Background. Despite widespread COVID-19 vaccine availability, vaccine hesitancy remains a barrier to achieving public health goals, especially in underserved communities. Trust in healthcare providers, scientists, and government institutions plays a critical role in shaping vaccine perceptions and uptake. Purpose. To inform targeted interventions, we tested a mediational path model examining predictors of perceived vaccine safety, effectiveness, and vaccination status among public housing residents. Methods. We surveyed 120 public housing residents in Central and Southeast Virginia. Participants completed questionnaires assessing trust in various people and institutions, a sense of community responsibility, beliefs about vaccination as a personal choice, and vaccination-related perceptions and status. A mediational path model was tested to examine direct and indirect associations. Results. Among 10 trust domains examined, only trust in the federal government and trust in local clinics and pharmacies significantly predicted vaccination-related perceptions and behavior. Trust in local clinics was directly associated with perceived vaccine safety (β = .42, 95% CI [.18, .66]) and effectiveness (β = .36, 95% CI [.11, .62]) and indirectly predicted vaccination status through perceived safety (β = .11, 95% CI [.01, .22]). Trust in the federal government directly predicted perceived effectiveness (β = .35, 95% CI [.04, .66]) but not safety. The final model explained 62% of the variance in vaccination status. Discussion. An indirect effect emerged where trust in local clinics predicted vaccination status via perceived safety, underscoring the critical role of local health centers in fostering vaccine confidence and uptake. Strengthening relationships between local providers and their communities may be a key strategy for addressing vaccine hesitancy. These findings highlight the importance of building trust to support vaccine uptake efforts.
MacDonaldNESage Working Group on Vaccine Hesitancy. Vaccine hesitancy: definition, scope and determinants. Vaccine2015; 33(34): 4161–4164. https://doi.org/10.1016/j.vaccine.2015.04.036
2.
MonteroDAVidalRMVelascoJ, et al.Two centuries of vaccination: historical and conceptual approach and future perspectives. Front Public Health2023; 11: 1326154. https://doi.org/10.3389/fpubh.2023.1326154
YasminFNajeebHMoeedA, et al.COVID-19 vaccine hesitancy in the United States: a systematic review. Front Public Health2021; 9: 770985. https://doi.org/10.3389/fpubh.2021.770985
5.
KricorianKCivenREquilsO. COVID-19 vaccine hesitancy: misinformation and perceptions of vaccine safety. Hum Vaccines Immunother2022; 18(1): 1–8. https://doi.org/10.1080/21645515.2021.19505046
6.
IslamMSKamalAHMKabirA, et al.COVID-19 vaccine rumors and conspiracy theories: the need for cognitive inoculation against misinformation to improve vaccine adherence. PLoS One2021; 16(5): e0251605. https://doi.org/10.1371/journal.pone.0251605
Centers for Disease Control and Prevention. Weekly COVID-19 vaccination dashboard, Updated June 21, 2024. Accessed August 8, 2024.
10.
Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases. COVID-19 can surge throughout the year, 2024. Published July 3, 2024. Accessed August 8, 2024.
11.
NguyenLHJoshiADDrewDA, et al.Self-reported COVID-19 vaccine hesitancy and uptake among participants from different racial and ethnic groups in the United States and United Kingdom. Nat Commun2022; 13: 636. https://doi.org/10.1038/s41467-022-28200-3
12.
WillisDEAndersenJABryant-MooreK, et al.COVID-19 vaccine hesitancy: race/ethnicity, trust, and fear. Clin Transl Sci2021; 14(6): 2200–2207. https://doi.org/10.1111/cts.13077
13.
BogartLMDongLGandhiP, et al.COVID-19 vaccine intentions and mistrust in a national sample of Black Americans. J Natl Med Assoc2022; 113(6): 599–611. https://doi.org/10.1016/j.jnma.2021.05.011
14.
