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2023 HSR&D/QUERI National Conference Abstract

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4009 — COVID-19 Vaccination Motivations and Hesitations in Veterans Affairs Community Living Center Patient Care Services Staff

Lead/Presenter: Nicole Beyer,  COIN - Pittsburgh/Philadelphia
All Authors: Beyer NM (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System), Pellathy T (Highmark Health; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System) Burkitt KH (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System) Mor MK (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System; University of Pittsburgh School of Public Health) Rodriguez KL (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System) Hoffman BL (University of Pittsburgh School of Public Health) Sidani JE (University of Pittsburgh School of Public Health) Hruska KL (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System) Lovelace EZ (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System) Barrett AK (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System; VA Center for Medication Safety) Wolynn R (University of Pittsburgh School of Public Health) Switzer G (Division of General Internal Medicine, University of Pittsburgh School of Medicine) Sonel AF (VA Pittsburgh Healthcare System) Fine MJ (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System; Division of General Internal Medicine, University of Pittsburgh School of Medicine)

Objectives:
Health professionals at Veterans Affairs (VA) Community Living Centers (CLCs) are a high priority group for COVID-19 (C-19) vaccination due to the age and frailty of CLC residents. However, relatively low vaccine rates have been reported in this group. Our objective was to assess vaccination motivations and hesitations among VA CLC staff.

Methods:
In this partnered quality-improvement (QI) project conducted with senior clinical leaders at the VA Pittsburgh Healthcare System (VAPHS), we invited all 371 respiratory therapists, registered nurses, and allied health personnel employed at the CLC affiliated with VAPHS to complete an online questionnaire (June-August 2021). Items assessed concerns about infecting patients, becoming infected with C-19, and experiencing severe illness from infection. We conducted qualitative telephone interviews (August-October 2021) with a subset of assenting respondents to explore vaccination decision-making, including motivating and concerning information they received about C-19 vaccines and who they involved in their vaccine decision-making. We used descriptive statistics to analyze responses to closed-ended questionnaire items and rapid qualitative analysis to identify themes from the open-ended interviews.

Results:
Among the 83 questionnaire respondents (22% response rate), 55 (66%) self-identified as white race and 55 (66%) as female gender; 39 (47%) were allied health professionals, 26 (31%) registered nurses, and 18 (22%) respiratory therapists. Sixty-nine (84%) reported > = 1 C-19 vaccination. Concerns about infecting patients with C-19 were more prevalent among unvaccinated than vaccinated respondents (62% vs. 16%, p = 0.001). When asked to reflect on their concerns before vaccination, vaccinated respondents expressed greater concern about becoming infected with C-19 (n = 43, 62%) and experiencing severe illness (n = 39, 56%) than unvaccinated respondents (n = 4, 31% for each concern). For the 17 of 30 (57%) assenting questionnaire respondents participating in qualitative interviews, the most common vaccine motivations were: 1) protecting Veterans, self, and family members (n = 13 participants); 2) talking with others who were vaccinated (n = 6); and 3) seeing the devastating effects of C-19 in patients, family, and health care workers (n = 4). The most common hesitations were potential allergic reactions/side effects (n = 6) and concerns about the safety and quick development of C-19 vaccines (n = 5). Interviewees (n = 10) noted that physicians, coworkers, and respected supervisors were influential in vaccine decision-making.

Implications:
Our quantitative results demonstrate unvaccinated CLC staff are more concerned about infecting their patients with C-19 but less concerned about the personal risks of C-19 infection and illness severity. Qualitative results demonstrate the influence and experiences of family, colleagues, and patients as motivators for vaccination, whereas hesitations stemmed from overly rapid development and safety concerns for C-19 vaccines.

Impacts:
Senior clinical leaders at VAPHS and VISN4 were briefed regarding these QI project findings and are incorporating this information into ongoing messaging/informational campaigns to augment C-19 vaccine uptake among unvaccinated VA CLC and other staff. Tailored messaging that communicates objective information about the risks of C-19 infection and illness severity, vaccine effectiveness in reducing anxiety about infecting patients, and personal stories of the impact of C-19 illness may be most effective.