Applying the Social Ecological Model to Understand Support for Home Healthcare Workers and Covid-19 Vaccine Uptake in N.J.

Abstract

More than 3.6 M home healthcare aides are key parts of the U.S. healthcare workforce, serving older adults and individuals with disabilities living in the community. This study used a social ecological framework (SEM) to identify facilitators and barriers to Covid-19 vaccination among home healthcare aides and administrators in N.J. Key informant interviews with a purposive sample of home healthcare aides along with federal and state policy review were used to develop a survey of home healthcare administrators (HHA), which was sent to all home healthcare agencies in N.J. Results show that completed vaccination series rates among HHA were the same or higher than statewide and national rates, but there was skepticism about the utility of a booster among both aides and HHA. While organizational policy and information support around Covid-19 from the agencies to the staff was inconsistent, overall agencies acted as a driver for higher vaccination rates. At the intrapersonal level, individual self-assessment of risk was not consistent with actual risk, impeding vaccination. When all levels of the SEM are working in concert it can increase completed vaccinations. Key areas to target addressing the call for yearly boosters include organizational policy and intrapersonal factors aligning perceived and actual risk.