Facilitators to vaccination among hesitant adopters

ABSTRACT

To end the COVID-19 pandemic, it is essential to increase vaccine coverage in the United States (U.S.). In this study, we examine the facilitators that helped hesitant adopters – those who are both vaccinated and report some degree of hesitancy – overcome barriers to vaccination. Drawing on a sample of 867 hesitant adopters in Arkansas, we find social networks, individual actions, health care organizations and professionals, employers, religious communities and leaders, and the media all play a role in helping the vaccine hesitant overcome barriers to vaccination. Our findings demonstrate vaccine hesitancy and uptake occur simultaneously, and overcoming hesitancy in the U.S. population requires multifaceted strategies from multiple entities. We provide recommendations for overcoming barriers, including hesitancy, based on our findings.

Introduction

Distribution of COVID-19 vaccines began in December 2020.¹ Demand for the vaccines was initially high but began to slow as early adopters received their shots. Despite expanding eligibility criteria, there was a substantial decline in vaccination rates over the summer months of 2021.² As of August 2021, 51% of the United States (U.S.) population is fully vaccinated, and an additional 10% is partially vaccinated.³ To halt the spread of COVID-19 in the U.S., vaccination rates must increase, especially in areas with low inoculation rates and high community spread.⁴

There are structural barriers to vaccine uptake, including access, convenience, and costs (financial and time).^5,6 Vaccine hesitancy is also a key barrier to vaccine uptake.⁷ COVID-19 vaccine hesitancy in the U.S. is more common among Black Americans, rural residents, women, younger individuals, and those with less education and income.^8–10 Lower trust in vaccines in general, lower perceived health risk from the COVID-19 virus, and low or no confidence in the COVID-19 vaccines are also associated with greater hesitancy.^8–10

While vaccine hesitancy is often perceived as a continuum of behavior ranging from delay to refusal of vaccination,¹¹ some scholars recognize vaccine hesitancy as an attitude that is related to but not synonymous with vaccination behavior.¹² Thus, vaccine hesitancy can include accepting vaccination but feeling unsure about that decision.¹³ While hesitancy toward vaccines generally and COVID-19 vaccines specifically is well documented,^7,10,11 less is known about what helps people overcome their barriers to vaccination, including hesitancy.

Existing research has focused on quantitative descriptions of sociodemographic and other predictive factors of COVID-19 vaccine hesitancy.^8–10 However, to effectively address barriers to vaccination, including hesitancy, it is important to understand which facilitators helped individuals overcome barriers and receive the COVID-19 vaccine. The current study uses qualitative methods to examine facilitators that hesitant adopters (people who are both vaccinated and report some degree of hesitancy) in Arkansas identified as helping them overcome barriers to COVID-19 vaccination.

Arkansas is an appropriate study setting as it ranks third among states with a high proportion of adults (43.5%) at high risk of serious illness from COVID-19.¹⁴ Yet, Arkansas currently has the fifth lowest vaccination rate³ and some of the highest rates of COVID-19 vaccine hesitancy among U.S. states.¹⁵ Arkansas also has one of the country’s largest rural populations (41%);¹⁶ rural residents often lack access to health care and are more likely to be vaccine hesitant.^17,18 To our knowledge, this is the first qualitative study to examine facilitators for overcoming barriers to vaccination among hesitant adopters in the U.S. Hesitant adopters are an important population to study to understand what helps individuals with hesitancy make the decision to get vaccinated.

Methods

Study approach and design

This study describes facilitators that contributed to COVID-19 vaccine uptake for hesitant adopters. The study team used a qualitative descriptive design to examine who or what helped respondents overcome barriers to COVID-19 vaccination. All study materials and procedures were approved by the University of Arkansas for Medical Sciences Institutional Review Board (IRB# 262645).

