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 1. Healio
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 4. Practice Management


AMERICAN THORACIC SOCIETY INTERNATIONAL CONFERENCE

ByIsabella Hornick
Fact checked byKristen Dowd
Source/Disclosures
Source:

Riley IL. Scientific Symposium. SPS2. ATS advancing adult immunization
initiative: Immune boost! Addressing vaccine hesitancy and the landscape of
vaccine-preventable diseases. Presented at: American Thoracic Society
International Conference; May 19-24, 2023; Washington, D.C.

Disclosures: Riley reports no relevant financial disclosures.

Read next
Understanding how health care providers can prompt vaccine uptake
Read next
Engaging PCPs in COVID-19 vaccine distribution could save ‘thousands of lives’
July 14, 2023
5 min read
Save


ADDRESSING WHY VETERANS MAY BE VACCINE HESITANT, WAYS TO BUILD PATIENT-PROVIDER
TRUST

ByIsabella Hornick
Fact checked byKristen Dowd
Source/Disclosures
Source:

Riley IL. Scientific Symposium. SPS2. ATS advancing adult immunization
initiative: Immune boost! Addressing vaccine hesitancy and the landscape of
vaccine-preventable diseases. Presented at: American Thoracic Society
International Conference; May 19-24, 2023; Washington, D.C.

Disclosures: Riley reports no relevant financial disclosures.
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KEY TAKEAWAYS:

 * Explaining misconceptions is one way to help veterans who are hesitant about
   getting the COVID-19 vaccine.
 * Providers must remember to consider a patients’ local context when talking
   about vaccination.

WASHINGTON — When discussing COVID-19 vaccination with veterans who do not trust
the health system, it is important to listen and not argue with them, according
to a presentation at the American Thoracic Society International Conference.

“I work with communities that are currently experiencing adverse relationships
with health systems,” Isaretta Lee Riley, MD, MPH, assistant professor of
medicine at Duke University School of Medicine, said during the presentation.
“I've worked in these communities, and I started building [their] trust prior to
me needing to convince them to do something that could potentially save their
lives.”

According to Riley, a patient who is vaccine hesitant falls into one of five
categories: dissent, deliberation, distrust, indifference or skepticism.

“Some people just do not like vaccines,” she said. “Others just need more
information; that's the deliberation group. Others do not trust the government
and health systems in general. Others are actually indifferent and really not
concerned about COVID or getting the flu. Then of course, you have skepticism.”

UNDERSTANDING VETERAN POPULATIONS

Using results from a survey conducted by Guneet K. Jasuja, PhD, MPH, and
colleagues in 2021 of 1,178 veterans (mean age, 66.7 years; 83% men; 84% white),
Riley discussed barriers and facilitators in COVID-19 vaccination among
veterans.

In this study, 71% of the veterans were vaccinated, and the remaining 29% were
not. Of those not vaccinated, 36% said they have not received the vaccine yet
because they were worried about side effects. Other reasons rated as important
by these patients included “The COVID vaccine is new, so I want to wait a while
before deciding” by 22% of veterans, “I prefer to use as few medicines as
possible” by 20% of veterans and “I prefer gaining natural immunity” by 19% of
veterans. Riley said these responses demonstrate instances of vaccine skepticism
and deliberation. Notably, “I do not trust the health care system to act in my
best interest,” an example of vaccine distrust, was also rated important by 18%
of unvaccinated veterans.

In terms of facilitators for vaccine uptake, Riley explained that among veterans
who either have the vaccine or definitely will get the vaccine, most individuals
got it so they would not get a SARS-CoV-2 infection, so they could help with
ending the pandemic and getting life back to its pre-pandemic state or so they
could stop the spread of the virus to other people.

“Some have a personal reason for why they got [the vaccine], and others are
looking at the community as a whole,” Riley said.

Within this survey, researchers also collected responses from unvaccinated
veterans on who they trust for information about COVID-19, which Riley
highlighted in her presentation because of how meaningful this information is
when talking to patients.

