Abstract
Background
The coronavirus disease 2019 (COVID-19) vaccination campaign highlighted the requirement to better understand the needs of different populations. French-speaking minorities (FSMs) have greater difficulty accessing quality care in French, and this problem was exacerbated during the COVID-19 pandemic.
Objective
The aim of this survey was to develop a descriptive portrait of the health needs of FSMs in relation to the COVID-19 vaccination campaign by describing their vaccination status, attitudes and beliefs compared with English-speaking majorities.
Methods
A survey was conducted among eligible participants using convenience sampling. Data measurement includes a descriptive statistical comparison using analysis of the variance, univariate logistic regressions and a two-proportions z-test.
Results
Of the 1,505 respondents (554 FSMs vs. 951 English speakers), the FSMs have an average age of 51.4 years and 89.2% are Canadian citizens. Vaccination of children was preponderant among English speakers (74.2% vs. 86.3%), including against COVID-19 (58.6% vs. 73.9%). A higher proportion of FSMs had gotten vaccinated in order to obtain a vaccine passport (39% vs. 29.3%). Among the unvaccinated, FSMs were more likely to question the efficacy of vaccines (60% vs. 36.4%). Canadian citizen FSMs with higher education could be divided in relation to the vaccine regimen.
Conclusion
This survey revealed differences between FSMs and the English-speaking majority in their perceptions of vaccine efficacy, particularly vaccination of children, and a polarization of attitudes/beliefs among FSMs according to certain sociodemographic factors.
Keywords: vaccines, vaccine hesitancy, Francophone minorities, community survey
Introduction
The coronavirus disease 2019 (COVID-19) vaccination campaign highlighted the requirement to better understand the needs of different Canadian populations during a pandemic. The lack of data on the needs of linguistic minorities ((1–3)) had a significant impact on vaccine uptake and trust in healthcare institutions ((4,5)).
French-speaking minorities (FSMs) have greater difficulty accessing quality care in French ((6–12)), which is one of the problems exacerbated during a pandemic ((8,12,13)). However, vaccine uptake is influenced by multiple factors linked to the sociocultural context, including values, morality, accessibility and therapeutic experience, requiring adapted medical practices ((14–17)). This study is necessary to fill the knowledge gap on the subject and improve the active offer.
Given the fragmented nature of Canadian Francophonie ((18)), it is difficult to establish an overall picture of the needs of FSMs based on up-to-date evidence. An existing survey ((19)) explores some relevant areas, but does not provide a breakdown by language, at least not in publicly available data. This survey, carried out between May 1 and June 30, 2022, aims to describe the health needs of FSMs in relation to the COVID-19 vaccination campaign through the lens of vaccination status, attitudes and beliefs, and provides for a comparison with English-speaking majorities.
Methods
This article was written according to the guidelines of Improving the Quality of Web Surveys: The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) ((20)).
Population, time and place
The survey was conducted over an eight-week period ending on June 30, 2022, among FSMs and English speakers outside Québec, Canada. The study defines FSMs as residents outside Québec whose preferred language is French, and Anglophones as residents outside Québec whose preferred language is English. Given the rapid evolution of the pandemic, convenience sampling was used.
Link to the research objective
The descriptive portrait of FSMs vis-à-vis the COVID-19 vaccination campaign includes the collection of sociodemographic data, vaccination status, attitudes and beliefs.
Development of the survey questionnaire
The questionnaire (Supplemental material, Survey) was designed by the research team based on a validated survey ((19)) by Statistics Canada. To meet the requirements of the study, questions dealing with language, attitudes and beliefs were added before conducting a pilot study with 30 participants drawn from the mailing list of Léger Marketing Inc.
Sampling technique
Participants were recruited primarily via the sampling strategy, the mailing list of Léger Marketing Inc. and Canadian Francophone organizations (Supplemental material, Survey invitation letter). The sample was created taking into account the response rates for each age category and the quotas required to obtain a representative sample. Representative quotas were established for age, gender and province. The sample was sent out strategically to ensure representativeness. For example, attention was focused on the 18 to 24 age group, as these respondents are generally harder to reach, while less attention was paid to the 65+ age group, as they are conversely much easier to reach. This required constant attention to the quotas defined in the survey platform, while ensuring random selection. An invitation letter, a consent form and the questionnaire were distributed to those who met the inclusion criteria.
Informed consent
The study was approved by the University of Ottawa Research Ethics Board (H-02-22-7648). A consent form had to be completed by participants prior to conducting the survey.
Optimizing response rates
The survey was made available on FocusVision Decipher (Forsta, 2022) and on the LEO mobile app (Léger Marketing Inc., 2020), in addition to being widely distributed via the social networks of the University of Ottawa Faculty of Medicine’s Francophone Affairs. Participants were invited to share the survey, allowing snowball sampling to be used to optimize the response rate.
Measurement
Data measurement was carried out in accordance with two research questions designed to identify 1) the vaccination status, attitudes and beliefs of FSMs compared with English speakers, and 2) the sociodemographic characteristics of FSMs in relation to vaccination status, attitudes and beliefs.
Sociodemographic data includes: province/territory of residence, age, gender, income, education, marital status, ethnicity, citizenship and health status. Vaccination status includes COVID-19 vaccine doses, willingness to follow the recommended vaccine regimen, and vaccination of children (ages 5 to 11 years). Attitudes include reasons for uptake and hesitancy, as well as trusted sources of information. Beliefs include vaccine safety, perceived risks and efficacy, health practices and social responsibility.
Analysis
Descriptive statistics were calculated and analyzed using SPSS (version 22.0). Continuous variables were presented as means and standard deviations, and categorical variables as totals and/or percentages. Analyses of variance (ANOVA) were performed to examine significant differences in continuous variables. Univariate logistic regressions were performed to determine the associations between FSMs and English speakers, and also sociodemographic variables with vaccination status and belief. The findings are presented as odds ratios (OR) with 95% confidence intervals (CI), as well as the likelihood chi-squared statistic. A two-proportions z-test was performed for multiple-response questions to compare proportions between groups; the Bonferroni correction was used for multiple comparisons. A p-value of less than 0.05 indicates a statistically significant difference.