Participant recruitment, consent, and remuneration

Potential participants were recruited in Arkansas between April 22, 2021 and July 6, 2021 when they received a COVID-19 vaccine at outpatient primary care clinics, churches, community events, and outdoor vaccination drive through locations. COVID-19 vaccines were provided to all, including those persons who chose not to participate in the study. Those over the age of 18 who were receiving the COVID-19 vaccine were invited to participate in the study. Consent information was provided in English, Spanish, or Marshallese on sterilized iPads, or participants were given a QR code to access and complete the survey on their own electronic devices. Participant consent was captured using REDCap, a widely used web-based software created for research data capture and management.¹⁹ Those who took part in the study and provided contact information were entered into a raffle to win a $100 gift card. One $100 gift card was given out for each day surveys were completed.

Data collection

Respondents completed the survey using REDCap while they waited for the required 15 minutes of observation after receiving the COVID-19 vaccine. The survey took participants approximately 10 minutes to complete. Participants completed the survey in their preferred language (i.e., English, Spanish, or Marshallese). Bilingual study staff translated text responses to open-ended questions provided in Spanish or Marshallese to English.

Instrument

The survey captured demographics, vaccine hesitancy, and facilitators for overcoming barriers related to the COVID-19 vaccine. Demographic items included age, sex, race/ethnicity, education, marital status, and employment status. Sociodemographic factors were assessed using questions from the Behavioral Risk Factor Survey.²⁰ To assess COVID-19 vaccine hesitancy, we modified a single-item measure of general vaccine hesitancy.^12,21 The survey asked, “Thinking specifically about the COVID-19 vaccine, how hesitant were you about getting vaccinated?” Possible response options were: “not at all hesitant,” “a little hesitant,” “somewhat hesitant,” “very hesitant,” and “prefer not to answer.”

To understand what or who served as facilitators for overcoming barriers to COVID-19 vaccination for hesitant adopters, participants were asked an open-ended question: “What or who helped you overcome any barriers to getting vaccinated?” Respondents wrote a text-based response. The open-ended question allowed respondents to identify facilitators for overcoming barriers to COVID-19 vaccination based on their own perception and insight, without categories pre-determined by researchers.

Study sample

A total of 1,475 valid responses to the survey were collected between April 22, 2021 and July 6, 2021. Of these valid responses, 1,452 provided a response regarding their COVID-19 vaccine hesitancy. Of these respondents, 867 reported being either “a little hesitant” (n = 448), “somewhat hesitant” (n = 269), or “very hesitant” (n = 150) about getting vaccinated, and these hesitant adopters comprise the analytic sample of this study. Any respondent who reported “prefer not to answer” (n = 18) was excluded from analysis.

Qualitative data analysis

The study team used MAXQDA 2020 to analyze and categorize data into key themes. Thematic analysis was done by three qualitative researchers who read and analyzed all responses and created a codebook with emergent primary and subthemes. Data segments were coded and categorized by the first author, and confirmation-coding analysis was performed by two additional qualitative researchers. Initial codes were refined, and the codebook was revised three times. Any differences in data interpretation were discussed by the research team and resolved via consensus. The most illustrative quotes were used to describe and elaborate each thematic domain. Some responses referred to multiple facilitators, and quotes are presented within the themes they represent best. The study team critically reviewed each analysis summary to ensure the data and illustrative excerpts were extracted to the appropriate thematic domain and to ensure analytic rigor and reliability. Once thematic codes were finalized, the study team used MAXQDA code frequencies to calculate the frequency of each primary code out of the total of 867 responses.

Results

Table 1 presents sociodemographic characteristics of participants. The average age of participants was 37 years. A majority were female (60.21%). The sample had substantial racial diversity, with 44.54% of respondents identifying as white, 32.55% as Hispanic/Latinx, 8.46% as Native Hawaiian or Pacific Islander, 6.46% as Black/African American, 4.70% as Asian, 2.35% as Multiracial, and about 1% as American Indian/Alaska Native. There was also a range of education levels, with 37.86% having a four-year degree or more, 23.81% having some college, 25.24% having a high school or GED diploma, and 13.10% having completed less than high school. A slight majority of respondents (52.63%) were not married, and about half (50.61%) were employed full time. Most respondents (51.67%) reported being a little hesitant about getting the COVID-19 vaccine, almost a third (31.03%) reported being somewhat hesitant, and 17.30% reported being very hesitant.

