Community Resident Survey of COVID-19 Vaccine Attitude, Knowledge and Acceptance

Abstract

Introduction

COVID-19 infects minority groups with comorbidities at higher rates than whites. In addition, children are at risk of vaccine hesitancy based on parents’ acceptance and due to disparity. About twenty percent of workers would get vaccinated, especially if required by work.

Methods

A community survey was created and distributed in Qualtrics© to focus on vaccine hesitancy. We collected demographics, attitudes, knowledge, and acceptance of vaccines on a post-survey following COVID-19 training from July 2021 through January 2023. The number of participants in the survey was 159.

Results

Women comprised 81.8% of the survey participants. The sample included African Americans (73.6%), Latinos (25.8%), Non-Hispanic whites (16.4%), Native Americans (1.9%), and Asians (1.6%). In addition, 93.6% spoke English and 16.4% spoke Spanish. The medical plans documented were 63% private insurance, 15.3% Medicare, 10.2% Medicaid, and 11.5% no coverage. The vaccine training post-survey demonstrated correct knowledge scores ranged from 79.2% to 94.7%. The documented attitude was 6.3% for those who did not want the vaccine, 6.3% believed the vaccine was not safe, and 10% for those concerned with the side effects.

Conclusion

After the training, participants gained a strong knowledge of the concepts that the trainer presented to them. A small number of individuals had a reduced attitude toward vaccination.

Introduction

The Florida Department of Health contract provided extensive COVID-19 training and vaccine information, outreach, and education to primarily African Americans in North Florida, and select counties in Central and South Florida. One of the major concerns of the community trainers was to stress the need for a shortened vaccine acceptance presentation, and the community requested a shortened vaccine hesitancy The study team created a 30-minute vaccine acceptance training to include a fact sheet with a QR code for small gatherings like churches, barbershops, and one-on-one meetings at small events. In addition, we develop a 15-minute training using factsheets with QR code in English, Spanish and Creole for individual training in buses, barbershops, churches, and community events answer questions one-on-one community events. From the train-the trainer COVID-19 training the community requested a shortened vaccine hesitancy and fact sheet training that was developed by FAMU researchers (Becker, Luque, Reyes-Ortiz, Axelrad, Tawk, Lee et al. 2024). Many of the trainers received the train-the-trainer COVID-19 training (Becker, Luque, Reyes-Ortiz, Axelrad, Tawk, Lee et al. 2024). The vaccine hesitancy training included vaccine safety, facts and myths about vaccine hesitancy, vaccine administration and fact sheet information (Table 1). The vaccine hesitancy also contained training related to prevention of exposure through social distancing, hand washing, using N95 masks, safety of vaccines, understanding misinformation, and overcoming vaccine hesitation and information on where to get vaccines, boosters and test kits (Becker, Luque,

Table 1.

Outline of Knowledge of Vaccine Hesitancy/Acceptance Training and Fact Sheet

MODULES	Comments
Vaccine Safety 10 minutes	Safety of vaccines and how they work Mild cases of myocarditis age 12–17 Pfizer-BioNTech and Moderna Johnson and Johnson Janssen-very rare clotting condition in women under 50 on estrogen therapy or birth control COVID-19 Vaccine common side effects
Facts and Myths about COVID-19 10 minutes	Misinformation about COVID-19 How to protect family and community. Vaccines prevents hospitalization and death. Black, Hispanic and Native Americans are disproportionate number of deaths. COVID-19 vaccine hesitancy and ways to support them.
Vaccine Administration COVID-19 10 minutes	Don’t let the virus use you to harm others Be proactive finding sites for Vaccination. How do I get COVID-19 vaccine CDC.gov Find vaccines near you with toll free phone number or zip codes How to order COVID-19 test kits Provider resources for COVID-19 conversations with patients
COVID-19 Fact Sheets 15 minutes	COVID-19 shots cannot give you COVID-19 disease, COVID-19 shots will not cause you to get COVID-19. After getting shots you might have side effects. People who have already had COVID-19 will benefit from shot. The best shot is the current approved shot. You will still need to wear masks and socially distance after getting the shot. Long term side effects are rare but may occur.

A Trainer’s perspective of the value of vaccine acceptance training

“After receiving the comprehensive training provided by FAMU on COVID-19, as a trainer I took on the responsibility of educating others about the virus. Organized workshops used the informational materials provided and conducted seminars in my community. Misconceptions, emphasized preventive measures, and highlighted the importance of vaccination. Additionally, local barbershops and faith institutions were locations where the trainer presented the COVID-19 information. An evaluation survey tool collected input in the content and feedback from the community.