HallMADuganEZhengB, et al.Trust in physicians and medical institutions: what is it, can it be measured, and does it matter?Milbank Q2001; 79(4): 613–639. https://doi.org/10.1111/1468-0009.00223
O’NeillO. A question of trust: the BBC reith lectures 2002. Cambridge University Press, 2002.
17.
QuinnKDickson-GomezJZarwellM, et al.“A gay man and a doctor are just like, a recipe for destruction”: how racism and homonegativity in healthcare settings influence PrEP uptake among young black MSM. AIDS Behav2019; 23(7): 1951–1963. https://doi.org/10.1007/s10461-018-2375-z
AllenJDFuQShresthaS, et al.Medical mistrust, discrimination, and COVID-19 vaccine behaviors among a national sample of U.S. adults. SSM Popul Health2022; 20: 101278. https://doi.org/10.1016/j.ssmph.2022.101278
21.
AgleyJXiaoYThompsonEE, et al.Factors associated with reported likelihood to get vaccinated for COVID-19 in a nationally representative U.S. survey. Public Health2021; 196: 91–94. https://doi.org/10.1016/j.puhe.2021.05.009
22.
SchernhammerEWeitzerJLaubichlerMD, et al.Correlates of COVID-19 vaccine hesitancy in Austria: trust and the government. J Public Health2022; 44(1): e106–e116. https://doi.org/10.1093/pubmed/fdab122
23.
RozekLJonesPMenonAR, et al.Understanding vaccine hesitancy in the context of COVID-19: the role of trust and confidence in a seventeen-country survey. Int J Publ Health2021; 66: 636255. https://doi.org/10.3389/ijph.2021.636255
ThomDHHallMAPawlsonLG. Measuring patients’ trust in physicians when assessing quality of care. Health Aff2004; 23(4): 124–132. https://doi.org/10.1377/hlthaff.23.4.124
26.
O’MalleyASSheppardVBSchwartzM, et al.The role of trust in use of preventive services among low-income African-American women. Prev Med2004; 38(6): 777–785. https://doi.org/10.1016/j.ypmed.2004.01.018
27.
ArmstrongKRoseAPetersN, et al.Distrust of the health care system and self-reported health in the United States. J Gen Intern Med2006; 21(4): 292–297. https://doi.org/10.1111/j.1525-1497.2006.00396.x
28.
LaVeistTAIsaacLAWilliamsKP. Mistrust of health care organizations is associated with underutilization of health services. Health Serv Res2009; 44(6): 2093–2105. https://doi.org/10.1111/j.1475-6773.2009.01017.x
StreetRLJMakoulGAroraNK, et al.How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Educ Counsel2009; 74(3): 295–301. https://doi.org/10.1016/j.pec.2008.11.015
31.
JamisonAMQuinnSCFreimuthVS. “You don’t trust a government vaccine”: narratives of institutional trust and influenza vaccination among African American and white adults. Soc Sci Med2019; 221: 87–94. https://doi.org/10.1016/j.socscimed.2018.12.020
32.
SalmonDADudleyMZGlanzJM, et al.Vaccine hesitancy: causes, consequences, and a call to action. Am J Prev Med2015; 49(6 Suppl 4): S391–S398. https://doi.org/10.1016/j.amepre.2015.06.009
33.
TajfelHTurnerJC. An integrative theory of intergroup conflict. In: AustinWGWorchelS (eds). The Social Psychology of Intergroup Relations. Brooks/Cole, 1979, pp. 33–48.
34.
WakefieldJRHKhauserA. Doing it for us: community identification predicts willingness to receive a COVID-19 vaccination via perceived sense of duty to the community. J Community Appl Soc Psychol2021; 31(5): 603–614. https://doi.org/10.1002/casp.2542
35.
MastersonJMLuuMDallasKB, et al.Disparities in COVID-19 disease incidence by income and vaccination coverage—81 communities, Los Angeles county, July 2020–September 2021. MMWR Morb Mortal Wkly Rep2023; 72: 728–731. https://doi.org/10.15585/mmwr.mm7226a5
36.