Table 1.

Descriptive characteristics of recently vaccinated Arkansans (N = 867)

	Frequency	% or $\bar{\mathrm{x}}$
Age	867	37.21
18–24	178	20.53%
25–34	219	25.26%
35–44	227	26.18%
45–54	136	15.69%
55–64	84	9.69%
65+	23	2.65%
Sex	862
Female	519	60.21%
Male	343	39.79%
Race/ethnicity	851
American Indian/Alaska Native	8	0.94%
Asian	40	4.70%
Black/African American	55	6.46%
Native Hawaiian or Pacific Islander	72	8.46%
White	379	44.54%
Hispanic/Latinx	277	32.55%
Multiracial	20	2.35%
Education	840
Less than high school	110	13.10%
High school or GED	212	25.24%
Some college	200	23.81%
Four-year degree or more	318	37.86%
Marital status	838
Married	397	47.37%
Not married	441	52.63%
Employment status	816
Full time	413	50.61%
Part time	82	10.05%
Other	321	39.34%
COVID-19 vaccine hesitancy	867
A little hesitant	448	51.67%
Somewhat hesitant	269	31.03%
Very hesitant	150	17.30%

Hesitant adopters reported a variety of people, information, and organizations that helped them overcome barriers to getting vaccinated. Facilitators for overcoming barriers to vaccination fell into four primary groups: 1. social networks (47%); 2. health care infrastructure (12%); 3. individual actions (11%); and 4. employer (4%). An additional 20% of responses explained that hesitant adopters had no barriers or facilitators. These themes represent 94% of responses. The other 6% of responses are comprised of several smaller themes. “Religious community, leaders, and faith” and “traditional media and social media” each comprised approximately 2% of responses and are summarized.

Social networks

Almost half (47%) of hesitant adopters’ responses described social network members who helped them overcome barriers to COVID-19 vaccination. The most common network mentioned was family, followed by friends and broader social networks.

Family

Family was the most frequently mentioned facilitator. Many respondents stated without elaboration that it was “family” who helped them. For example, many respondents wrote brief responses such as “my family,” “my parents and siblings,” and “spouse.” Among respondents who described how family helped them overcome barriers to vaccination, there were two primary themes: 1) family influence and 2) family got the vaccine.

Family influence

Respondents described influence from family members ranging from friendly encouragement and support to pressure to get the COVID-19 vaccine. Some respondents reported receiving encouragement and support, noting, “my son encouraged me to take the vaccine” and “family support.” One respondent shared, “my family providing the funds to help me go and get the shot gave [me] the support I needed.” Some respondents were influenced by family members who work in health care, noting, “my mom – she’s a nurse” and “son is an RN, daughter doctor, family helped.” Others described more direct pressure from family to get vaccinated. Respondents reported “pressure by loved ones,” “my family would pester me,” and “my mom made me come and if she didn’t then I wouldn’t be here.”

Notably, women family members were mentioned more than twice as often as men, suggesting women play a more active role in influencing and convincing hesitant family members to get vaccinated. For example, one man shared, “my wife. I was a little hesitant but she pushed me to get it for the kids and the elders around me that I really respect.” Another said plainly, “my wife asked me to stop being such a hard ass.” One young woman said, “my mom urged me to,” while another explained, “my mother, because I didn’t want to get the vaccine until she told me I can’t travel anywhere without it and because it will be safer for the community for me to take the Covid-19 vaccine.” While men family members were also mentioned, women family members appeared more often as key facilitators of vaccination for hesitant family members.