Background

COVID-19 by Race/Ethnicity

In the US, from January 2020 to March 2024, COVID-19 cases aged 18–29 numbered 22,308 per 100,000, age 30–39 numbered 21,698 per 100,000, and age 40–49 numbered 20,187 per 100,000 respectively (Centers of Disease Control Case Surveillance 2024). A systematic review and meta-analysis demonstrated that COVID-19 infected minority groups at higher rates (Duong, Le, Veettil, Saidoung, Wannaadisai, Nelson, et al. 2023). Minority groups experienced a higher risk of hospitalization, and there are some studies in this review showing death rates were higher and some studies were lower (Duong, Le, Veettil, Saidoung, Wannaadisai, Nelson, 2023). However, minorities had a higher risk of COVID-19 infections and hospitalization rates consistent with other studies. Disparity for race and ethnicity existed in the pre-hospitalization stage (Duong, Le, Veettil, Saidoung, Wannaadisai, Nelson, 2023). Hospitalization rates by race ethnicity reported 45% were white, 33% were non-Hispanic black and 8% were Hispanic (Garg, Kim, Whitaker, O’Halloran, Cummings C, Holstein, et al., 2020). Disparity and crowded conditions can increase COVID-19 transmission (Carrozza, 2020). Multigenerational households are overcrowded with shared facilities and individuals are unable to isolate (Carrozza, 2020). In addition, minorities are more likely to work in essential industries and come in close contact with others to increase risk of infection (Hawkins, 2020). Language barriers may also disrupt messaging for COVID-19 prevention (Ortega, Martínez, Diamond, 2020). Lack of access to N95 face coverings increased risk of COVID-19 infection (Chopra, Abiakam, Kim, Metcalf, Worsley, Cheong, 2021). Higher risk of hospitalization was associated with chronic disease or comorbidities which primarily include hypertension, diabetes, obesity, heart disease and lung disease (Garg, Kim, Whitaker, O’Halloran, Cummings, Holstein, et al., 2020). Because minorities may be uninsured, they do not receive the treatment and testing until they were hospitalized (Artiga, Hill, Orgera, 2021). In addition, children were at risk of vaccine hesitancy based on parents’ acceptance for their children. Of 3,167 parents 47.6% had their children vaccinated against COVID-19, Sixty nine percent had inadequate safety information and the worry of serious side effects and the vaccines effectiveness (Temsah, Alhuzaimi, Aljamaan, Bahkali, Al-Eyadhy, Alrabiaah et al., 2021).

Development and Acceptance of COVID-19 Vaccines

Guidance for the emergency use authorization of COVID-19 vaccines was issued in October 2020 by the United States Food and Drug administration (Omer, Benjamin, Brewer, Buttenheim, Callaghan, Caplan, et al, 2021). In January 2021. Twenty percent of adults in the US reported they would be vaccinated (Hamel, Lopes, Kearney, Sparks, Stokes, Brodie, 2021), only if required by work, or not get vaccinated (Salmon, Opel, Dudley, Brewer, Breiman, 2021). Political polarization contributed to misinformation and distrust of federal agencies authority on preventive measures (Biswas, Mustapha, Khubchandani, Price, 2021). The medical community did have some concerns with COVID-19 vaccine due to safety, efficacy, and side effects; however, vaccination rates did increase in the initial rollout period (Winch, Cao, Maytorena-Sanchez, Pinto, Sergeeva, Zhang, 2021). Vaccine hesitancy can be reduced through communication and education strategies and mandates (Winch, Cao, Maytorena-Sanchez, Pinto, Sergeeva, Zhang, 2021). Developing a coordinated, evidence-based education, communication and behavioral intervention strategies are important (Winch, Cao, Maytorena-Sanchez, Pinto, Sergeeva N, Zhang, 2021). In addition, CBS news reported that a dozen anti-vaccine accounts were responsible for 65% of disinformation shared online on Facebook, YouTube, Instagram, and Twitter (CBS news. March 25, 2021). Many platforms removed accounts promoting misinformation, but the task is enormous. In the current project, we decided not to alert the community about this misinformation but instead provide vaccine-acceptance/hesitancy training so that each person could make their own judgement following the training. A COVID-19 vaccine acceptance study in Germany identified COVID-19 anxiety, health fears and economic consequences were associated with a reduction in vaccine acceptance (Bendau, Plag, Petzold, Ströhle, 2021). In Italy trust in research of vaccines, understanding perceptions and behavior along with health literacy plays key role (Palamenghi, Barello, Boccia, Graffigna, 2020).

