Ensuring strong demand for vaccination is critical to ending the COVID-19 public health emergency. However, demand for vaccination among communities who identify as Black, Indigenous, or people of color (BIPOC) has been lower than for White people, despite the increased COVID-19 vulnerability for BIPOC communities. Contributing to this challenge is the BIPOC communities’ distrust of government, researchers, and health institutions due to historic and recent abuses, as well as widespread disinformation about the vaccine. Community engagement is critical to building trust for the vaccine and to develop communication strategies that will meet the needs of diverse populations but it has lagged behind the “warp speed” vaccine development process. When community partners of the CTSI Community Engagement Program expressed concern about being able to conduct a successful COVID-19 vaccination campaign for BIPOC communities, the CTSI responded with a RFA for vaccine hesitancy. The goal of the RFA was to provide timely and actionable COVID-19 vaccine communication strategy for BMC health system’s BIPOC communities and for other health systems who serve similar populations.
COVID-19 Vaccine Hesitancy Pilot Awardees
Using Community Storytelling to Understand, Address and Begin to Heal Medical Distrust and Vaccine Hesitancy in BIPOC communities
COVID-19 has brought untold suffering to our communities, including illness, economic devastation and death. Further, there is abundant evidence that COVID-19 rates and deaths disproportionately affect Black and Latinx individuals. As infection rates climb, public health experts see the COVID-19 vaccine as our only hope. However, data shows that vaccine readiness varies among communities, with only 32% of Black adults saying they would definitely or probably get a COVID-19 vaccine (compared with 52% of White adults, 56% of Hispanics, and 72% of Asian Americans). In seeking to better understand vaccine hesitancy in Black, Indigenous, and People of Color (BIPOC) communities, one must move away from traditional top-down, transactional approaches where (mostly white) researchers may leave community members feeling tokenized and unheard, exacerbating feelings of mistrust. In this pilot grant, Dr. Gergen Barnett is partnering with the community-based organization, Everyday Boston, and using the powerful tool of storytelling as a means of better surfacing and understanding both historical and present-day medical distrust in BIPOC communities. This pilot will use both restorative justice storytelling circles with BIPOC leaders, BIPOC community members, and health providers as well as one on one interviews. The narrative analysis of these stories will then be used to 1) generate a curriculum that increases the cultural competency of health providers; helps them to build trust with their BIPOC patients; and ultimately leads to better health outcomes, including increasing COVID-19 vaccine readiness; and 2) to shape and disseminate PSAs to name and increase awareness around unspoken concerns of medical distrust in BIPOC communities.
Dr. Katherine Gergen Barnett is the Vice-Chair of Primary Care Innovation and Transformation and the Program Director in the Department of Family Medicine at Boston Medical Center (BMC). She is an Associate Clinical Professor at Boston University School of Medicine and a fellow at BU’s Institute for Health System Innovation and Policy. Dr. Gergen Barnett has been attending BMC since 2009 after completing her residency and chief residency there. Prior to BMC, Dr. Gergen Barnett attended Yale University School of Medicine, worked at NIH, and completed a fellowship studying a model of group prenatal care for women in low-income communities. Her primary clinical interests are behavioral health integration, preventive medicine, nutrition, mindfulness-based stress reduction, women’s health, and group care. Dr. Gergen Barnett’s research career has been primarily focused on innovative models of care to address chronic medical conditions, physician burnout, and engaging community partners in creating feasible solutions to increase health and wellness in urban communities. Finally, she is involved in local and state health policy involved in addressing health inequities.
COVID-19 Vaccine Attitudes and Message Preferences (CAMP)
COVID-19 vaccines could dramatically impact the trajectory of the pandemic if widely used. Healthcare providers play a unique role as they are the first population eligible to receive vaccination and they also recommend vaccines for high-risk patients. We aim to understand factors affecting healthcare workers’ attitudes toward and informational needs around readiness to (1) accept vaccination for themselves and (2) recommend vaccination for high-risk patients. We will use mixed methods to understand the attitudes of healthcare workers to COVID-19 vaccines for themselves and their high-risk patients, identify barriers and facilitators of vaccine acceptance, and elucidate informational needs and preferred messaging strategies to support vaccination. We have recruited a Community Stakeholder Advisory Panel, which represents key stakeholders including physicians, nurses, and ambulance workers from inpatient (emergency, ICU, obstetrics) and outpatient (clinics, nursing homes). The Board will oversee all aspects of the research, including providing input on interview and survey content. We will first perform qualitative interviews with 50 healthcare workers to understand the diversity of attitudes and informational needs. Interviews will be analyzed using principles of rapid formative research and directed content analysis. We will then survey 200 healthcare workers about their willingness to accept vaccination, barriers and facilitators, and message preferences. Survey data will be analyzed using multivariable logistic regression models. Data will be available to inform policy in real-time through our Community Stakeholder Advisory Board. Findings will be used to develop and test additional interventions to promote COVID-19 vaccine uptake, focusing on disproportionately affected communities.
Meet the Team
Dr. Perkins is an Associate Professor of Obstetrics and Gynecology at Boston University School of Medicine, and a practicing gynecologist at Boston Medical Center and the East Boston Neighborhood Health Center. Her career is dedicated to reducing health disparities in cervical cancer and improving the utilization of vaccinations. Her current research includes working with low-income and communities of color to improving the utilization of HPV vaccination, maternal and infant vaccinations, and COVID vaccinations. Dr. Perkins is currently working on national projects with the American Cancer Society, CDC, HRSA, NCI, and American College of Obstetricians and Gynecologists. She currently Co-Chairs the National HPV Vaccination Roundtable. She was Co-Chair and one of the lead authors of the 2019 ASCCP Risk-Based Management Consensus Guidelines, and the President’s Cancer Panel Cervical Cancer Subcommittee.
Dr. Joseph is a Clinical Associate Professor of Pediatrics at Boston University School of Medicine (BUSM). She is an award-winning professor and pediatrician specializing in adolescent health. Dr. Joseph has devoted her immense knowledge, training, and personal experiences as a Haitian Creole bilingual immigrant faculty member to develop and champion multi-generational and dyadic strategies for both population-based prevention and patient-centered medical care. Her research focuses on HPV vaccine initiation among low-income and minority women in public healthcare settings. Her work to address racial/ethnic disparities in HPV vaccination rates in adolescents and in cervical cancer screenings in adult women has made me a world leader in cancer prevention among minority communities. Recently, she was selected as the 2018 Massachusetts HPV Vaccine Is Cancer Prevention Champion, awarded as part of a partnership between the Centers for Disease Control and Prevention, Association of American Cancer Institutes, and the American Cancer Society, in part for achieving HPV vaccination completion rates of ≥60% among the patient population she serves at Boston Medical Center. As Director of the Teen and Tot Clinic at Boston Medical Center, Massachusetts’ only adolescent CenteringPregnancy and CenteringParenting programs, she is a proven cross-functional team leader and mentor who has sought to advance medical care and equity, as well as maximize students’ learning potential. She thinks critically and pursues innovative approaches to maximize the health of her patients and their families.