Ole Miss Vax Hesitancy presentation PDF

Vaccine Hesitancy in Rural Communities Delesha Carpenter, PhD, MSPH Abigail Gamble, MA Objectives 1. Provide background on COVID-19 in rural communities 2. Define vaccine hesitancy 3. Share survey results about COVID-19 vaccine challenges in rural areas 4. Practice communication techniques to addres...

Vaccine Hesitancy in Rural Communities Delesha Carpenter, PhD, MSPH Abigail Gamble, MA Objectives 1. Provide background on COVID-19 in rural communities 2. Define vaccine hesitancy 3. Share survey results about COVID-19 vaccine challenges in rural areas 4. Practice communication techniques to address vaccine hesitancy Background DEFINING RURAL Defining rural Federal definitions ◦ Rural-Urban Commuting Areas (RUCAs) ◦ Federal Office of Rural Health Policy (FORHP) ◦ Core-Based Statistical Areas (CBSAs) ◦ CDC Rural Classification Scheme ◦ Rural Continuum Codes (RUCSs) ◦ Urban Influence Codes (UICs) ◦ Urban Areas and Urban Clusters (UAs/UCs) ◦ Frontier and Remote Access Codes (FAR) Rural population varied from 75.5 million Agreement in definition of rurality Long et al. Which Definition of Rurality Should I Use? Medical Care 2021;59: S413–S419. What about Mississippi? Long et al. Which Definition of Rurality Should I Use? Medical Care 2021;59: S413–S419. Background RURAL-CP Rural Research Alliance of Community Pharmacies (RURAL-CP) The first multi-state practice-based research network exclusively for rural community pharmacies. Mission: To reduce rural health disparities by supporting high-quality implementation research with rural community pharmacies. 7 southeastern states: Alabama, Arkansas, Georgia, Mississippi, North Carolina, South Carolina, Tennessee 139 rural community pharmacies Independent, grocery store, regional, & some national chains https://ruralcp.web.unc.edu/ Recruitment began shortly before the pandemic started www.ruralcp.web.unc.edu How we (initially) defined rural RUCA codes consist of measures of population density, urbanization, and daily commuting from U.S. census data. There are 10 primary codes. https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/documentation/ Guess the RUCA? Limitations: St. Matthews, SC Guess the RUCA? Limitations: Atkinson, NC Find a rural pharmacy https://www.ruralhealthinfo.org/am-i-rural Background DEFINING VACCINE HESITANCY COVID-19 disproportionately affected rural areas Early in the pandemic, two times the number of COVID-related deaths as urban areas1 High prevalence of risk factors, including older age, obesity, and diabetes2 Lack of health services infrastructure2 Community pharmacies increase access to COVID-19 vaccination & treatment Pharmacists have been critical in the U.S.’s rapid vaccine roll-out strategy3 Nearly 68,000 community pharmacies4 Most accessible health professional in rural areas What is “vaccine hesitancy”? Vaccine hesitancy is defined as a “motivational state of being conflicted about or opposed to getting vaccinated.”5 Brewer et al. Increasing Vaccination: Putting Psychological Science Into Action. Psychol Sci Public Interest. 2017;18(3):149-207. Vaccination rates https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-people-booster-percent-pop5 Vaccine hesitancy in rural communities Lower intentions to vaccinate 29% of rural residents would not get the COVID vaccine vs. 16% of urban residents Lower vaccination rates in rural states https://www.covidstates.org/reports/covid-19-vaccine-rates-and-attitudes-among-americans. COVID-19 vaccine hesitancy by county Early April 2021 Early June 2021 https://vaccine-hesitancy.healthdata.org/ https://vaccine-hesitancy.healthdata.org/; https://covid.cdc.gov/covid-data-tracker/#vaccine-delivery-coverage The Behavioral and Social Drivers (BeSD) of COVID-19 Model https://apps.who.int/iris/handle/10665/339452 Brewer NT. What Works to Increase Vaccination Uptake. Academic Pediatrics. 