COVID-19 vaccine access and attitudes among people experiencing homelessness from pilot mobile phone survey in Los Angeles, CA

  1. Randall Kuhn
  2. Benjamin Henwood
  3. Alexander Lawton
  4. Mary Kleva
  5. Karthik Murali
  6. Coley King
  7. Lillian Gelberg

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Abstract

People experiencing homelessness (PEH) are at high risk for COVID-19 complications and fatality, and have been prioritized for vaccination in many areas. Yet little is known about vaccine acceptance in this population. The objective of this study was to determine the level of vaccine hesitancy among PEH in Los Angeles, CA and to understand the covariates of hesitancy in relation to COVID-19 risk, threat perception, self-protection and information sources. A novel mobile survey platform was deployed to recruit PEH from a federally qualified health center (FQHC) in Los Angeles to participate in a monthly rapid response study of COVID-19 attitudes, behaviors, and risks. Of 90 PEH surveyed, 43 (48%) expressed some level of vaccine hesitancy based either on actual vaccine offers (17/90 = 19%) or a hypothetical offer (73/90 = 81%). In bivariate analysis, those with high COVID-19 threat perception were less likely to be vaccine hesitant (OR = 0.34, P = 0.03), while those who frequently practiced COVID-19 protective behaviors were more likely to be vaccine hesitant (OR = 2.21, P = 0.08). In a multivariate model, those with high threat perception (AOR = 0.25, P = 0.02) were less likely to be hesitant, while those engaging in COVID-19 protective behaviors were more hesitant (AOR = 3.63, P = 0.02). Those who trusted official sources were less hesitant (AOR = 0.37, P = 0.08) while those who trusted friends and family for COVID-19 information (AOR = 2.70, P = 0.07) were more likely to be hesitant. Findings suggest that targeted educational and social influence interventions are needed to address high levels of vaccine hesitancy among PEH.

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  1. Version published to 10.1371/journal.pone.0255246
  2. ScreenIT

    SciScore for 10.1101/2021.03.23.21254146: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Informed consent was conducted via the survey questionnaire, requiring affirmative consent before proceeding with the survey and providing complete informed consent documentation at the start of each survey.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableIndependent variables: The initial baseline survey included self-reports of age (18-34, 35-44, 45-54, 55-64, 65+), sex/gender (male/female) and race/ethnicity (White non-Hispanic, any Hispanic/Latino, Black non-Hispanic, other).

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    [17] This rapid-reaction pilot study has a number of limitations. First, the sample size was small and addressed patients only in one portion of West Los Angeles. Nevertheless, the results have been received as valuable to public health officials who are supporting additional enrollments across all service areas to increase the sample. Second, while all homeless-flagged patients with phones had the opportunity to answer the survey and response rates were considerably higher than most online or phone-based polls, we know that those who answered the survey were more likely to be female (59% vs. 35%) and less likely to be African-American (9% vs. 24%) than that clinic’s homeless patient base as a whole. Given the lack of differences in hesitancy across any demographic groups and the small sample size, we did not report weighted results. Finally, we note that these interviews were conducted prior to PEH receiving universal vaccine eligibility on March 15, 2021, and that some hesitancy may more accurately reflect indifference or frustration at the difficulty of obtaining the vaccine. In spite of these limitations, our findings point to challenges in widespread vaccine scaleup that are not so different than those faced in the general population. It is important to know that those people who need the vaccine most - those who fear COVID-19 but are less likely to protect themselves through social distancing measures - are those most highly willing to be vaccinated. But achieving wides...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2021.03.23.21254146v1 on medRxiv