effective and instrumental in helping Latinx individuals navigate health care systems, respondents did not highly rank them as sources of information regarding COVID-19 and its vaccinations. In addition, findings from this study emphasize the importance of addressing the family and not just the individual. This is congruent with the cultural value of familismo within the collectivist culture of the diverse Latinx community. Thus, images of family members getting vaccinated and smiling with the knowledge that they are protecting themselves from serious consequences of COVID-19 and promoting health for themselves and their community should be well-utilized in media efforts to the Latinx community.

Based on this study's findings, investing in education about vaccines, what do they do and how do they work is a clear approach that should be undertaken by the Department of Health. Providing clear information that vaccines do help to prevent complications from COVID-19, but do not prevent contracting COVID-19 is also important. In addition, as previously noted, the themes of safety and protection of family should be central messages.

Summarizing here, the main themes identified by participants include:

Theme 01

Protection of Family

Most participants stated that their primary motivation for getting vaccinated was the protection of their families.

Theme 02

Fear of Vaccine Side Effects

A significant number of participants expressed that in their communities, the predominant fear was the potential side effects of vaccines. Some participants refrained from getting the COVID vaccine due to these fears, believing that vaccines could make them more susceptible to other illnesses.

Theme 03

Trust in Vaccines Derived from Others' Experiences

Many participants mentioned that early in the pandemic, their motivation to get vaccinated stemmed from observing others in their community who had received the vaccine without issues. Conversely, some participants cited distrust in the vaccine based on adverse reactions or side effects experienced by someone in their community or family.

Theme 04

Reassurance for Family Safety

Most participants expressed the need for reassurance regarding the safety of vaccines, particularly for their family members, especially children and older adults.

Interviewer Notes

Observations & Recommendations from the Research Assistant

Below are two observations and recommendations of the interviewer who had direct contact with the participants through administration of the study's interview guide.

The study guide questions were mostly clear and well-understood. The majority of participants had no difficulty understanding the questions. Only rarely did they seek additional prompts or explanations.
Regarding the test messages, in some instances these messages may not have been well understood by some respondents. Some questioned if they were ranking based on whether they think the statement is factually correct versus whether the message's power to motivate them to obtain vaccines.

Recommendations

Future testing of messages should consider a refined approach that would eliminate any semblance of ambiguity and ensure the capture of reliable information. Developing statements that are theory-informed would bring enhanced clarity.
Allocating more time for the recruitment process is advised to help ensure an even more diverse sample, including more male participants and individuals from rural communities.

References

Citations

1. Kekatos, M. (Jan. 10, 2024). Why are 1500 Americans still dying from COVID every week. ABC News. Accessed January 13, 2024.

2. Kekatos, M. (Jan. 10, 2024). Why are 1500 Americans still dying from COVID every week. ABC News. Accessed January 13, 2024.

3. Latino Center for Health, University of Washington (2021). Vaccination Rates Among Washington State's Latinos Are Improving, But Challenges Remain. https://latinocenterforhealth.org/wordpress_latcntr/wp-content/uploads/2021/10/DRAFTv2_VaccinationRatesOctober2021.pdf

4. Influenza vaccination data. (n.d.). Washington State Department of Health. https://doh.wa.gov/data-statistical-reports/health-behaviors/immunization/influenza-vaccination-data. Accessed January 17, 2024.

5. Morales, L. (2024). Long COVID Among Latinos in Washington State. Unpublished manuscript. Latino Center for Health, University of Washington.

Acknowledgements

Study Team

Dr. Gino Aisenberg, Co-Director of the Latino Center for Health, was Principal Investigator of this study. In the writing of this report, Andrea Cabrera, Research Project Coordinator of the Latino Center for Health, and Luisana Valero, Student Assistant with the Latino Center for Health, also made significant contributions and are co-authors of this report.

Suggested Citation: Aisenberg, G., Cabrera, A., & Valero, L. (2024). Latinx Perceptions and Attitudes Regarding COVID-19 Vaccines and Vaccines in General: Report to Washington State Department of Health. Latino Center for Health, University of Washington.

Appendix

LCH DOH Qualitative Interview Script — COVID-19 and Test Messages

Thank you so much for taking the time to talk with me today. My name is Luisana, and I am a Research Assistant for the Latino Center for Health at the University of Washington. The Center is working with the WA State Department of Health to understand the perspectives and attitudes of Latinos towards vaccines and to inform the media campaign messaging of the Department of Health. There are no right or wrong answers.

Your responses to this interview are confidential and will not be shared with anyone outside the research team. This interview is completely voluntary. You may choose not to answer any questions you prefer not to answer. The interview will take approximately 30 minutes and we will send you a $40 gift card after completing the interview as a thank you for your participation and compensation for your time. The focus of these interview questions is on COVID-19 vaccines.

What you say to us is important, so we'd like to take notes. To make sure our notes correctly represent what you say, we would also like to take a sound recording. The recording is confidential and will not be shared with anyone outside of the Latino Center for Health. We will destroy the recording in January 2024. If you have no objections, we'll proceed with the questions.