2021;21:S9-S16. Data TWO SURVEYS OF RURAL COMMUNITY PHARMACIES Emailed link to 10-min online survey Survey Procedures Open from Dec 2020 to March 2021 $25 incentive Two reminder emails Measures ▪ ▪ ▪ ▪ ▪ Demographics and pharmacy characteristics Ability to deliver COVID-19 vaccines Barriers to deliver COVID-19 vaccines Pharmacists’ vaccine hesitancy Vaccine training preferences Sample Characteristics (N=69) Age N(%) 18-29 30-39 40-64 65+ 5(7%) 16(23%) 39(57%) 9(13%) Gender Female Male Non-binary or transgender Prefer not to answer 31(45%) 36(52%) 1(1%) 1(1%) Race/ethnicity Black or African American White or Caucasian Prefer not to answer 3(4%) 63(91%) 3(4%) BSPharm PharmD Other Did not answer 22(32%) 44(64%) 1(1%) 2(3%) Single independent Mult. independents Grocery store or regional chain National chain 37(54%) 24(35%) 6(9%) 2(3%) Highest level of pharmacy education Type of pharmacy Carpenter et al (2022). Rural community pharmacists’ ability and interest…. JAPhA, 62(4), 1379-1383. Patient-level barriers to providing vaccine (N=69) Mean SD Patients refusing because they are concerned about long-term safety 3.72 1.2 Patients refusing because they do not trust the vaccine 3.72 1.1 Patients refusing because they are concerned about immediate adverse reactions 3.49 1.1 Patients refusing because they do not think they need it 3.03 1.0 Patients not coming in for a second dose Patients refusing because they are concerned about its efficacy 2.76 2.68 1.2 1.2 Patients refusing because they feel they are not susceptible to COVID-19 2.62 1.2 Patients refusing because they feel COVID-19 is not a severe illness 2.51 1.1 Patients being too busy to discuss the vaccine with the pharmacist Patient preferring to go to a non-pharmacy setting, such as medical clinic 1.83 1.72 0.9 1.0 * 1=not a barrier; 2=slight barrier; 3=somewhat of a barrier; 4=moderate barrier; 5= extreme barrier Carpenter et al (2022). Rural community pharmacists’ ability and interest…. JAPhA, 62(4), 1379-1383. Specific fears voiced by patients Infertility Fear of being injected with COVID-19 Don’t trust the COVID vaccines Don’t trust the government, concerned about tracking/microchips Don’t believe it’s needed or question effectiveness of the vaccine Worried about immediate and long-term side effects Carpenter et al (2022). Rural community pharmacists’ ability and interest…. JAPhA, 62(4), 1379-1383. Pharmacist vaccine hesitancy 1 Not at all 2 A little ___ Wanted to get the vaccine ___ Trusted the vaccine ___ Thought getting a vaccine would protect others 3 Moderately 4 Very much 62% thought their family and friends would want them to get a vaccine Carpenter et al (2022). Rural community pharmacists’ ability and interest…. JAPhA, 62(4), 1379-1383. Pharmacist vaccine hesitancy: Safety How safe for you? 1 Not at all safe 2 3 4 Very safe 3 4 Concerned How concerned about having a serious reaction? 1 Not at all concerned 2 Carpenter et al (2022). Rural community pharmacists’ ability and interest…. JAPhA, 62(4), 1379-1383. Booster Survey Procedures Emailed link to 10-min online survey Open from Feb 2022 to March 2022 $50 incentive Two reminder emails Measures ▪ ▪ ▪ ▪ ▪ Whether pharmacists were offering booster Communication with patients about booster Barriers to administering COVID-19 vaccines Impact of COVID-19 vaccinations on pharmacies Pharmacists’ own COVID-19 vaccine status Results Yes Pharmacies offering the COVID-19 booster (n=80) Not currently, but plan to No and don't plan to 22 20 85% reported currently offering COVID-19 boosters 18 16 14 12 10 5% were not offering but planned to 8 10% did not plan to offer 6 4 2 0 Pharmacists’ own COVID-19 vaccination status South Carolina n % Completed the primary series and received a booster 42 52.5 Completed the primary series but not the booster 26 32.5 Haven’t received any COVID-19 shots 12 15.0 Alabama North Carolina Arkansas Georgia Tennessee Mississippi Of 12 pharmacists at pharmacies not currently offering the booster, 5 had been vaccinated and 1 was vaccinated and boosted Gamble et al. (2023). COVID-19 booster vaccination in rural community pharmacies. Vaccine, 41(5), 999-1002. Pharmacist reasons for not receiving the booster (n=26) n % Had COVID-19 disease – not eligible or don’t believe it’s needed 11 42.3 Not yet due for the booster 4 15.4 Concerned about side effects 