A Mixed Methods Investigation Examining COVID-19 Vaccine Decision-Making Among Older Vaccinators and Non-Vaccinators in the Southeastern U.S.

Abstract

Prior research has explored factors influencing COVID-19 vaccine decision-making among older adults at the national level, but limited work has focused on this population within the Southeastern U.S. context or compared vaccinated and unvaccinated older adults within the same study. To examine COVID-19 vaccination decision-making in the U.S. South among a sample of vaccinated and unvaccinated adults aged 65 years and older. A cross-sectional, mixed methods study design was conducted from November to December 2021. Groups and interviews were stratified by whether participants were fully vaccinated or not against COVID-19. The study's sample draws on insights from 73 participants aged 65 years and older purposively recruited from three Southeastern U.S. states with various COVID-19 vaccination statuses. Online focus groups, interviews, and a pre-group questionnaire were conducted. Analysis of transcripts leveraged a line-by-line, team-based coding approach drawing on perspectives from grounded theory and thematic analysis. Questionnaire data were analyzed descriptively and via bivariate testing. All data were analyzed separately, but in parallel, and merged for confirmation and expansion using a narrative weaving approach. Results from the study indicated both vaccinated and unvaccinated participants' COVID-19 vaccination decision-making leveraged similar processes, including "doing their own research" and having conversations with trusted others like adult children or personal healthcare providers. Vaccinated participants more often described getting a COVID-19 vaccine to avoid death, protect loved ones, or because they trusted its development. Unvaccinated participants more often expressed a lack of trust in the vaccine due to its novelty, potential side effects, and the politicized environment surrounding its development and deployment. Results underscore the need for patient-centered communication strategies, trusted local health information resources, and expanded vaccine access efforts that meet older adults where they are to promote informed COVID-19 vaccine decision-making among those aged 65 years and older.