Abstract
The purpose of this submission to respond to a Letter to the Editor recently submitted regarding our manuscript, “Exploring COVID-19 Vaccine Hesitancy among Stakeholders in African American and Latinx Communities in the Deep South through the Lens of the Health Belief Model” published in the American Journal of Health Promotion in February, 2022. The manuscript reported on a study that had as its purpose to qualitatively explore perceptions related to COVID-19 vaccination intention among African American and Latinx participants and suggest potential intervention strategies.
Keywords: interventions, underserved populations, specific populations, qualitative research, research methods, health disparities, health communication, racial minority groups, underserved populations, specific populations
Dear Dr. Terry,
We would like to thank Andrea W. Stubbs, Sanjaya Regmi, Kenneth D. Ward for their interest in our paper, “Exploring COVID-19 Vaccine Hesitancy Among Stakeholders in African American and Latinx Communities in the Deep South Through the Lens of the Health Belief Model.” The authors have made suggestions on issues related to design, and we appreciate the chance to respond to those points.
To begin, the manuscript emerged as part of our response to a global pandemic, with the stated purpose being “to explore perceptions related to COVID-19 vaccine intention among African American and Latinx community members and stakeholders across two urban counties and one rural county in Alabama, and to suggest potential intervention strategies based on these perceptions.” At the time of data collection (December 2020), no vaccine had been approved for emergency use by the FDA.
The authors suggest that a deductive approach, “in which constructs are specifically queried,” could yield “richer data on theory” as opposed to the inductive method we chose. Inductive approaches are often utilized when researchers are studying something new as a way to understand a phenomenon without coming in with preconceived notions that may bias the data. 1 In December 2020, with the landscape of COVID-19 continuously changing, we wanted to provide space to listen to our target audience. We used a semi-structured focus group guide that examined barriers and facilitators to preventive health practices, testing, vaccination, and clinical trials, and the manuscript explores themes that emerged with regard to vaccination. We considered multiple theories as we constructed the guide, including socioecological models and individual behavior change theories, but did not want to choose a theory a priori because we wanted primarily to hear the perspectives from our community members and allow themes, including those related to theory, to emerge. The authors of the letter suggest that “This inductive approach allowed novel themes to be assessed.” This was exactly our goal. True to inductive research, based on the themes we identified, the Health Belief Model (HBM) emerged as a reasonable way to examine the data to inform intervention design.1,2 We prioritized the exploration of novel themes because we felt this was crucial to intervention development in the unique social and political context of a pandemic that the world had not experienced in a century.
Stubbs, Regbi, and Ward question how we operationalized the “benefits” section of the HBM. As indicated in the “Perceived Benefits/Facilitators” box, the benefits construct includes not only the perceived benefits themselves but also the factors that facilitate the perception of benefits. Other authors too have included facilitators in their representations of the HBM.3,4 In hindsight, it may have been more appropriate to include facilitators under “Cues to Action” or in their own box pointing to benefits.
We agree with the suggestion that researchers should “consider assessing multiple theories in the same qualitative study,” and that we should have examined levels of influence beyond the individual. However, this manuscript represents only one piece of our study. Whereas we recognize that social and structural determinants are crucial to understanding health status and health disparities, we must make decisions about how to focus each paper, particularly given space limitations. Since the main goal of our research was to design interventions that can decrease the immediate harm of COVID-19 in marginalized communities, we felt the HBM was appropriate. Conceptual frameworks examining social and structural determinants, while important, were beyond the scope of this particular manuscript.
The authors’ last point suggests that we did not enroll representative members of targeted communities, due to our focus on stakeholders and the use of the online platform, Zoom. We acknowledged in the Limitations section that “Residents in vulnerable communities who are not leaders may have different perspectives.” However, we utilized a snowball sampling approach to recruit participants through our community partners who were well connected in the communities they serve. This yielded a sample that was disproportionately female, which, we agree, is a limitation. However, most of our participants did live in the respective communities. Finally, we used the online platform Zoom to conduct our focus groups as we were respecting public health and university guidelines at the time when vaccines were not yet available, and we found in an earlier study that took place in the same communities that all individuals we recruited had access to the internet. 5
We appreciate the interest in our article and the opportunity to respond. The points made by Stubbs, Regbi, and Ward provide for an interesting discussion related to differences in approaches based on research goals.
Sincerely,
Lori Brand Bateman, PhD, School of Medicine,The University of Alabama at Birmingham,MT 623, 1720 2nd Ave South,Birmingham, AL 35294.
Allyson G. Hall, William A. Anderson, Andrea L. Cherrington, Anna Helova, Suzanne Judd, Robert Kimberly, Gabriela R. Oates, Tiffany Osborne, Corilyn Ott, Melissa Ryan,Christian Strong, and Mona N. Fouad
Footnotes
Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was funded through a grant from NHLBI, # OT2HL156812 (Lead Principal Investigator: Mona N. Fouad).
References
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