3 11.5 Not needed because healthy and not high risk 3 Haven’t found the time Patient concerns about the booster (n=68) n % Side effects 56 82.4 Ineffectiveness against new variants 42 61.8 Not needed because of “natural immunity” 32 47.1 11.5 Not needed because the primary series is sufficient 19 27.9 2 7.7 Pregnancy or breastfeeding concerns 11 16.2 No longer trust CDC guidelines 1 3.8 Believe it’s ineffective against new strains 1 3.8 No reason 1 3.8 Gamble et al. (2023). COVID-19 booster vaccination in rural community pharmacies. Vaccine, 41(5), 999-1002. The impact of COVID-19 vaccinations on rural community pharmacies Positive Increased foot traffic “COVID-19 vaccinations have allowed pharmacies to prove their value and meet a significant need during the pandemic. Moving forward, I believe patients will look to pharmacies more for routine immunizations…it has become a much needed financial boost when many pharmacies needed it the most. Actually being paid our value was nice for a change.” Increased workload Negative “Since vaccinations have become available we have had to deal with workflow issues. We are a small pharmacy and only have 3 employees and only 1 pharmacist at any given time. The vaccines have caused our workflow and wait times to increase.” Time burden/strain on workflow Gaining new customers Boosted revenue Increased respect of pharmacy profession Need for additional staff Added stress, feeling overwhelmed Gamble et al. (2023). COVID-19 booster vaccination in rural community pharmacies. Vaccine, 41(5), 999-1002. Addressing Vaccine Hesitancy ASORT ASORT Development Stakeholder Panel 4 rural pharmacists COVID-19 vaccination expert Pt-provider communication expert Implementation scientist Educational design team Website designer Iterative Training Development Process Present Results Analyze data Share findings Prioritize Content Select barriers to address Draft Content Module Video scripts Review & Revise Share drafts Revise Iterative Training Development Process Present Results Analyze data Share findings Prioritize Content Select barriers to address Draft Content Module Video scripts Review & Revise Share drafts Revise Iterative Training Development Process Present Results Analyze data Share findings Prioritize Content Select barriers to address Draft Content Module Video scripts Review & Revise Share drafts Revise A S O R T Ask if they would like to receive a COVID vaccine Solicit their main vaccine concern Offer to address their concerns Recommend the vaccine Try again later if they refuse or are unsure A Ask if they would like to receive a COVID vaccine S Solicit their main vaccine concern O Offer to address their concerns R Recommend the vaccine T Try again later if they refuse or are unsure ASORT demonstration (video) Apply what you learned Practice responding to patient vaccine concerns Rural communities are negatively impacted by COVID-19 and have higher levels of vaccine hesitancy than urban communities Key take-aways Community pharmacists are well-positioned to address vaccine hesitancy and increase vaccine uptake in rural communities Pharmacist messaging around COVID-19 vaccines needs to account for the unique concerns of rural populations and conversations should be tailored accordingly Contact information Delesha Carpenter ◦ [email protected] ◦ @LeshaCarpenter Additional Sources Cited 1. B. J and J. K. The Changing Geography of COVID-19 in the U.S. Pew Research Center. 2020. 2. Souch JM, Cossman JS. A Commentary on Rural-Urban Disparities in COVID-19 Testing Rates per 100,000 and Risk Factors. J Rural Health. 2020. 3. Maidment J, et al. 2021. Rapid realist review of the role of community pharmacy in the public health response to COVID-19. BMJ Open, 11(6): e050043. Published online 2021 Jun 16. 4. Qato DM, Zenk S, Wilder J, Harrington R, Gaskin D, Alexander GC. The availability of pharmacies in the United States: 2007-2015. PLoS One. 2017;12(8):e0183172. 5. Brewer NT, Chapman GB, Rothman AJ, Leask J, Kempe A. Increasing Vaccination: Putting Psychological Science Into Action. Psychol Sci Public Interest. 2017;18(3):149-207.