Table 3.

Descriptions of themes pertaining to congregational vaccine needs, public health climate, perceived responsibility to address vaccines, comfort and competing interests, and reported advocacy efforts, with sub-themes and representative quotations

Theme	Subtheme	Quotations
Congregational vaccine needs	Explicit requests Clergy perceptions	“I have been [asked], but I feel like I’m being asked as a parent, and not as a pastor. ‘What did you and your wife do about vaccines?’ Not, ‘Pastor, what does the church think about [vaccines]?’” “I sort of assume they’re down with vaccines, that they listen to their doctors. I might be surprised if we were to poll, to do the research here, that there are probably more anti–vaccine people here.”
Public health climate	News reports Prevailing social norms	“Recent news has taken place in the Jewish community in Brooklyn. Interestingly, I heard there was a connection to Israel. I think they traced this recent [measles] outbreak in Brooklyn to Israel.” “There is generally a break down in our society’s sense that we’re in this together. And that’s a problem for religion, civic leaders broadly, and clergy – to rebuild a sense of social solidarity.” “For us [African-Americans], there’s always the nascent – with those kinds of questions – trust in the government piece […] There’s collective memory around the syphilis study and various other things.”
Perceived responsibility	Conditional responsibility	“I had not considered it as a responsibility until this conversation, because if I had, I would have said, ‘I’m sure there is a responsibility.’ And I would have thought, ‘I need to follow through on it.’” “It’s terrible to say this, but if I knew one of our kids – one of our babies – got infected with the measles right now, it would be a big issue […] It’s unfortunate, but that would be the thing.” “No, actually. I have to have some grip about the subject, and I don’t still. So if I don’t have the grip, even to some extent, then I don’t have any resolve in my mind that I need to talk to my people.”
Comfort and competing interests	Comfort or discomfort Competing interests	“I’m not going to give any false information or volunteer information I don’t know. […] I would want to get people who have their expertise in that particular area to see what they say.” “Increasingly, we’ve tried to narrow our focus over the last 10 years, instead of diluting the many things we could be doing and giving $500 here, $250 here, 3 hours to this, and 7 hours to that.”
Reported advocacy efforts	Individual Congregational Communal	“There’s a member of the congregation that I know, and she asked if I would write a letter to her employer […] I support her and her endeavors to be a person of faith. So that’s how I worded it.” “We have video boards at both entrances to the church, we usually make announcements after every mass starting about 3 weeks before [our congregational influenza vaccine drive], we put it in our bulletin, and then we also have an e-mail newsletter that goes out weekly.” “There was a time, in fact, over my first 5 years here as a pastor, that it was important for us to offer the opportunity to the community to come and have the flu shot, right here in the building.”