Findings
The sample comprised 1,505 participants: 554 FSMs and 951 English speakers. The findings include a 100% response rate for each participant, giving n=554 (FSMs) and n=951 (English speakers). The sociodemographic data are presented below (Table 1).
Table 1. Sociodemographic characteristics of French-speaking minority participants and English-speaking participants.
| Characteristics | % FSM (n=554) |
% English speakers (n=951) |
|---|---|---|
| Age (years) | ||
| Mean; standard deviation | 51.4; 16.9 | 48.1; 17.4 |
| Median | 53.0 | 47.0 |
| 18–24 | 4.7 | 11.1 |
| 25–34 | 17.0 | 15.3 |
| 35–44 | 14.6 | 17.0 |
| 45–54 | 17.5 | 20.1 |
| 55–64 | 20.9 | 17.5 |
| 65–74 | 17.5 | 9.3 |
| ≥75 | 7.8 | 9.6 |
| Gender | ||
| Female | 61.2 | 50.2 |
| Male | 38.8 | 49.8 |
| Other | 0.0 | 0.0 |
| Prefer not to answer | 0.0 | 0.0 |
| Province | ||
| Ontario | 47.1 | 50.4 |
| New Brunswick | 33.4 | 2.4 |
| British Columbia | 6.5 | 17.8 |
| Alberta | 6.5 | 14.2 |
| Manitoba | 2.7 | 4.9 |
| Saskatchewan | 1.4 | 4.1 |
| Nova Scotia | 1.4 | 3.7 |
| Nunavut | 0.4 | 0.0 |
| Newfoundland and Labrador | 0.2 | 2.1 |
| Prince Edward Island | 0.2 | 0.4 |
| Yukon | 0.2 | 0.0 |
| Income | ||
| ≤$30,000 | 12.4 | 13.2 |
| $30,000 to $60,000 | 23.4 | 23.6 |
| $60,000 to $90,000 | 20.7 | 22.0 |
| $90,000 to $120,000 | 17.4 | 17.9 |
| $120,000 to $150,000 | 11.3 | 9.8 |
| >$150,000 | 14.8 | 13.5 |
| Education | ||
| Less than a high school diploma or equivalent | 3.1 | 1.2 |
| High school diploma or certificate of equivalence | 15.6 | 18.2 |
| Trade certificate or diploma | 5.6 | 6.9 |
| College, CEGEP or other non-university certificate or diploma | 20.0 | 22.4 |
| University certificate or diploma below bachelor level | 5.1 | 6.8 |
| Bachelor’s degree | 30.0 | 30.5 |
| University certificate, diploma or degree above bachelor level | 20.5 | 14.0 |
| Marital status | ||
| Single | 23.4 | 24.1 |
| Couple | 49.5 | 34.9 |
| Family | 27.2 | 40.9 |
| Indigenous status | ||
| North American First Nation | 1.3 | 2.1 |
| Métis | 2.5 | 2.0 |
| Inuk (Inuit) | 0.0 | 0.3 |
| Ethnicity | ||
| Arab | 0.9 | 1.4 |
| Southeast Asian | 1.6 | 0.5 |
| West Asian | 0.7 | 0.2 |
| Caucasian | 70.8 | 91.5 |
| Chinese | 8.8 | 1.3 |
| Korean | 0.6 | 0.0 |
| Japanese | 0.5 | 0.0 |
| Latin American | 1.5 | 0.5 |
| African American | 1.8 | 2.5 |
| Filipino | 1.3 | 0.0 |
| South Asian | 6.6 | 0.5 |
| Other | 4.7 | 1.6 |
| Citizenship status | ||
| Canadian citizen by birth | 89.2 | 77.2 |
| Canadian citizen by naturalization | 7.6 | 18.6 |
| Permanent resident | 2.5 | 2.7 |
| None | 0.7 | 1.5 |
| State of health | ||
| Obesity | 9.4 | 9.2 |
| Heart and/or vessel disease | 4.7 | 4.7 |
| Diabetes | 10.1 | 6.3 |
| Liver disease | 0.7 | 0.4 |
| Chronic kidney disease | 0.0 | 0.7 |
| Alzheimer’s disease | 0.2 | 0.0 |
| Immunodeficiency | 3.3 | 3.3 |
| Lung disease | 7.2 | 6.7 |
| None of these health problems | 64.3 | 68.7 |
Abbreviation: FSM, French-speaking minority
Vaccination status
Differences between French-speaking minorities and English speakers
According to the univariate regression values, FSMs were less willing to have their children vaccinated against preventable diseases (74.2% vs. 86.3%) (χ2[1, N=440]=7.069, p=0.008; OR=0.455 [95% CI: 0.259–0.799]), against COVID-19 (58.6% vs. 73.9%) (χ2[1, N=436]=7.531, p=0.006; OR=0.500 [95% CI: 0.306–0.815]) or to follow the recommended vaccine regimen (0.0% vs. 22.0%) (χ2[3, N=126]=16.879, p=0.001) (Table 2).