Family got the vaccine

Some hesitant adopters reported being influenced by family members who already received the vaccine or got the COVID-19 vaccination along with them. Family members who had already been vaccinated were key for some, with respondents noting, “my mom and my sister who have already received the vaccine” and “family members who had already gotten theirs.” Others described getting vaccinated as a family decision or event. One man explained, “my wife and I decided,” while a woman noted it was a “family decision.” One young man stated, “what helped me was my father wanting to also get vaccinated, so we could go together.” A young woman shared, “my mom and sisters took it with me. Also, my aunt was there too to support.” Viewing COVID-19 vaccination as a family norm or decision was key for these hesitant adopters.

Friends

Friends were also key facilitators for some hesitant adopters. Similar to the theme of family, many respondents simply stated that friends were the ones who helped them without elaboration. Many wrote “friend” or “friends,” with some reporting “peers” or “roommate.” Among respondents who described how friends helped them overcome their barriers to vaccination, two key themes emerged: 1) friends’ influence and encouragement and 2) friend facilitated scheduling.

Friends’ influence and encouragement

Respondents cited influence and encouragement from friends, including friends who work in health care, as helping them overcome their barriers to COVID-19 vaccination despite their hesitancy. One woman noted, “my friends encouraged me to get it,” while another respondent was influenced by “a friend telling me to do it for others not myself.” Others were influenced by friends who work in health care, naming “friends in the medical profession who I’ve seen post or discuss info about it,” “nurse friends,” and a “friend who works at [local health care provider]” as influencing their decision to get vaccinated.

Friend facilitated scheduling

Friends appeared to play an important facilitation role for hesitant adopters. Several respondents reported friends provided key information that helped them schedule their COVID-19 vaccination. Respondents explained, “a friend of mine sent a link to me for a vaccination clinic near me,” “my roommate showed me how to do it,” and “a friend shared the number to get scheduled. I hadn’t heard about it and had been stressing over finding an opening.” For some, help from friends went even further: respondents noted, “Friend called for me” and “Friend sent me a link and went with me to get vaccinated.”

Broader social networks

Social norm

For some respondents, knowing that others in their network had received the COVID-19 vaccine was a key facilitator. “Knowing that others had done it” helped them make the decision to get vaccinated. Respondents shared, “other people I know that got vaccinated before me,” “people who got vaccinated,” and “fellow people who have gotten the vaccine.” One person was influenced by “seeing all the health care providers getting it and others.” For these hesitant adopters, seeing others get the COVID-19 vaccination as something increasingly normal and common was key.

Talking with others who got vaccinated

Respondents noted that hearing the experiences of others who received the COVID-19 vaccine was the key factor in their decision to get vaccinated. For some, this exchange of information was important in assuaging their concerns regarding the vaccine and its side effects. One woman explained, “I delayed getting the vaccine at first but over the first few months [I] talked to others who had gotten the vaccine and decided I should get vaccinated. Talking to people who had received the vaccine was helpful to help ease some my concerns and questions I had.” Others similarly noted what helped them was “hearing from those that were vaccinated” and “several others getting it with little side effects.” For one woman, hearing from vaccinated people relieved her anxiety related to potential side effects: “I had a lot of anxiety about the vaccine because I heard it could make you sick and I have a weak immune system, but I spoke with people who had similar conditions and said they had no symptoms after the shot.”

No barriers or facilitators

Twenty percent of responses stated that nothing or no one helped them overcome any barriers to COVID-19 vaccination, or they had no barriers in the first place. Many simply replied “no one” or “nothing” in response to the question about who or what helped them overcome barriers. Others explained they did not face any barriers to vaccination, stating for example, “I didn’t feel like there were any barriers,” and “I did not experience any barriers to getting the vaccine.”

Health care infrastructure

Approximately 12% of responses described health care infrastructure as what helped them overcome barriers to getting vaccinated. There were two key themes related to health care infrastructure: 1) health care organization made convenient and 2) health care professional(s).