Safety of Vaccines

Many people thought that the vaccine was developed too fast to be rigorously evaluated. Operation Warp Speed which included the U.S. Government collaboration with manufacturers and developers delivered three hundred million doses of safe vaccine by January 2021. Over 70,000 persons were recruited in these vaccine studies, and these individuals were tracked for safety monitoring (Winch, Cao, Maytorena-Sanchez, Pinto, Sergeeva, Zhang, 2021).

Other topics related to COVID-19 Vaccines

• Mild cases of myocarditis related to Pfizer-BioNTech and Moderna vaccines has been associated with children 12–17 (Dhaduk, Khosla, Hussain, Mangaroliya, Chauhan, Ashish, Gupta, et al., 2022). The risk of myocarditis and other cardiac conditions can be very serious in COVID-19 disease. (Centers for Disease Control and Prevention (CDC), 2022).

• Johnson and Johnson Janssen are related to a very rare clotting condition in women under 50 on estrogen therapy or birth control (Bilotta, Perrone, Adelfio, Spatola, Uzzo, Argo, et al., 2021).

• COVID-19 vaccines reduce the severity of infection and reduces the risk of long COVID. Long term COVID may occur with the COVID-19 disease (Ceban, Kulzhabayeva, Rodrigues, Di Vincenzo, Gill, Subramaniapillai, et al., 2023).

• The virus which causes COVID-19 spread because there was no herd immunity. The virus continued to mutate, and vaccine or boosters may not protect from a new variant (Suryawanshi & Biswas, 2023).

• In addition, there could be symptoms from Covid-19 vaccines. The common symptoms are dizziness, light-headedness, arm aching or sore and feeling faint or tired, slight fever, lymph nodes aching, rapid breathing and sweating (Canas, Osterdahl, Deng, et al., 2021).

• The vaccines reduced contracting COVID-19 infection, hospitalization and death (Temsah, Alhuzaimi, Aljamaan, Bahkali, Al-Eyadhy, Alrabiaah, et al., 2021). This is due to the normal defensive response to protect you from future infection from COVID-19.

Methods

The training entailed the “Safety of Vaccines, Facts, and Myths” about vaccines and vaccine information related to vaccine administration and factsheet topics is included in Table 1, as an outline of vaccine hesitancy/acceptance training knowledge. A community survey was created and distributed through Qualtrics© to describe the demographics, attitude, knowledge, and acceptance of the COVID-19 vaccines. Survey data were collected from July 2021 through January 2023. The post-survey included sociodemographic characteristics, attitude, knowledge, and acceptance questions developed from the training. The FAMU Internal Review Board approved the train-the-trainer study [1764181-3], entitled “FAMU COVID-19 Vaccine Community Out-Reach from July 2021 through January 2023.

Measures

Sociodemographic characteristics include age, gender (male or female), race (Whites, Blacks/African Americans, American Indians/Alaska Natives, Asians & other), ethnicity (Hispanic, non-Hispanic), language at interview (English, Spanish), education (grades 1–8, grades 9–11/some HS, grades 12/HS diploma or GED, some college/AD/TD, bachelor’s degree), employment (full time, part time, self-employed, student-full or part time, unemployed, stay at home/parent, retired), income ($ yearly, categories from 0–9,999 to ≥75,000), residence (house/condo, shelter, apartment, dormitory, mobile home, not consistent place), number of adults, number of children, marital status (married, widowed, divorced, separated, never married, living together), medical plan (private, Medicare, Medicaid, no coverage). Questions about vaccine hesitancy, attitudes and knowledge include attitude (If you have not received the Covid-19 vaccine yet, why?), acceptance (received Covid-19 vaccine, yes or no), and knowledge (10 questions).

Statistical Analysis

To describe the characteristics of the study population means (± SD) and frequencies with percentages were included. Frequencies with percentages were also included in reporting participants’ correct answers to vaccine attitude and knowledge and acceptance questions correct answers. All analyses were performed using the statistical program SAS version 9.4 for Windows (SAS Institute, Inc., Cary, NC).