Table 2. Vaccination status among French-speaking minorities and English speakers.
| Vaccination status | % FSM (n=554) |
% English speakers (n=951) |
Likelihood chi-squared | Approx. sig. (bilateral)a | OR | 95% CI | |
|---|---|---|---|---|---|---|---|
| Adult vaccinated against COVID-19 | |||||||
| Yes | 93.60 | 91.80 | 1.763 | 0.184 | 0.756 | 0.500 | 1.144 |
| No | 6.40 | 8.20 | N/A | N/A | N/A | ||
| COVID-19 vaccination doses | |||||||
| 1 dose | 0.80 | 1.30 | 5.758 | 0.124 | 0.472 | 0.144 | 1.549 |
| 2 doses | 19.50 | 23.50 | 0.640 | 0.429 | 0.953 | ||
| 3 doses | 66.70 | 65.20 | 0.790 | 0.559 | 1.116 | ||
| 4 doses | 13.00 | 10.10 | N/A | N/A | N/A | ||
| Plausibility of following the recommended full vaccine regimen (vaccinated adult) | |||||||
| Very likely | 62.20 | 62.60 | 2.463 | 0.482 | 0.881 | 0.559 | 1.390 |
| Somewhat likely | 20.10 | 22.50 | 0.792 | 0.483 | 1.300 | ||
| Unlikely | 11.10 | 9.10 | 1.082 | 0.623 | 1.879 | ||
| Very unlikely | 6.60 | 5.90 | N/A | N/A | N/A | ||
| Plausibility of following the recommended full vaccine regimen (unvaccinated adult) | |||||||
| Very likely | 2.90 | 6.40 | 4.523 | 0.210 | 0.354 | 0.039 | 3.194 |
| Somewhat likely | 5.70 | 17.90 | 0.253 | 0.053 | 1.200 | ||
| Unlikely | 17.10 | 16.70 | 0.817 | 0.277 | 2.405 | ||
| Very unlikely | 74.30 | 59.00 | N/A | N/A | N/A | ||
| Previous vaccination for children (against other diseases) | |||||||
| Yes | 74.20 | 86.30 | 7.069 | 0.008 | 0.455 | 0.259 | 0.799 |
| No | 25.80 | 13.70 | N/A | N/A | N/A | ||
| Children vaccinated against COVID-19 | |||||||
| Yes | 58.60 | 73.90 | 7.531 | 0.006 | 0.500 | 0.306 | 0.815 |
| No | 41.40 | 26.10 | N/A | N/A | N/A | ||
| COVID-19 vaccination doses | |||||||
| 1 dose | 29.20 | 17.20 | 3.382 | 0.184 | 2.064 | 0.784 | 5.433 |
| 2 doses | 54.20 | 62.60 | 1.053 | 0.446 | 2.486 | ||
| 3 doses | 16.70 | 20.30 | N/A | N/A | N/A | ||
| Plausibility of following the recommended full vaccine regimen (children) | |||||||
| Very likely | 0.0 | 22.0 | 16.879 | 0.001 | 6.84E-10 | 6.84E-10 | 6.84E-10 |
| Somewhat likely | 28.6 | 34.10 | 0.473 | 0.180 | 1.247 | ||
| Unlikely | 28.6 | 19.8 | 0.815 | 0.296 | 2.246 | ||
| Very unlikely | 42.9 | 24.2 | N/A | N/A | N/A | ||
Abbreviations: CI, confidence interval; COVID-19, coronavirus disease 2019; FSM, French-speaking minority; N/A, not applicable; OR, odds ratio
a Approx. sig. (bilateral) is a p-value of less than 0.05 for univariate analyses is considered significant
Differences according to sociodemographic data
Compared with those born outside the country, Canadian-born FSMs are more inclined to not follow the recommended vaccine regimen (85.2% vs. 37.5%) (χ2[3, N=35]=10.714, p=0.013; OR=7.667 [95% CI: 1.035–56.770]), but have more doses (67.7% and 13.6% vs. 56.9% and 7.8%) (χ2[3, N=513]=9.848, p=0.020; OR=15.750 [95% CI: 1.736–142.882]). Among those, individuals with a college/certificate education are less inclined to agree with the vaccine regimen compared with those with a higher education (52.7% vs. 75.7%) (χ2[9, N=509]=22.968, p=0.006; OR=0.313 [95% CI: 0.109–0.903]). More FSMs are vaccinated in Ontario (96.2% vs. 86.2% [West] and 93.8% [Atlantic]) (χ2[2, N=547]=10.317, p=0.017; OR=4.012 [95% CI: 1.695–9.497]) receive more doses compared with other regions (20% vs. 8.6% [West] and 5.6% [Atlantic]) (χ2[6, N=511]=43.713, p<0.001). Men (18.9% vs. 9.3%, women) (χ2[3, N=514]=14.229, p=0.003; OR=2.044 [95% CI: 1.203–3.471]) and older individuals (52.2 ± 16.1 and 68.8 ± 11.2 years vs. 40.8 ± 18.3 and 40.9 ± 12.2 years; F(3, 510)=46.58, p<0.001) more often had 3–4 doses. Among FSMs with vaccinated children, a high income was preponderant (87% [>$120,000] vs. 56.8% [$60,000 to $120,000] vs. 34.6% [<$60,000]) (χ2[2, N=86]=14.963, p=0.001; OR=12.593 [95% CI: 2.931–54.107]).
Attitudes
Differences between French-speaking minorities and English speakers
There are two significant differences: a greater proportion of FSMs had gotten vaccinated to obtain the vaccine passport (39% vs. 29.3%, p<0.001); among the unvaccinated, more FSMs questioned the efficacy of the COVID-19 vaccine (60.0% vs. 36.4%, p=0.019) (Table 3).