Health care organization made convenient

Participants expressed that the convenience and ease of access provided by health care organizations facilitated their COVID-19 vaccination process. Participants identified drive-through vaccination clinics and highly visible signage advertising vaccine clinics as factors that made getting vaccinated convenient and easy. One woman said, “UAMS [University of Arkansas for Medical Sciences- academic medical center] made it easy. I’m glad I drove by and saw the signs,” while another person recalled, “I saw the … flags (COVID 19 VACCINE DRIVE THRU) while driving.” Several people praised drive-through clinics, finding this option both safe and accommodating of busy schedules. One woman explained, “the drive-thru vaccine clinic allowed me to get the vaccine at my convenience without being exposed to other parties,” while another woman said, “the drive through was so convenient for me since I work in a law firm it’s hard to always leave for appointments. It was quick and super easy.” For others, the wide availability of appointments at local health care providers facilitated their vaccination, with one woman noting the clinic where she was vaccinated “provided vaccination appointments for times that accommodated my work schedule, which was a problem with other places I looked at.” Some respondents explained language interpretation offered by a local health care provider made vaccination accessible, noting, “Marshallese interpreters” and “the hotline in Spanish was A LOT OF HELP!.”

Health care professionals

For some hesitant adopters, it was a health care professional, such as a doctor, nurse, a child’s pediatrician, or staff, who helped them overcome their barriers to getting vaccinated. For some hesitant adopters, a conversation with their doctor was key. “My primary care physician was key in convincing me,” reported one woman, while two others shared, “my Dr explained everything and answered all my questions” and “somewhere I heard [it] caused infertility issues after talking to my Dr I felt better as well as getting the Pfizer vaccine.” Some hesitant adopters discussed that the facilitation of health care professionals continued throughout the process as they or their child received the vaccination and identified vaccination site workers specifically as helping them overcome their hesitancy. Respondents identified, “the staff of the site that I took the vaccines from” and “those working where I got vaccinated” as helpful to them. One woman shared, “my daughter, 15, getting the vaccine is afraid of needles. Nurses were fabulous!” Another stated, “the staff giving the vaccines were very helpful!”

Individual actions

About 11% of responses described getting vaccinated as an individual process and decision. In other words, they acted as their own facilitator. Individual actions fell into two main themes: 1) decided by self and 2) personal research.

Decided by self

Several respondents named themselves as the person who helped them overcome their barriers to COVID-19 vaccination. These respondents stated they were not influenced or helped by anyone; getting vaccinated was their own decision. Some respondents referred to themselves, writing for example “myself,” “me myself and I. I make my own mind up about things,” and “my own mind!!!” Others were clear that it was an individual decision, noting for example, “I decided myself to get vaccinated,” “it was my personal decision,” and “no one, I went by my own volition.” Others characterized overcoming barriers as an individual process of overcoming one’s own doubts about the vaccine. For example, some stated, “the only barrier was being unsure if I actually wanted to get it, so it was all just an internal conflict,” and “just made up my mind to.”

Personal research

Some respondents shared that doing their own research about the COVID-19 vaccine helped them overcome their hesitancy about vaccination. Hesitant adopters stated, “I did research” and “studies and doing research on everything about it.” Some respondents described doing research using academic and other official sources of information. They were helped by “researching information on its efficiency and safety for immunocompromised people,” and “doing more research on what is in the vaccine and how it works to combat the Corona Virus.” Others expressed some skepticism toward available information and the vaccine itself, yet doing their own research nonetheless facilitated their decision to get vaccinated. For example, one woman was helped by “my own research, there was like non-propaganda resources though. Just provide facts good and bad,” and another reported, “my own research, however there is hesitancy regarding how quickly the vaccine was created and tested.”

Employer

Approximately 4% of responses named an employer as the entity that helped them overcome barriers to COVID-19 vaccination. Some respondents simply stated “my workplace” and “work at Sam’s Club.” A few respondents mentioned being influenced by their workplace, stating for example, “the pressure I felt from work and protecting others” and “decided to go ahead and get since … need to travel for work.” As described below, most explained their employer actively facilitated their vaccination by offering sign-up information and on-site vaccination opportunities.