Results

Demographics

In Table 2, most participants were female (81.8 %) and the majority were African American (73.6 %) followed by Latino (25.8%), white (16.4 %). Native American (1.9%), Asian (1.6%) and other (7.5%). In addition, 83.6% of participants surveyed spoke English and 16.4% surveyed spoke Spanish. The education level documented was 32.7% had a bachelor’s degree, 27% had some post graduate education, 25.2% had some college 7.6% had a high school diploma or GED and 6.3% had less than a high school diploma. Medical plans were private insurance (63%), Medicare (15.3%), Medicaid (10.2%), No coverage (11.5%).

Table 2.

Community Demographics for Residents’ Vaccine Hesitancy, n=159

Characteristics	n (%) or mean ± SD
Age (range 21–82)	41.7 ± 14.0
Female	130 (81.8)
Race [all that apply may >100%]
White	26 (16.4)
Black/African American	117 (73.6)
American Indian/Alaska Native	3 (1.9)
Asian	1 (0.6)
Other	12 (7.5)
Ethnicity
Non-Hispanic	118 (74.2)
Hispanic	41 (25.8)
Language at interview
English	133 (83.6)
Spanish	26 (16.4)
Education
Grades 1–8	9 (5.7)
Grades 9–11/some HS	1 (0.6)
Grades 12/HS diploma or GED	12 (7.6)
Some college, AD, TD	40 (25.2)
Bachelor’s degree	52 (32.7)
Any postgraduate	43 (27.0)
Refuse to answer	2 (1.2)
Employment (missing 1)
Employed full time	96 (60.7)
Employed part time	15 (9.5)
Self-employed	17 (10.8)
Full time student	7 (4.4)
Part time student	1 (0.6)
Unemployed	9 (5.7)
Stay at home parent	2 (1.3)
Retired	11 (7.0)
Income ($ yearly) (missing 5)
0 to 9,999	25 (16.2)
10,000 to 14,999	15 (9.7)
15,000 to 24,999	11 (7.2)
25,000 to 34,999	21 (13.6)
35,000 to 49,999	28 (18.2)
50,000 to 74,999	33 (21.4)
≥ 75,000	13 (8.5)
Refuse to answer	8 (5.2)
Where do you live (missing 1)
House/condo	102 (64.6)
Shelter	6 (3.8)
Apartment	35 (22.1)
Dormitory	2 (1.3)
Mobile home	10 (6.3)
No consistent primary residency	3 (1.9)
Number of adults	2.1 ± 0.9
Number of children	0.9 ± 1.1
Marital status (missing 2)
Married	74 (47.1)
Widowed	8 (5.1)
Divorced	22 (14.0)
Separated	3 (1.9)
Never married	37 (23.6)
Living together	13 (8.3)
Medical plan (missing 2)
Private	99 (63.0)
Medicare	24 (15.3)
Medicaid	16 (10.2)
No coverage	18 (11.5)

In Table 3, one hundred fifty-nine community residents completed the vaccine acceptance post-survey. Ninety-four demonstrating a vaccine acceptance of 59.1%; 16.3% already had recovered from a COVID-19 infection. The attitude towards the vaccine documented that 6.3% did not want it, 6.3% did not think it was safe, 8.8% were concerned about its side effects, 10% did not want it, and 1.9% did not view COVID-19 as a threat. After the training, the knowledge section demonstrated that the participants had a strong knowledge of the concepts the trainer presented. Knowledge scores increased from 79.2% to 94.9%, so surveyed participants achieved increases in knowledge from the COVID-19 training.

Table 3.

COVID-19 Vaccine Hesitancy, Attitudes and Knowledge, N=159

Questions
Attitude and Acceptance toward vaccine
If you have not received the Covid-19 vaccine yet, why? (all that apply)
I don’t want it	10 (6.3)
I don’t think is safe	10 (6.3)
I am concerned about the side effects	14 (8.8)
I already had Covid-19	26 (16.3)
I don’t think Covid-19 is a threat to me	3 (1.9)
Received Covid-19 vaccine	94 (59.1)
Knowledge *
You can prevent from getting sick with Covid-19 shots	127 (79.9)
Getting the shot does not give the disease	116 (73.0)
Getting the shot will protect you from getting Covid-19	122 (76.7)
After the shots might have effects which as body’s building protection	149 (93.7)
People who had Covid-19 will benefit from the shot	142 (89.3)
Covid-19 shots are effective, safe	139 (87.4)
Should continue to wear mask & social distancing after shot	151 (94.9)
Long term side effects are few based on Covid-19 shots	126 (79.2)
Antibody response reduces sickness and serious risks	146 (91.8)
The best shot is the first approved	105 (66.0)