Table 3. Vaccination attitudes between French-speaking minorities and English speakers.
| Vaccination attitudes | FSMs | English speakers | Statistical z-testa | p-value | ||
|---|---|---|---|---|---|---|
| n | % | n | % | |||
| Reasons for vaccination (vaccinated adult)b | ||||||
| Vaccination is mandated by my workplace | 112 | 21.7% | 163 | 18.8% | −1.34 | 0.1811 |
| Vaccination passport | 201 | 39.0% | 254 | 29.3% | −3.72 | 0.0002 |
| I want to protect myself against serious illness | 395 | 76.7% | 686 | 79.0% | −1.02 | 0.3099 |
| Return to normal life | 275 | 53.4% | 433 | 49.9% | −1.26 | 0.2064 |
| I want to protect others | 329 | 63.9% | 574 | 66.1% | −0.85 | 0.3964 |
| Leisure | 179 | 34.8% | 288 | 33.2% | −0.60 | 0.5487 |
| Other | 14 | 2.7% | 22 | 2.5% | −0.21 | 0.8355 |
| Reasons for vaccine hesitancy (unvaccinated adult)c | ||||||
| The vaccine is not recommended for me | 5 | 14.3% | 7 | 9.1% | −0.83 | 0.4088 |
| I do not have the necessary information to make a decision | 4 | 11.4% | 8 | 10.4% | −0.17 | 0.8688 |
| I know too many people who have had side effects | 12 | 34.3% | 32 | 41.6% | −0.73 | 0.4642 |
| I’m afraid | 5 | 14.3% | 9 | 11.7% | −0.39 | 0.6994 |
| I am not at a great risk of contracting COVID-19 | 9 | 25.7% | 17 | 22.1% | −0.42 | 0.6720 |
| If I get COVID-19, I won’t be very sick | 6 | 17.1% | 17 | 22.1% | 0.60 | 1.4517 |
| We do not know the long-term side effects | 22 | 62.9% | 44 | 57.1% | −0.57 | 0.5681 |
| I don’t know who to believe | 3 | 8.6% | 8 | 10.4% | −0.30 | 0.7640 |
| I don’t know how, when or where to get vaccinated | 0d | 0.0% | 1 | 1.3% | N/Ad | N/Ad |
| I should be given a choice | 18 | 51.4% | 36 | 46.8% | −0.46 | 0.6456 |
| There was a problem with the appointment | 0d | 0.0% | 2 | 2.6% | N/Ad | N/Ad |
| I didn’t have time | 0d | 0.0% | 4 | 5.2% | N/Ad | N/Ad |
| I’ve already had COVID-19 | 3 | 8.6% | 15 | 19.5% | −1.46 | 0.1446 |
| I don’t want to get vaccinated at this time | 14 | 40.0% | 25 | 32.5% | −0.78 | 0.4370 |
| In general, I don’t believe in vaccines | 4 | 11.4% | 10 | 13.0% | −0.23 | 0.8169 |
| The vaccine I want is not available or has not been offered to me | 0d | 0.0% | 2 | 2.6% | N/Ad | N/Ad |
| I don’t trust the vaccine offered to me | 10 | 28.6% | 20 | 26.0% | −0.29 | 0.7731 |
| I don’t trust the health system | 5 | 14.3% | 10 | 13.0% | −0.19 | 0.8513 |
| Cultural, philosophical or religious reasons | 5 | 14.3% | 7 | 9.1% | −0.83 | 0.4088 |
| I’m pregnant or plan to become pregnant | 1 | 2.9% | 3 | 3.9% | −0.28 | 0.7833 |
| I’m not sure that vaccines against COVID-19 are effective | 21 | 60.0% | 28 | 36.4% | −2.34 | 0.0194 |
| Other | 1 | 2.9% | 10 | 13.0% | −1.67 | 0.0947 |
| Reasons for hesitancy concerning vaccination of childrene | ||||||
| The vaccine is not recommended for them | 7 | 20.0% | 29 | 32.2% | −1.35 | 0.1754 |
| I do not have the necessary information to make a decision | 8 | 22.9% | 11 | 12.2% | −1.49 | 0.1370 |
| I know too many people who have had side effects | 5 | 14.3% | 14 | 15.6% | −0.18 | 0.8591 |
| I’m afraid and/or my children are afraid | 2 | 5.7% | 6 | 6.7% | −0.20 | 0.8451 |
| My children are not at high risk of contracting COVID-19 | 4 | 11.4% | 11 | 12.2% | −0.12 | 0.9024 |
| If they contract COVID-19, my children won’t be very sick | 8 | 22.9% | 10 | 11.1% | −1.68 | 0.0931 |
| We do not know the long-term side effects of the vaccine that was offered to me for them | 11 | 31.4% | 27 | 30.0% | −0.16 | 0.8761 |
| I don’t know who to believe | 3 | 8.6% | 3 | 3.3% | −1.23 | 0.2187 |
| I don’t know how, when or where to get my children vaccinated | 0d | 0.0% | 1 | 1.1% | N/Ad | N/Ad |
| I should be given a choice | 8 | 22.9% | 16 | 17.8% | −0.65 | 0.5174 |
| There was a problem with the appointment | 1 | 2.9% | 2 | 2.2% | −0.21 | 0.8350 |
| I didn’t have time | 2 | 5.7% | 2 | 2.2% | −1.00 | 0.3192 |
| They’ve already had COVID-19 | 6 | 17.1% | 10 | 11.1% | −0.91 | 0.3648 |
| I don’t want my children to get vaccinated at this time | 5 | 14.3% | 19 | 21.1% | −0.87 | 0.3844 |
| In general, I don’t believe in vaccines | 0d | 0.0% | 6 | 6.7% | N/Ad | N/Ad |
| The vaccine I want for my children is not available or has not been offered to me | 1 | 2.9% | 3 | 3.3% | −0.14 | 0.8920 |
| I don’t trust the vaccine offered to me | 4 | 11.4% | 10 | 11.1% | −0.05 | 0.9597 |