Among those who definitely/probably do not want the COVID-19 vaccine, Riley said
media sources were the most trusted.

“That's why it's important to have a spokesperson out there educating the
community on the vaccine, why you should get it and demystifying the process,”
Riley said.

For these individuals, the VA, the CDC, coworkers/classmates and the state
government all came after the media with a similar number of responses as their
most trusted source for information. Next in line according to the survey was
the local government, a VA health practitioner and their contacts on social
media.

“I have a lot of people on social media that I don’t talk to on a regular
basis,” Riley said, “but [unvaccinated veterans] value them just as much as they
do their provider who's writing their medicine, up titrating, down titrating and
went to all these years of schooling.”

For veterans who were unsure about getting the COVID-19 vaccine, the media, the
VA, a VA health practitioner and the CDC made up their most trusted sources for
information.

“This is a group that I can potentially convince,” Riley said. “I can talk to
them about the risks, the benefits, what we know about [the vaccine], directly
address the myths and go from there.”

In addition to this study, Riley talked about a systematic review that found
four interventions to increase uptake for all vaccines. Depending on the
barriers/concerns of patients, the type of intervention differed, according to
Riley.

For addressing a lack of awareness/knowledge, lack of motivation, religious
beliefs and misinformation, community health training is an intervention that
may help with getting hesitant patients vaccinated, Riley said. For patients
with little finances, motivation and awareness, as well as worries about side
effects, an incentive-based intervention is recommended.

Technology-based health literary is the third intervention option, which Riley
said addresses misinformation, worries about side effects/safety, lack of
knowledge/awareness and negative attitudes. Lastly, for targeting a lack of
awareness/knowledge, limited finances and negative attitudes, a media-based
intervention may promote vaccination, according to Riley’s presentation.

PERSONAL EXPERIENCES

Alongside these published studies, Riley talked about her personal experiences
with increasing vaccine uptake as a health equity research and community
engagement expert.

“At the VA, people travel long distances,” she said. “I'm at the Durham VA, but
I have people who are coming from the rural parts, so that's a whole different
microcosm over there. I'm not just dealing with urban mistrust. ... I have to
consider where [a patient is] coming from and what they're saying locally when
I'm addressing these things.”

According to Riley, she sees three types of patients: patients that follow
orders, patients who are unsure/want to talk about any skepticism they have and
patients that do not trust the health system.

For her patients that are unsure, Riley said she connects with them in several
different ways by establishing relationships, discussing facts that apply to
their specific risk profile, clarifying misconceptions, hearing out their
concerns and understanding their local context.

“For some patients, even if I convince them to get their vaccine, they won't
tell their family or their community because everyone else in their community
doesn't want it and they look down on you if you get it,” Riley said. “But I can
convince them to take it because it's confidential.”

When talking with patients who do not trust the system, there is some overlap on
ways to connect with them and unsure patients, Riley said.

“I have a conversation [with these types of patients], and I do it over multiple
sessions,” she said. “Just like if you have smoking cessation, you will talk to
them one day and ask, ‘Hey, are you ready to quit the next time?’ I do it like
that. I put at the end of my note, ‘Readdress the COVID-19 vaccine.’ I try to
address their myths during each of the conversations but again, I'm not arguing
with them.

“You don't want to be judgmental,” Riley added. “[Also], it's important to
readdress [vaccination] at a later date because sometimes with time people
change their mind.”

Read next
Understanding how health care providers can prompt vaccine uptake
Engaging PCPs in COVID-19 vaccine distribution could save ‘thousands of lives’

REFERENCE:

 * Jasuja GK, et al. JAMA Netw Open.
   2021;doi:10.1001/jamanetworkopen.2021.32548.


READ MORE ABOUT

vaccine hesitancy
vaccination
covid-19 vaccine
covid-19
veterans health
duke university
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