Understanding COVID-19 vaccine hesitancy among Black pregnant individuals: a mixed methods study of social media messenger and content type preferences.

Résumé

INTRODUCTION: Pregnant individuals are at increased risk of developing severe illness from coronavirus disease 2019 (COVID-19). They also tend to be vaccine-hesitant, which is even more pronounced in certain racial and ethnic minority groups. The study objective was to determine whether social media advertisements promoting COVID-19 vaccination could influence vaccination likelihood among pregnant and recently pregnant participants who self-identified as Black or African American.METHODS: Participants were interviewed individually or in focus groups to explore their attitudes toward vaccination and were asked to rate their likelihood of receiving a COVID-19 vaccine after seeing a panel of advertisements featuring different messengers (e.g., doctors, peers, older adults, and faith leaders) and content types (e.g., social proof, text-heavy, fear-based, and activation). Advertisement ratings were analyzed using linear mixed-effects models to examine the effects of vaccination status, advertisement messenger, and advertisement content type. Interview data were coded and analyzed to identify qualitative themes. Advertisement ratings differed significantly according to vaccine status, religious affiliation, political affiliation, and marital status.RESULTS: Participants who were vaccinated, religious, politically conservative, and/or married were more likely to report an increased willingness to receive a COVID-19 vaccine after seeing the social media ads. No specific advertisement messenger or content type was rated as more probable to motivate vaccination. Qualitative analysis identified several themes related to attitudes toward vaccination, including trust in oneself, family, doulas, and faith leaders; mistrust of the government and healthcare system; concerns about medical racism; and personal experiences with individuals recommending or discouraging vaccination.DISCUSSION: Although no single advertisement messenger or content type was preferred, personal testimony from a trusted source, such as a faith leader or doula, may support vaccine acceptance among Black pregnant women.