| I don’t trust the health system because of a bad experience | 3 | 8.6% | 5 | 5.6% | −0.62 | 0.5362 |
| Cultural, philosophical or religious reasons | 0d | 0.0% | 3 | 3.3% | N/Ad | N/Ad |
| I’m not sure that vaccines against COVID-19 are effective | 5 | 14.3% | 21 | 23.3% | −1.12 | 0.2631 |
| In general, the risks associated with vaccines are greater than the benefits | 6 | 17.1% | 15 | 16.7% | −0.06 | 0.9490 |
| Other | 0d | 0.0% | 4 | 4.4% | N/Ad | N/Ad |
| Trusted sources of information on COVID-19 vaccinationf | ||||||
| Friends, family members or acquaintances | 51 | 9.3% | 132 | 13.9% | −2.64 | 0.008 |
| My physician | 379 | 69.0% | 657 | 69.4% | −0.14 | 0.890 |
| My pharmacist | 238 | 43.4% | 380 | 40.1% | −1.23 | 0.220 |
| Other healthcare professionals (e.g. nurses) | 228 | 41.5% | 439 | 46.4% | −1.82 | 0.069 |
| Community leaders | 17 | 3.1% | 35 | 3.7% | −0.61 | 0.540 |
| Politicians | 24 | 4.4% | 18 | 1.9% | −2.80 | 0.005 |
| Social media | 23 | 4.2% | 26 | 2.7% | −1.52 | 0.129 |
| Alternative medicine professionals | 32 | 5.8% | 48 | 5.1% | −0.63 | 0.527 |
| Public health authorities | 335 | 61.0% | 529 | 55.9% | −1.95 | 0.051 |
| Health scientists and researchers | 352 | 64.1% | 593 | 62.6% | −0.58 | 0.561 |
| World Health Organization (WHO) | 267 | 48.6% | 437 | 46.1% | −0.93 | 0.351 |
| Pharmaceutical companies | 24 | 4.4% | 70 | 7.4% | −2.34 | 0.020 |
| Other | 29 | 5.3% | 59 | 6.2% | −0.75 | 0.451 |
| Means of validating COVID-19 vaccination informationg | ||||||
| Confirm with other sources | 338 | 61.6% | 558 | 59.1% | −0.94 | 0.3481 |
| Click on the link to read the full article | 230 | 41.9% | 461 | 48.8% | −2.59 | 0.0095 |
| Check the date of the information | 204 | 37.2% | 354 | 37.5% | −0.13 | 0.8949 |
| Check the number of likes or shares | 6 | 1.1% | 29 | 3.1% | −2.47 | 0.0134 |
| Research the author or source | 242 | 44.1% | 407 | 43.1% | −0.36 | 0.7154 |
| Read the comments or take note of the discussions on the subject | 93 | 16.9% | 164 | 17.4% | −0.21 | 0.8300 |
| Consult friends and family | 59 | 10.7% | 142 | 15.0% | −2.33 | 0.0196 |
| Check the credibility of the URL | 203 | 37.0% | 339 | 35.9% | −0.41 | 0.6785 |
| Other | 60 | 10.9% | 86 | 9.1% | 1.15 | 1.7482 |
Abbreviations: COVID-19, coronavirus disease 2019; FSM, French-speaking minority; N/A, not applicable
a Statistical z-test results are based on bilateral tests with a significance level of 0.05. The tests are adjusted for all pairwise comparisons within a row of each innermost sub-table, using the Bonferroni correction
b Total N for FSMs=35 and for English speaking=77
c This category is not used in the comparisons as its proportion of columns is equal to zero
d Total N for FSMs=515 and for English speaking=868
e Total N for FSMs=35 and for English speaking=90
f Total N for FSMs=549 and for English speaking=947
g Total N for FSMs=549 and for English speaking=944
Differences according to sociodemographic data
French-speaking minorities who are Canadian citizens by birth are mainly vaccinated for a return to normal life (55% vs. 39%, p=0.034) and protection against serious illness (79% vs. 59%, p=0.002). To obtain information on COVID-19, they mainly consulted family and friends (10% vs. 20%, p=0.015), pharmacists (45% vs. 30%, p=0.026) and public health authorities (63% vs. 47%, p=0.016). Ontarians are more confident in the safety and efficacy of vaccines/health measures (58.1% vs. 38.9% [West] and 42.7% [Atlantic]) (χ2[6, N=545]=19.141, p=0.004; OR=1.829 [95% CI: 0.786–4.255]). This confidence is also preponderant among men (58.4% vs. 43.4%, women) (χ2[3, N=548]=12.337, p=0.006; OR=1.724 [95% CI: 0.804–3.695]) who are more willing to get vaccinated to protect themselves against serious illness (83% vs. 72.6%, p<0.001). The higher the level of education, the more likely it was that article publication dates would be consulted to validate information (40% vs. 24%, p=0.008) and that scientific professionals would be regarded with confidence (76% vs. 56%, p<0.001).
Beliefs
Differences between French-speaking minorities and English speakers
FSMs frequently disagreed with the efficacy of herd immunity (Table 4).
Table 4. Vaccination beliefs among French-speaking minorities and English speakers.
