Community-engaged research to promote SARS-CoV-2 vaccine uptake in Montanas American Indian and rural communities

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Project Summary/Abstract Racial and ethnic minorities, and other medically underserved groups, including rural adults, have been particularly hard hit by SARS-CoV-2, the virus that causes COVID-19 disease. In the United States, the COVID-19 case fatality rate is 25% higher in rural versus urban areas. In Montana, a large, rural Western state, American Indians (AIs) are 7% of the population but have accounted for 18% of COVID-19 deaths. As of April 2021, SARS-CoV-2 vaccines are widely available to eligible adults throughout the state; however, only 33% of Montana adults are fully vaccinated, and demand for the vaccine is waning. As we transition from initial implementation to long-term delivery of these vaccines, primary care providers (PCPs) will be responsible for recommending booster doses, offering the vaccine to newly eligible populations such as children, and convincing previously unvaccinated people to get the vaccine. In this Center for Population Health Research (CPHR) community-engaged research project, our long-term goal is to identify culturally specific and community competent health systems- and provider-level strategies for increasing SARS-CoV-2 vaccine acceptance in AI and rural populations. To achieve this goal, we will collaborate with All Nations Health Center in Missoula, MT to conduct qualitative interviews with vaccinated and unvaccinated AI and rural adults to identify causes of SARS-CoV-2 vaccine confidence and hesitancy (Aim 1). Using qualitative content analyses, we will also identify trusted sources of vaccine information and participant-generated ideas for promoting vaccine confidence and uptake in these communities. We will also conduct a statewide survey of PCPs to determine readiness for addressing SARS-CoV-2 vaccine hesitancy (Aim 2). The survey will include a module regarding knowledge, attitudes, and beliefs about the SARS-CoV-2 vaccines, including questions about confidence in addressing patients’ vaccine questions and concerns, as well as questions regarding perceptions of future vaccine authorization for children. Due to our collaborative history with the Montana Department of Public Health and Human Services Immunization Section and health systems throughout the state, we are positioned to facilitate the rapid translation of this study’s results into immunization services delivery practice. Furthermore, we anticipate that findings from this study will be generalizable to other states with similar populations, and our team will serve as a key contributor to the national conversation on effective strategies to address SARS-CoV-2 vaccine hesitancy among vulnerable AI and rural populations.