Employer facilitated vaccination

Respondents explained that their employer facilitated their COVID-19 vaccination by providing information on appointments or bringing a vaccination event to the workplace. Participants articulated that information from their employer gave them the encouragement they needed, with one woman saying, “my company sent me the link to the … site. I probably wouldn’t have had the drive to go find vaccine info myself.” Another remarked, “my workplace helped me find how where I would be able to get my vaccination and sent [link] to make the appointment.” For others, their employer hosting a COVID-19 vaccine event at their place of employment was key. One man shared, “venue being at my workplace, multiple communications from work about how to register, flexible timing, limited paperwork, minimal steps to the process (from arrival to departure),” while another simply stated, “having the vaccine at my workplace.”

Other facilitators

While considerably less than other themes, religious community, leaders, and faith were identified in 2% of responses, and traditional media and social media were named in an additional 2% of hesitant adopters’ responses regarding what or who helped them overcome barriers to COVID-19 vaccination, representing 4% of total responses.

Religious community, leaders, and faith

Some respondents named their church communities, leaders, or personal faith as helping them overcome barriers to COVID-19 vaccination. One woman explained, “because of an announcement made at the Catholic church;” others noted, “at my church” and “the priest at St. Raphael.” For some participants, their faith in God helped them decide to get vaccinated. One woman shared that she “prayed about it and my lord Jesus Christ gave me peace.” Others similarly said, “praying to God about it,” “God helped me,” and “I’m still not sure but praying it works for everyone.”

Traditional media and social media

Information from the media, including social media, was a source of help for some hesitant adopters. Responses suggest the media was helpful both in providing information about the COVID-19 vaccine itself, as well as communicating information about vaccination opportunities. Respondents wrote, “data available from news and social media” and “media inspired confidence in me to get vaccinated,” as well as “information on social media” and “Facebook helped a lot with vaccine pages.” These hesitant adopters perceived information from traditional media and social media as trustworthy and helpful in their decision to get vaccinated. Others noted, “it was on the local news,” “I saw this mobile unit advertised on tv,” and “I honestly found out about getting vaccinated here through social media,” suggesting respondents learned about vaccination opportunities through local news and social media accounts.

Discussion

The results of this study demonstrate that a range of individuals, organizations, and information helped hesitant adopters overcome their barriers to COVID-19 vaccination. The most frequently identified facilitators were social networks, with almost half of participants identifying family, friends, and broader networks as important in helping them overcome barriers and get vaccinated. This aligns with past research showing social networks influence members’ vaccination uptake through encouragement, example, and actions such as scheduling appointments on their behalf.²² Our finding that women were particularly influential in family members’ vaccine uptake is consistent with existing knowledge that women are most often the health care decision makers for their families.²³

In addition to overt facilitation from friends and family, our results show social networks may influence COVID-19 vaccine uptake among members through social norms and contagion (i.e., influence across social networks).²² Social norms can influence vaccine behavior as people fit their activities to the behavior and expectations of those around them. For example, a recent study found that 52% of people who knew someone who had been vaccinated against COVID-19 reported they would get the vaccine “as soon as they can,” compared to 37% of those who did not know someone who had been vaccinated.²⁴ The current study contributes to the literature as it provides a more nuanced understanding into the power of social networks specifically for COVID-19 vaccination.

Hesitant adopters reporting health care organizations and professionals as helpful aligns with research showing health care providers are key influencers of vaccination.^11,25–27 The patient-provider dyad is the traditional setting where vaccine uptake is discussed and promoted.²² Health care providers who are confident about vaccines and recommend them to patients can increase vaccination uptake.^25–27 One study found that the most frequent reason parents changed their minds about delaying or refusing vaccines for their children was information or assurances from a health care provider.²⁸ Our findings suggest health care professionals have significant influence over the vaccination decisions of both their patients and their personal contacts.