| Vaccination beliefs | % FSM (n=554) |
% English speakers (n=951) |
Likelihood chi-squared | Approx. sig. (bilateral) | OR | 95% CI | |
|---|---|---|---|---|---|---|---|
| Vaccines are safe despite the risks | |||||||
| Strongly agree | 52.00 | 51.40 | 5.561 | 0.135 | 3.009 | 1.023 | 8.854 |
| Agree | 40.60 | 39.70 | 2.971 | 1.114 | 7.923 | ||
| Disagree | 4.90 | 5.60 | 1.876 | 0.692 | 5.084 | ||
| Strongly disagree | 2.50 | 3.30 | N/A | N/A | N/A | ||
| COVID-19 vaccines are safe, despite the risks | |||||||
| Strongly agree | 49.30 | 48.50 | 6.656 | 0.084 | 0.290 | 0.089 | 0.943 |
| Agree | 36.70 | 36.90 | 0.258 | 0.090 | 0.743 | ||
| Disagree | 8.00 | 9.00 | 0.342 | 0.134 | 0.875 | ||
| Strongly disagree | 6.00 | 5.70 | N/A | N/A | N/A | ||
| I distrust COVID-19 vaccines because they were developed too quickly | |||||||
| Strongly agree | 10.30 | 9.60 | 1.981 | 0.576 | 0.692 | 0.366 | 1.310 |
| Agree | 15.90 | 16.40 | 0.763 | 0.468 | 1.245 | ||
| Disagree | 39.80 | 38.60 | 0.816 | 0.588 | 1.134 | ||
| Strongly disagree | 34.00 | 35.40 | N/A | N/A | N/A | ||
| By getting the COVID-19 vaccine, I am protecting myself against severe forms of this disease | |||||||
| Strongly agree | 52.60 | 50.30 | 3.161 | 0.367 | 1.614 | 0.622 | 4.188 |
| Agree | 35.60 | 36.70 | 1.251 | 0.501 | 3.124 | ||
| Disagree | 7.10 | 7.40 | 1.556 | 0.642 | 3.772 | ||
| Strongly disagree | 4.70 | 5.60 | N/A | N/A | N/A | ||
| Physical distancing, frequent hand washing and wearing a mask are effective methods of slowing the spread of COVID-19 | |||||||
| Strongly agree | 58.00 | 56.10 | 3.332 | 0.343 | 0.734 | 0.295 | 1.828 |
| Agree | 34.60 | 35.60 | 0.616 | 0.250 | 1.514 | ||
| Disagree | 4.50 | 6.20 | 0.517 | 0.197 | 1.353 | ||
| Strongly disagree | 2.90 | 2.10 | N/A | N/A | N/A | ||
| Physical distancing, frequent hand washing and wearing a mask are enough to protect me against COVID-19 | |||||||
| Strongly agree | 13.60 | 11.60 | 1.311 | 0.727 | 0.853 | 0.537 | 1.356 |
| Agree | 28.50 | 29.50 | 0.795 | 0.529 | 1.196 | ||
| Disagree | 43.20 | 43.30 | 0.896 | 0.625 | 1.284 | ||
| Strongly disagree | 14.70 | 15.70 | N/A | N/A | N/A | ||
| Only those at risk of becoming seriously ill due to COVID-19 need to be vaccinated | |||||||
| Strongly agree | 6.90 | 6.00 | 3.537 | 0.316 | 0.822 | 0.469 | 1.443 |
| Agree | 12.90 | 12.20 | 1.012 | 0.613 | 1.670 | ||
| Disagree | 36.70 | 35.40 | 0.771 | 0.550 | 1.080 | ||
| Strongly disagree | 43.60 | 46.40 | N/A | N/A | N/A | ||
| By getting vaccinated against COVID-19, I’m helping to protect the health of others in my community | |||||||
| Strongly agree | 57.50 | 56.10 | 3.842 | 0.279 | 1.862 | 0.817 | 4.244 |
| Agree | 30.50 | 29.20 | 1.564 | 0.701 | 3.490 | ||
| Disagree | 6.50 | 8.60 | 1.032 | 0.464 | 2.297 | ||
| Strongly disagree | 5.50 | 6.00 | N/A | N/A | N/A | ||
| I prefer to develop immunity to COVID-19 by catching the disease than through the vaccination | |||||||
| Strongly agree | 9.40 | 7.10 | 48.820 | 0.000 | 5.716 | 2.997 | 10.901 |
| Agree | 15.60 | 14.70 | 3.693 | 2.207 | 6.181 | ||
| Disagree | 40.60 | 29.30 | 2.918 | 2.060 | 4.134 | ||
| Strongly disagree | 34.40 | 48.90 | N/A | N/A | N/A | ||
| Those who have already had COVID-19 do not need to get vaccinated | |||||||
| Strongly agree | 5.60 | 6.50 | 13.088 | 0.004 | 0.522 | 0.253 | 1.077 |
| Agree | 12.00 | 12.80 | 0.961 | 0.560 | 1.647 | ||
| Disagree | 49.00 | 39.00 | 1.489 | 1.079 | 2.055 | ||
| Strongly disagree | 33.40 | 41.70 | N/A | N/A | N/A | ||
Abbreviations: CI, confidence interval; COVID-19, coronavirus disease 2019; FSM, French-speaking minority; N/A, not applicable; OR, odds ratio
Differences according to sociodemographic data
French-speaking minorities with high incomes, >$120,000, were not wary of the rapid development of the vaccines (47.2% [>$120,000] vs. 32.2% [$60,000 to $120,000] and 25.0% [<$60,000]) (χ2[6, N=546]=33.064, p<0.001; OR=6.381 [95% CI: 2.454–16.592]), did not believe in the stand-alone efficacy of physical distancing (21.7% [>$120,000] vs. 12.5% [$60,000 to $120,000] vs. 11.9% [<$60,000]) (χ2[6, N=544]=15.805, p=0.015; OR=3.836 [95% CI: 1.671–8.805]), or herd immunity (46.8% [>$120,000] vs. 30.8% [$60,000 to $120,000] vs. 29.1% [<$60,000]) (χ2[6, N=545]=20.787, p=0.002; OR=5.789 [95% CI: 2.080–16.112]) and that a previous diagnosis would result in less serious illness (42.6% [>$120,000] vs. 30.9% [$60,000 to $120,000] vs. 29.1% [<$60,000]) (χ2[6, N=544]=15.185, p=0.019; OR=5.965 [95% CI: 1,659–21,449]).
Discussion
Summary of key findings
The survey highlights three findings of interest: a polarization of attitudes/beliefs according to citizenship and education, vaccine uptake for a return to normal, and significant hesitancy concerning vaccination of children.
Comparative analysis
Compared with English speakers, FSMs show a polarization of attitudes/beliefs according to certain sociodemographic characteristics. Among FSMs, Canadian-born citizens with a higher education were more likely to completely disagree or agree with the recommended vaccine regimen. This trend is noted by other studies in high-income countries ((17)). The literature indicates that mixed attitudes may stem from inconsistent information from official sources ((21–24)), becoming a risk to communication and patient disregard for medical care ((25)).