Thank you for being willing to share your experience. We hope that we can take what you share to the WA Department of Health to help us understand better the needs and desires of your community.

Before we start with the main portion of the interview, I would like to ask if you could answer a few short-ended questions about yourself. You may decline to answer any of these.

What is your preferred language?

1. What is your opinion on the use and effectiveness of COVID-19 vaccines?

I know this can be a sensitive topic, but we welcome and respect all types of perspectives. Please share your honest thoughts and feelings about the use of COVID-19 vaccines and their effectiveness.

2. Have you ever received any COVID vaccine? Yes / No

If yes:

2.1 Can you name the top 2 reasons that influenced you in that decision?

Note: these are f/u prompts: Perhaps the desire to protect your family, friends, community, personal health protection, fear of hospitalization, easy to get vaccine, trust that it is safe, because it was a mandate, all possible options are welcome.

2.2 Have you received or are you considering getting the most current 2023–24 updated COVID-19 vaccine? Why or why not?

2.3 What does it mean to you to be "up to date" on your COVID-19 vaccine?

If no:

Can you name the top 2 reasons that influenced you in that decision?

Note: these are f/u prompts: For example, it could be that you don't believe vaccines are safe, fear of side effects, you don't have confidence in their effectiveness, don't think that the risk of getting COVID-19 is that high, concern that the vaccine affects your fertility, concern that vaccines cause autism, or the difficulty to get the vaccine due to your work schedule, or lack of transportation to get to appointment for vaccination. Feel free to be honest, all possible reasons are welcome and accepted.

3. What is your primary source of information for staying updated with news overall?

Options: TV, radio, Facebook, Twitter, Instagram, WhatsApp group chats, text messages, telegram, newspaper, or other.

3.1 Is there a specific TV show, or social media account that you listen to or read more frequently?

4. What sources of information do you seek out or use when it comes to staying informed about COVID-19? Please answer yes or no to each of the following prompts.

CDC guidelines ___Yes ___No

What the local health department said ___Yes ___No

What you heard on TV news ___Yes ___No

What a leader of your community said ___Yes ___No

What the priest or pastor said ___Yes ___No

What the school said ___Yes ___No

What a flyer said at a health fair ___Yes ___No

What your doctor said ___Yes ___No

What a promotora de salud said ___Yes ___No

What you heard on the radio ___Yes ___No

What you learned from social media ___Yes ___No

What a neighbor told you ___Yes ___No

Of these trusted sources of information you indicated, what are the top 3 messengers you actually trust for COVID-19 related information? e.g. information from the radio, doctors, church leaders, community leaders, promotoras de salud, schools?

5. What are beliefs and conceptions/perceptions towards COVID-19 vaccines that you have found or heard about in your community?

F/U prompts if needed: For example, they prevent hospitalizations, they make people sick, they cost too much, COVID-19 vaccines are good for my family and community.

6. What message or information would make you more inclined or motivated to get a vaccination?

F/U prompt: For example, if you saw a picture of a family receiving the vaccine or heard a radio announcement explaining how COVID-19 vaccines are safe for children, that vaccines are available free of cost, are available at a time that is convenient for you, would that or anything similar motivate you to get vaccinated?

7. Now, I am going to ask you about how much you agree or disagree with a series of statements about vaccines in general, not just COVID-19 vaccines. For each statement, there are five options: strongly disagree, disagree, agree, strongly agree, or 'I'm not sure.'

Do you have any questions?

How strongly do you agree or disagree with the following statement? (strongly disagree, disagree, agree, strongly agree, I'm not sure)

Statement 1:

There are ways to access vaccines convenient for my work and family schedule, including mobile, school, and community-based vaccine clinics and pharmacies that are open seven days a week or in the evenings.

___Strongly Disagree   ___Disagree   ___Agree   ___Strongly Agree   ___I'm not sure

Statement 2:

Most vaccines (including COVID and Flu) are available to children and adults in Washington at no- or low cost. There are easy-to-access programs to cover the cost, regardless of insurance status.

___Strongly Disagree   ___Disagree   ___Agree   ___Strongly Agree   ___I'm not sure

Statement 3:

Natural immunity isn't enough to protect individuals and communities from serious diseases, so we need a boost from vaccine immunity to help keep everyone safe.

___Strongly Disagree   ___Disagree   ___Agree   ___Strongly Agree   ___I'm not sure

Statement 4:

By getting routine and seasonal vaccines, I'm giving myself extra protection but maybe more importantly, I'm helping protect everyone in my family.

___Strongly Disagree   ___Disagree   ___Agree   ___Strongly Agree   ___I'm not sure

That concludes the questions we have for you today. Thank you for your participation!

Do you have any additional questions or thoughts you would like to share with us? We sincerely appreciate your participation and the insights you have provided; your time and commitment are highly valued by our team.