Addressing why veterans may be vaccine hesitant, ways to build patient-provider trust
Click Here to Manage Email Alerts
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.”