According to the literature, the prospect of a “return to normal” is strong motivation for vaccine uptake ((4,21)). Although FSMs generally doubted its efficacy, they mainly got vaccinated to obtain the vaccine passport and to protect themselves against serious illness, especially in the case of men. Given the inconsistency of information, also felt among healthcare professionals ((25)), FSMs were not always able to count on the news and relied on the recommendations of government agencies, promising a return to normality thanks to vaccination ((24,26)).
Although FSMs are often described as an older population ((7,27)), this survey was designed to be representative of all FSM generations. Despite the low representation of French-speaking parents with young children, vaccination hesitancy for children is of particular interest. Vaccine hesitancy (COVID-19 and other diseases) for children is more pronounced among FSMs, who are less likely to follow the vaccine regimen, unless they have a high income. In a broader context, the efficacy of COVID-19 vaccines in children has been widely disputed in literature ((17,28)).
The problem of childhood vaccination, which existed prior to the emergence of COVID-19 ((17)) and led to parental vaccine hesitancy during this pandemic ((28)), could be caused by sub-optimal physician-patient communication ((4,29)). The finding of this study could indicate greater inaccessibility for linguistic minorities. We hypothesize that the current shortage of family physicians in rural and urban settings ((30,31)), and by extension a lack of accessibility to bilingual health professionals, could contribute to an exacerbation of the problem of vaccination of children during a health crisis. Vaccination of children and parental hesitancy should be the subject of further research to pursue this line of thought and optimize access to care.
Strengths and weaknesses
Considering the rapid evolution of the virus and of health recommendations, the study has some conceptual and methodological limitations. Media saturation and collective exhaustion made participation less appealing and influenced the sampling technique that was selected, resulting in a sampling bias caused by a convenience sample. Despite the strategy employed by Léger Marketing Inc., it is difficult to ensure the representativeness of FSMs and English speakers, as well as the potential for statistical generalization of the findings. Furthermore, the survey presents a portrait of FSMs for a given period, rather than according to a specific situation during the pandemic. The time elapsed between the data collection period and the comparative analysis must also be considered a bias for the representativeness of the findings. Despite this, the study met its objective and thus contributed to the active offering of French-language health services.
Impact
This survey provides health professionals with the relevant information they need to tailor their communication with patients who are faced with a vaccination choice. The findings also point to the need for new studies establishing a portrait of FSMs in order to better address their vaccine needs.
Next steps
By filling the knowledge gap regarding vaccination against COVID-19, this data could help improve access to information and, consequently, help adapt the training of health professionals for a therapeutic alliance based on trust.
Conclusion
Although difficult to generalize, this survey did reveal significant differences between FSMs and English speakers in their perceptions of vaccine efficacy, particularly vaccination of children, as well as a polarization of the attitudes/beliefs of FSMs according to certain sociodemographic factors. The findings imply a requirement to better understand the overall needs of FSMs in order to improve access to information and care in French.
Supplemental material
These documents can be accessed on the Supplemental material file
Survey, data collection tool
Survey invitation letter and distribution list
Acknowledgements
We would like to thank Léger Marketing Inc. for their contribution to the development and distribution of the survey that enabled us to collect the data. We would also like to thank the réseaux de la francophonie that helped distribute the survey.
Footnotes
Competing interests
No conflicts of interest were declared.
Funding
This community survey was funded by the Public Health Agency of Canada.
References
- 1.Getachew Y, Zephyrin L, Abrams MK, Shah A, Lewis C. M. Doty M. Beyond the Case Count: Wide-Ranging Disparities COVID-19 in U.S. | Commonwealth Fund. Published 2020. [Accessed 2022 Feb 18]. https://www.commonwealthfund.org/publications/2020/sep/beyond-case-count-disparities-covid-19-united-states
- 2.Cascini F, Pantovic A, Al-Ajlouni Y, Failla G, Ricciardi W. Attitudes, acceptance and hesitancy among the general population worldwide to receive the COVID-19 vaccines and their contributing factors: A systematic review. EClinicalMedicine 2021;40:101113. 10.1016/j.eclinm.2021.101113 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Tang X, Gelband H, Nagelkerke N, Bogoch II, Brown P, Morawski E, Lam T, Jha P; Action to beat coronavirus/Action pour battre le coronavirus (Ab-C) Study Investigators . COVID-19 vaccination intention during early vaccine rollout in Canada: a nationwide online survey. Lancet Reg Health Am 2021;2:100055. 10.1016/j.lana.2021.100055 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger J. Vaccine hesitancy: an overview. Hum Vaccin Immunother 2013;9(8):1763–73. 10.4161/hv.24657 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Dubé E, Gagnon D, MacDonald N. Between persuasion and compulsion: the case of COVID-19 vaccination in Canada. Vaccine 2022;40(29):3923–6. 10.1016/j.vaccine.2022.05.053 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Bouchard L, Desmeules M. [Linguistic minorities in Canada and health]. Healthc Policy 2013;9(Spec Issue):38–47. 10.12927/hcpol.2013.23589 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Drolet M, Bouchard P, Savard J. Accessibilité et Offre Active: Santé et Services Sociaux En Contexte Linguistique Minoritaire.; 2017. [Accessed 2021 Aug 31]. https://ruor.uottawa.ca/handle/10393/36889
