HYD-PRC Researchers Explore Ways to Reduce Barriers and Increase COVID-19 Vaccine Confidence
In early 2021, as COVID-19 vaccine rollout began, the Centers for Disease Control and Prevention established a Vaccine Confidence Network among the country’s 26 Prevention Research Centers, with the goal of increasing vaccine confidence and uptake among communities disproportionately affected by the COVID-19 pandemic. This national network of academic, public health, and community partners was awarded funding to identify, develop, and implement various community-engaged projects focused on COVID-19 vaccine confidence and uptake.
The Healthy Youth Development - Prevention Research Center (HYD-PRC) received funding to implement theCDC’s COVID-19 Vaccine Confidence Strategy among two populations that PRC faculty have been working with – people in prisons and jails and youth experiencing homelessness.
Promoting Vaccine Confidence among Incarcerated Individuals and Prison and Jail Staff
Led by Associate Professor and Principal Investigator, Rebecca Shlafer, Project Director, Ingie Osman, and team, the goal of this HYD-PRC project is to understand barriers to COVID-19 vaccination and inform intervention strategies to increase COVID-19 vaccine confidence and uptake among people who are incarcerated and staff in Minnesota’s prisons and jails.
The toll of COVID-19 is far greater among the prison population than the overall U.S. population. Congregate living in prisons and jails often precludes physical distancing and barriers to personal hygiene, which increase the risk of contracting COVID-19 for incarcerated people and prison/jail staff. Incarcerated people are also at increased risk for severe COVID-19 disease/death, due in part to high rates of chronic conditions and limited staff capacity–in the best of times–for corrections healthcare services to meet their health needs. Staff also have the potential to carry COVID-19 into facilities from their communities and back out into their communities from facilities, posing a great public health threat to both people who are incarcerated and people in their nearby communities.
Knowing the importance of centering those who have been directly impacted in this work, Shlafer and team established a 14-member project advisory board composed of individuals who have lived experience with incarceration. “Our advisory board’s partnership is essential to our project's success and to our efforts to document and challenge the ways in which systemic racism perpetuates harm against people involved in the criminal legal system and compromises the health of communities,” said Shlafer. “Addressing COVID-19 within carceral facilities is an issue of health equity.”
To date, the team has collected information from hundreds of prison and jail staff members (including information featured on MPR, Star Tribune, and MinnPost websites), as well as thousands of people currently incarcerated in prison and jail settings. The advisory board meets monthly with the project team to discuss what is happening with COVID-19 inside of prisons and jails, share their stories and experiences, and collaborate on how to move the work forward.
This collective wisdom, paired with extensive survey data, guides the creation of trauma-informed, culturally-tailored strategies aimed at increasing vaccine confidence and uptake in prisons and jails. “We have hosted a vaccine clinic at a local jail, continued to develop tailored print and video educational materials for incarcerated people, facilitated discussions with jail staff and health care providers across the state, and are designing a peer education program for people in prisons,” said Osman. "Throughout this project, we have worked to meet people where they're at, share trusted, timely, and tailored information, and help support people in making an informed decision for themselves about vaccination," said Shlafer.
Promoting Vaccine Confidence among Youth Experiencing Homelessness
In addition to Shlafer and team’s work with people in prisons and jails, CDC funding was also used to support a community-partnered project focused on improving vaccine confidence and access among youth experiencing homelessness in Hennepin County, Minnesota’s most populous county. Over 13,300 unaccompanied youth experience homelessness annually in Minnesota, and, when it comes to reducing COVID-19 risk, they have been largely left out of the conversation locally and nationally.
Over half of youth experiencing homelessness are individuals from communities of color that experience increased risk of COVID-19 morbidity/mortality. Many identify as LGBTQ+. This population experiences practical barriers (such as lack of insurance, inconsistent access to health care) and psychosocial barriers (such as structural racism/marginalization and trauma associated with systems-involvement) to vaccination.
Youth experiencing homelessness are at increased risk of contracting and transmitting COVID-19 due to a range of complex social, situational, and structural factors. Multiple points of contact to access services and conditions of living arrangements make it challenging for youth to adhere to masking and social distancing. Disproportionately high rates of chronic conditions and disparities within chronic conditions, related in large part to structural racism and oppression, increase the risk for severe illness from COVID-19. Recognizing that young people experiencing homelessness show remarkable resilience in the face of significant adversity and are the experts in their experiences, the interdisciplinary team, led by Pediatrician and Assistant Professor, Janna Gewirtz O’Brien, is committed to centering youth voices in every phase of the project.
To address these disparities and mitigate these risks, Gewirtz O’Brien and team worked in partnership with youth, youth-serving agencies, and public health and healthcare leaders to develop tailored, youth- and community-driven, equitable strategies to increase COVID-19 vaccine confidence and access among youth experiencing homelessness in Hennepin County.
“We’ve practiced–not perfected–this,” said Gewirtz O’Brien. “We’ve had a series of uncomfortable conversations about equitable engagement strategies. For example, what are the ethics of our temporary team engaging this population for a one-year project? Our goal is to develop deep partnerships across sectors, rooted in trusted relationships, and to center the voices and wisdom of youth with lived experience with homelessness. They are the experts in their own experiences and, together with youth, we are excited to identify strategies that are most likely to meet their diverse needs.”
Through youth focus groups, interviews with staff at youth-serving agencies, many tabling events and conversations with individual youth and youth boards, and monthly cross-sector planning team meetings with key partners, the team has learned that the main barriers to vaccination faced by youth experiencing homelessness are: concerns about vaccine safety, mistrust of government and healthcare systems due to the impacts of systemic racism, doubts about whether vaccination is really necessary for young people, and unease with navigating the logistics of getting a vaccine.
The project’s engagement strategies, paired with a community survey, allowed the team to share what it had learned from the community, ask for input on communication messages and tactics, and build consensus on strategies that are likely to improve COVID-19 vaccine confidence. The resulting four strategies currently being implemented include:
- Developing youth-friendly, trauma-informed, culturally responsive messaging about COVID-19 vaccination in partnership with youth.
- Holding site-based, fun, and inclusive health events organized in partnership with youth and youth-serving agencies.
- Distributing vaccine aftercare kits to youth to offer physical, emotional, and educational support after vaccination.
- Offering training and resources to staff at youth-serving agencies who work directly with youth to help them navigate conversations about vaccination with youth.
“Our next steps include deciding with youth and cross-sector planning team members how to scale up and share these strategies among youth-serving organizations statewide,” said Gewirtz O’Brien. “We also plan to continue working with youth to develop a youth-driven guide to hosting health events, and find ways to sustain cross-sector partnerships focused on health and well-being among youth experiencing homelessness.”