Some hesitant adopters reporting that they decided for themselves or did their own research (i.e., framing vaccination as their personal choice) reflects the “democratization of information and cultural norms that demand individuals take personal responsibility for their health” and “decide what feels safe, ethical and scientifically sound.”²⁹ Rather than accepting expert advice or viewing vaccination as a public health imperative, many people approach vaccines as consumer products, evaluating which ones “feel safe and relevant to them.”²⁹ Conducting one’s own research also fits with past literature showing that individuals with higher levels of knowledge about a vaccine are more likely to get vaccinated.³⁰

Employers serving as facilitators by providing scheduling information and vaccination clinics at the workplace aligns with past research showing that vaccination promotion efforts by employers and providing vaccination opportunities on site can significantly increase vaccine uptake among employees.^31–33

Finally, hesitant adopters identifying church communities, leaders, and personal faith as facilitators is consistent with previous research suggesting faith communities and leaders can promote vaccination by building on established trust between congregates and church leaders.³⁴ Further, our findings regarding the influence of social media contributes to a growing body of research showing social media shapes vaccine attitudes.³⁵ However, while most research has focused on social media’s potential to promote vaccine hesitancy,^35,36 our findings show social media can also influence vaccination adoption. Our finding indicating local news and local social media accounts helped hesitant adopters find vaccination opportunities was not reflected in current literature. Utilization of local news media and local organizations’ social media accounts may be an under-acknowledged strategy for promoting vaccination.

This study is not without limitations. Respondents comprised a nonrandom sample of hesitant vaccine adopters; thus, the sample may not be representative of the entire population of hesitant adopters. We were unable to follow-up with respondents to probe for clarification regarding their open-ended responses. Despite these limitations, this study contributes to knowledge on vaccine hesitancy as the first qualitative article to examine who and what facilitated vaccine hesitant people to get a COVID-19 vaccine. The analysis is strengthened because it drew from a socioeconomically and racially diverse sample of hesitant adopters in Arkansas, a state with high rates of vaccine hesitancy and low vaccine coverage compared to other U.S. states.

These findings have important implications for the effort to address and overcome barriers to vaccination, including hesitancy, among the U.S. population. Our findings suggest that a person’s social networks play an important role in influencing an individual to get vaccinated. On the other hand, given the similarities and norms within social networks, one significant challenge may be addressing hesitancy among social networks whose members are highly hesitant or opposed to vaccines.^37,38 Our findings around individual actions as facilitators suggest that public health organizations should ensure easily understandable scientific information is readily accessible to the public, as many hesitant adopters seek out and evaluate information before deciding to get vaccinated. Our findings demonstrate health care providers must present clear, accessible information about the COVID-19 vaccines and express their own confidence in vaccines, as they are important influencers of both their patients and personal contacts. The study’s findings also suggest health care organizations should make vaccination events highly visible and convenient for community members. Drive-through locations, for example, were praised as being easy to find and accommodating to busy schedules. Further, our findings suggest employers should share vaccination scheduling information with their employees and host vaccination events on-site. Religious communities and leaders, news media, and social media platforms should leverage the trust and influence they have with their members and audiences to provide accurate information about vaccines and how to get vaccinated.

These findings demonstrate that vaccine hesitancy and vaccine uptake co-occur.^12,13 Further, these findings support the argument that vaccine hesitancy has no universal solution.³⁹ Rather, addressing hesitancy will require informed, multifaceted efforts by governments, health care providers, employers, community institutions (e.g., churches), media, and individuals to provide the information, influence, and access necessary to successfully increase COVID-19 vaccine uptake.

Funding Statement

The community engagement related to this research is supported by University of Arkansas for Medical Sciences Translational Research Institute funding awarded through the National Center for Research Resources and National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) (UL1 TR003107); Rapid Acceleration of Diagnostics (RADx) (NIH 3 R01MD013852-02S3); and Community Engagement Alliance (CEAL) Against COVID-19 Disparities (NIH 10T2HL156812-01). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Disclosure statement

No potential conflict of interest was reported by the author(s).