Table 2.

Quotations of HBPC Team Members Illustrating the Emerging Themes

Vaccine Communication and Education
Developing and identifying resources to prepare staff	[PD; site 29] “We took great pains to present the materials in a way that offered hope as well as presenting it in a way that would be accepted and understood. We ensured everyone knew we are always here for more information.” [Psychologist; site 60] Our ID clinic has done a great job of providing education about the vaccine to all staff, with power-points that we then have shared with Veterans/caregivers who had questions. [OT; site 11] With the daily briefings from the VA, I felt well prepared with the most up-to-date information each day. [RN; site 48] The COVID-19 vaccine was scary to most of the veterans, because it happened so fast. Educated on the facts, per CDC guidelines. The experience was positive, once they were educated on the facts. [PT; site 8] Would have preferred more talking points be shared with staff to provide a more uniform front from VA staff to Veterans.
Team members discussed the COVID-19 vaccine with enrolled Veterans	[SW; site 55] As a Social Worker, I limited my interaction to inquiring if they were interested in getting the vaccine and when it was a yes, I would enter the COVID-19 interest note and add the HBPC RN to the note for awareness. Most of the Veterans I spoke with about it were interested and willing to get the vaccine. [Dietician; site 55] The vaccination and questions associated are largely out of my scope of practice therefore I defer questions to the RN or ARNP. [RN; site 50] Providers and pharmacy go into great detail with the COVID vaccine, so when it comes my turn I usually just verify what the veteran repeats from their previous education on the vaccine and I go over the COVID vaccine handout with them.
Receptivity of Veterans to receiving the vaccine	[Psychologist; site unknown] “We have some Veterans who historically refuse all vaccines who refuse this one as well. We have folks who have understandable vaccine hesitancy, which we talk about openly…that there are legitimate reasons for BIPOC [Black, Indigenous, and people of color] to be hesitant, and lingering resentment from some military members being forced to take vaccines they didn't want or understand.” [Medical Director; site 9] The Veterans have been very grateful to obtain the COVID-19 immunizations, but about 20% have declined. However, these are the very same Veterans who never want to get the seasonal influenza, tetanus booster, shingles or pneumococcal vaccines.
Building on relationships between HBPC team members and HBPC-enrolled Veterans	[Psychologist; site unknown] Most people have been more interested in my own personal or anecdotal information about responses to the vaccine, rather than the data.… Personal anecdotes have been the biggest facilitator. [Psychologist; site 50] “Beliefs that COVID is not real and/or worry about detrimental long-term effect[s] of vaccine were not often reduced with psychoeducation alone. It often required frequent repetition and [the] Veteran having had a long positive history with HBPC program and respect for providers and staff.”
Advocating for Prioritizing HBPC Veterans' Vaccinations
	[HBPC Program Director; site 10] The HBPC medical director initially got a little hesitancy regarding the staff vaccinating in the home but ended up being fully supported by the facility leadership and praised for such a seamless job.
Access: Teamwork and Attention to Vaccine Logistics
Vaccine logistics	[Role not provided; site 55] [Our VA] Facility did not allow Pfizer to be given in the home so we had to get the Moderna vaccine which was stored at a different site about two hours away. This was very challenging to coordinate with limitations of the need for cold storage and time after opening a vial. Also, Pharmacy would not pre-fill vaccines therefore giving the entire vial to us so we also had to make sure we used the entire vial in 1 day (at least 10 doses needed to be coordinated within a 6-hour period), which meant the need for multiple staff to be used in order to drive to each Veteran's home to administer vaccine. [NP; site 15] No barriers—vaccine readily available and I have vaccinated (both doses) every patient on my panel who wanted the vaccine. Our HBPC leadership really worked VERY well with pharmacy in getting the vaccines to the HBPC NPs early on so that we could go vaccinate our patients [RN; site 47] “The VA began to do vaccine clinics at the CBOCs so we could have the vaccine we needed for that day delivered to the CBOC.”
Pride in HBPC team's success	[PD; site 27] Our program was the 1st in the nation to conduct in-home vaccinations. It was a combined effort from pharmacy, leadership, and my staff! [PD; site 11] This was a great opportunity to discuss what the VA was doing to protect them and their loved ones with the vaccines available and the value the Veteran/caregiver have for the team. The greatest is the opportunity to offer the vaccine in the home for the ones that have no ability to leave the home but have providers coming in and out—they may spread the virus to them unknowingly. [RN; site 46] We worked very closely with our support personnel to diagram which Veterans were to receive the vaccines due to the logistics of giving the vaccines within the time allotted. This was accomplished with no waste; however, it was certainly a TEAM effort.

ARNP, Advanced Registered Nurse Practitioner; CBOC, community-based outpatient clinic; CDC, Centers for Disease Control and Prevention; ID, infectious diseases.