SallamM. COVID-19 vaccine hesitancy worldwide: a concise systematic review of vaccine acceptance rates. Vaccines2021; 9(2): 160. https://doi.org/10.3390/vaccines9020160
37.
Langer Research Associates. Coronavirus vaccination hesitancy in the black and latinx communities. COVID Collaborative, 2020.
38.
BursacZGaussCHWilliamsDK, et al.Purposeful selection of variables in logistic regression. Source Code Biol Med2008; 3: 17. https://doi.org/10.1186/1751-0473-3-17
HooperDCoughlanJMullenM. Structural equation modelling: guidelines for determining model fit. Electron J Bus Res Methods2008; 6(1): 53–60.
41.
WynenJOp de BeeckSVerhoestK, et al.Taking a COVID-19 vaccine or not? Do trust in government and trust in experts help us understand vaccination intention?Adm Soc2022; 54(10): 1875–1901. https://doi.org/10.1177/00953997211073459
42.
van der WeerdWTimmermansDBeaujeanD, et al.Monitoring the level of government trust, risk perception and intention of the general public to adopt protective measures during the influenza A (H1N1) pandemic in the Netherlands. BMC Public Health2011; 11: 575. https://doi.org/10.1186/1471-2458-11-575
43.
BlairRAMorseBSTsaiLL. Public health and public trust: survey evidence from the Ebola virus disease epidemic in Liberia. Soc Sci Med2017; 172: 89–97. https://doi.org/10.1016/j.socscimed.2016.11.016
44.
Milošević ĐorđevićJMariSVdovićM, et al.Links between conspiracy beliefs, vaccine knowledge, and trust: anti-vaccine behavior of Serbian adults. Soc Sci Med2021; 277: 113930. https://doi.org/10.1016/j.socscimed.2021.113930
45.
Van OostPYzerbytVSchmitzM, et al.The relation between conspiracism, government trust, and COVID-19 vaccination intentions: the key role of motivation. Soc Sci Med2022; 301: 114926. https://doi.org/10.1016/j.socscimed.2022.114926
46.
TrentMSealeHChughtaiAA, et al.Trust in government, intention to vaccinate and COVID-19 vaccine hesitancy: a comparative survey of five large cities in the United States, United Kingdom, and Australia. Vaccine2022; 40(17): 2498–2505. https://doi.org/10.1016/j.vaccine.2021.06.048
WebbHMMitchellCMarshallVJ, et al.Understanding multilevel factors related to urban community trust in healthcare and research. Int J Environ Res Publ Health2019; 16(18): 3280. https://doi.org/10.3390/ijerph16183280
49.
RobinsonJPorterMMontalvoY, et al.Losing the wait: improving patient cycle time in primary care. BMJ Open Qual2020; 9(2): e000910. https://doi.org/10.1136/bmjoq-2019-000910
50.
MatulisJCMcCoyR. Patient-centered appointment scheduling: a call for autonomy, continuity, and creativity. J Gen Intern Med2021; 36(2): 511–513. https://doi.org/10.1007/s11606-020-06058-9
51.
GagneurA. Motivational interviewing: a powerful tool to address vaccine hesitancy. Can Commun Dis Rep2020; 46(4): 93–97. https://doi.org/10.14745/ccdr.v46i04a06
52.
U.S. Food and Drug Administration. FDA approves and authorizees updated mRNA COVID-19 vaccines to better protect against currently circulating variants. Published August 22, 2024. Accessed October 3, 2024.
53.
McClellanMMcKethanANLewisJL, et al.A national strategy to put accountable care into practice. Health Aff2010; 29(5): 982–990. https://doi.org/10.1377/hlthaff.2010.0194
54.
DamerySFlanaganSCombesG. Patients’ experiences of care in GP-led urgent care centers: a qualitative study. Br J Gen Pract2016; 66(650): e352–e360. https://doi.org/10.3399/bjgp16X685297