^*Correct answers were reported

Discussion

Vaccine hesitancy includes the behavior of confidence, complacency and convenience (Dorman, Perera, Condon, Chau, Qian, Kalk, et al., 2021). Mutually acceptance and unenthusiastic attitudes concerning COVID-19 vaccines may be ascribed to a lack of knowledge and understanding about benefits compared to risks (Yasmin, Najeeb, Moeed, Naeem, Asghar, Chughtai, et.al, 2021). Demographics, social factors, vaccination beliefs and attitudes, contributed to the acceptance of the COVID-19 vaccine, vaccine perceptions, health related perceptions, and perceived barriers (AlShurman, Khan, Mac, Majeed, Butt, 2021).

Knowledge, Attitude and Acceptance of COVID-19 Vaccinations

Knowledge, understanding, and comprehension concerning the health benefits of COVID-19 vaccinations have been recurring pre- and post-pandemic themes. (Duong, Le, Veettil, Saidoung, Wannaadisai, Nelson, et.al. (2023) conducted a cross-sectional study in 2022 to examine and assess knowledge and attitudes about COVID-19 vaccinations. A total of 423 participants between the ages of 18 and 60 were included in the study. Most study participants were between 18 and 29 (270 or 63.8%). Female participants represented 66.2% (280), while men represented 33.8% (143). Researchers further supported a positive correlation between increased levels of knowledge and acceptance, which are influential factors in vaccination acceptance (Duong, Le, Veettil, Saidoung, Wannaadisai, Nelson, et al. (2023). A study involving a cross-sectional study with a convenient sample of nurses in China found that attitude, knowledge and vaccine acceptance was 70.07, 80.70% and 84.38% respectively (Jiang, Wei, Lin, Wang, Chai, & Liu, 2021). Attitude was influenced by vaccination status of family members, knowledge was influenced by gender and academic background (Jiang, N., Wei, B., Lin, H., Wang, Y., Chai, S., & Liu, W., 2021). Vaccine acceptance was gender, grade, and academic background (Jiang, Wei, Lin, Wang, Chai, & Liu, 2021).

Individuals with higher levels of COVID-19 knowledge will know that the COVID-19 vaccine builds a person’s immunity and will understand the importance of wearing face coverings in certain situations, coupled with social distancing, and reduce sickness and serious complications following a COVID-19 infection. According to Mose et al. (2022), it established that marginal populations are more likely to resist vaccinations. Public health promotion through healthcare professionals, policymakers, mass media, and the utilization of influential platforms may increase COVID-19 vaccination acceptance

Public Health Implications

1. Continuity of public health campaigns to educate, promote, and provide information and vaccines are fundamental. Routine events may create or build trust practically, provide opportunities for open dialogue to provide on-site vaccinations (Jiang, Wei, Lin, Wang, Chai, Liu, et al., 2021).

2. Social media is a primary source of mass communication, a funnel for accurate and inaccurate information. Therefore, educating individuals about effective ways to decipher and source verify online health-related information is fundamental. Cultivating and promoting trustworthy sources may improve health literacy in marginalized populations. Positive attitude and good knowledge score, level of education, monthly income, presence of TV, Facebook, and understanding transmission increases acceptance (Yisak, Ambaw, Belay, Desalegn, Getie, Asrat, et al., 2022).

3. Attitude was influenced by vaccination status of family members, knowledge was influenced by the gender and academic background (Jiang, Wei, Lin, Wang, Chai & Liu, 2021).

4. Public health promotion through healthcare professionals, policymakers, mass media, and the utilization of influential platforms may increase COVID-19 vaccination acceptance. (Venkataraman, Yadav, Shrestha, Narayanaswamy & Basavaraju, 2022).

Conclusions

After the training, participants gained a strong knowledge of the concepts that the trainer presented to them. Knowledge increased from 79.2% to 94.9%, surveyed participants achieved knowledge from the COVID-19 training. A small number of individuals had a reduced attitude toward vaccination. The acceptance of the vaccine was 59.1%, and those who already recovered from COVID-19 was 16.3%. This suggests the misconception that past infection confers immunity on par with vaccination, which is a myth that needs to be overcome with consistent COVID-19 messaging and accurate information.

Funding Statement

Florida A & M University contract number 007561-DOH COVID-19, Florida Department of Health supported this work.