- 8.Bowen S. The Impact of Language Barriers On Patient Safety and Quality of Care Final Report. Société Santé en français. 2015. https://www.santefrancais.ca/wp-content/uploads/2018/11/SSF-Bowen-S.-Language-Barriers-Study-1.pdf
- 9.de Moissac D, Bowen S. Impact of language barriers on access to healthcare for official language minority Francophones in Canada. Healthc Manage Forum 2017;30(4):207–12. 10.1177/0840470417706378 [DOI] [PubMed] [Google Scholar]
- 10.Health Canada. Social determinants of health and health inequalities. HC; ON: 2020. [Accessed 2022 Feb 18]. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
- 11.Bouchard L. Minorités de Langue Officielle Du Canada: Égales Devant La Santé? Vol 50. PUQ.; 2011. [Google Scholar]
- 12.De Moissac D. Accès aux services de santé et d’interprète-accompagnateur: L’expérience des communautés minoritaires à faible densité de francophones au Canada. 2016. [Accessed 2023 Jan 4]. https://savoir-sante.ca/fr/content_page/download/275/446/21?method=view
- 13.Health Canada. Bowen S. Language Barriers in Access to Health Care. HC; ON: 2001. https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/health-care-accessibility/language-barriers.html
- 14.Peters MD. Addressing vaccine hesitancy and resistance for COVID-19 vaccines. Int J Nurs Stud 2022;131:104241. 10.1016/j.ijnurstu.2022.104241 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Jarrett C, Wilson R, O’Leary M, Eckersberger E, Larson HJ; SAGE Working Group on Vaccine Hesitancy . Strategies for addressing vaccine hesitancy - A systematic review. Vaccine 2015;33(34):4180–90. 10.1016/j.vaccine.2015.04.040 [DOI] [PubMed] [Google Scholar]
- 16.Attwell K, Betsch C, Dubé E, Sivelä J, Gagneur A, Suggs LS, Picot V, Thomson A. Increasing vaccine acceptance using evidence-based approaches and policies: insights from research on behavioural and social determinants presented at the 7th Annual Vaccine Acceptance Meeting. Int J Infect Dis 2021;105:188–93. 10.1016/j.ijid.2021.02.007 [DOI] [PubMed] [Google Scholar]
- 17.Gualano MR, Olivero E, Voglino G, Corezzi M, Rossello P, Vicentini C, Bert F, Siliquini R. Knowledge, attitudes and beliefs towards compulsory vaccination: a systematic review. Hum Vaccin Immunother 2019;15(4):918–31. 10.1080/21645515.2018.1564437 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Remysen W. Les communautés francophones dans les provinces majoritairement anglophones du Canada : aperçu et enjeux. Trav Linguist. 2019;1(78):15–45. 10.3917/tl.078.0015 [DOI] [Google Scholar]
- 19.Health Canada. COVID-19 Vaccination Coverage Survey (CVCS): Cycle 2 full report. HC; ON: 2021. https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/covid-19-vaccination-coverage-survey/full-report-cycle-2.html
- 20.Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res 2004;6(3):e34. 10.2196/jmir.6.3.e34 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Fullerton MM, Benham J, Graves A, Fazel S, Doucette EJ, Oxoby RJ, Mourali M, Boucher JC, Constantinescu C, Parsons Leigh J, Tang T, Marshall DA, Hu J, Lang R. Challenges and recommendations for COVID-19 public health messaging: a Canada-wide qualitative study using virtual focus groups. BMJ Open 2022;12(4):e054635. 10.1136/bmjopen-2021-054635 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Colautti L, Cancer A, Magenes S, Antonietti A, Iannello P. Risk-Perception Change Associated with COVID-19 Vaccine’s Side Effects: The Role of Individual Differences. Int J Environ Res Public Health 2022;19(3):1189. 10.3390/ijerph19031189 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Desson Z, Weller E, McMeekin P, Ammi M. An analysis of the policy responses to the COVID-19 pandemic in France, Belgium, and Canada. Health Policy Technol 2020;9(4):430–46. 10.1016/j.hlpt.2020.09.002 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Capurro G, Tustin J, Jardine CG, Driedger SM. When good messages go wrong: perspectives on COVID-19 vaccines and vaccine communication from generally vaccine accepting individuals in Canada. Hum Vaccin Immunother 2022;18(7):2145822. 10.1080/21645515.2022.2145822 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Tran A, Wallner C, de Wit K, Gérin-Lajoie C, Ritchie K, Mercuri M, Clayton N, Boulos M, Archambault P, Schwartz L, Gray S, Chan TM; Network of Canadian Emergency Researchers . Humans not heroes: canadian emergency physician experiences during the early COVID-19 pandemic. Emerg Med J 2023;40(2):86–91. 10.1136/emermed-2022-212466 [DOI] [PubMed] [Google Scholar]
- 26.Falkenbach M, Willison C. Resources or trust: what matters more in the vaccination strategies of high-income liberal democracies? Health Policy Technol 2022;11(2):100618. 10.1016/j.hlpt.2022.100618 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Drolet M, Dubouloz C, Benoît J. L’accès aux services sociaux et de santé en français et la formation des professionnelles et des professionnels en situation francophone minoritaire canadienne. Reflets Rev d’intervention Soc Communaut. 2014;20(2):10–19. https://www.erudit.org/fr/revues/ref/2014-v20-n2-ref01608/1027584ar/
- 28.Lachance-Grzela M, Charbonneau A, Dubé A, Jbilou J, Richard J. Parents and Caregivers’ Willingness to Vaccinate Their Children Against COVID-19. Can J Behav Sci Epub 2022. 10.1037/cbs0000333 10.1037/cbs0000333 [DOI] [Google Scholar]
- 29.Abrams EM, Shaker M, Greenhawt M. La COVID-19 et l’importance d’une communication efficace des risques aux enfants. Paediatr Child Health 2022;27 Suppl 2:S79–81. 10.1093/pch/pxac008 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Myhre D, Szafran O, Schipper S, Dickinson J, Janke F. Scope of practice of family medicine graduates who completed a rural versus urban program. Rural Remote Health 2018;18(3):4514. 10.22605/RRH4514 [DOI] [PubMed] [Google Scholar]
- 31.Malko AV, Huckfeldt V. Physician Shortage in Canada: A Review of Contributing Factors. Glob J Health Sci 2017;9(9): 10.5539/gjhs.v9n9p68 [DOI] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
These documents can be accessed on the Supplemental material file
Survey, data collection tool
Survey invitation letter and distribution list