Stepping up by stepping back: Engaging the vaccine hesitant

Recently, on the Massachusetts League of Community Health Centers’ communications platform, a health worker on Cape Cod posted the following message: 

“I wanted to share what I consider a very successful conversation I had with a hesitant patient that makes me feel better in those times. This woman responded to our text outreach for a vaccination clinic asking if she could get some counseling on the vaccine …We spoke at length about safety and development, but in the end she stopped me, saying, ‘I feel like your job is just to make me say yes.’ I felt awful at first, I explained to her that my job is never to make her feel pressured or guilty but only to give her the information we have available to help her make the best decision for herself and her body.

“She confessed to me that she believes all the science, she knows she should get it, but she is just afraid since she has had bad experiences in the past with vaccines…We spoke for a while, and in the end, I told her we would remove her from the call list. I assured her again that we support her decision, and that if or when she is ever ready, we are here with no judgment. We thanked each other, and she even gave me props for making her comfortable...This, for me, was the most successful conversation I had to date with a patient.”

“You’re probably scratching your head: Why, in a race to get shots in the arms of as many people as possible before they get Covid-19 or the coronavirus mutates into a more virulent form, does the Massachusetts League of Community Health Centers consider this to be one of our success stories?

Our reach into the state’s most vulnerable residents is deep. One in every seven Massachusetts residents receives care at a health center. In Boston, one of every two residents gets care at a health center. They often live in small, multi-generational homes; work in essential jobs; and use public transportation. They are the same communities that were—and, unfortunately, in some cases, continue to be—devastated by the pandemic. They are also among the most vaccine hesitant. Our patients’ more cautious attitudes were confirmed by a poll organized by the League on public attitudes toward the Covid and other vaccines last December with the Museum of Science Boston and MassINC. The poll oversampled Black and Latinx communities and was administered in English and Spanish. There were two key findings. The first was that a majority of Massachusetts residents planned to get the vaccine, but wanted to wait until others had gone first.

The second was that, across all groups, doctors are the most trusted source of information about the vaccines. But there was a drop of 10 percent between whites and communities of color when it came to getting vaccinated right away. That difference can be explained by the legacy of racism, concerns about immigration status, linguistic and cultural isolation, and logistical barriers to access.

To bridge it, we knew we would need to reach out to our community health workers, dig into vaccine hesitancy studies, and seek input from our partners in the work we do to serve vulnerable populations. We would also have to allay our patients’ fear and mistrust by showing them we believed in their good judgment, acknowledging their desire to make good decisions, and respecting their autonomy. Luckily, this approach aligns perfectly with our members’ philosophy of patient-centered care.

The League’s engagement campaign began in January 2021 with the development of materials to support people in having respectful conversations about the vaccine—and letting patients make up their own minds. The talks can be between health center staff and patients, between community health workers and patients, or among patients themselves with their families and friends.

There are four types of materials.

Tips for Talks — This is a simple guide for having open-ended, nonjudgmental conversations. They are written at a basic reading level and are available in 10 languages at our website, massleague.org.

Common Questions and Concerns — Our common questions and concerns aren’t like any others out there! They have been customized exactly for each population in Massachusetts, both in terms of what questions are included and in the order they are presented. The customizations were created by listening to the opinions of health center staff, community groups, and a community health worker advisory group. They have also been carefully written to make them easy for health center patients to understand and use. They are available on the League website and can be used online or as printed handouts. Feel free to personalize them by adding your own logo at our website, massleague.org.

Provider Videos —We asked Black and Latinx health center providers to talk about their experiences of the pandemic, the vaccine, and why they think people should get the shot. But we asked them to leave their lab coats at home and talk to us as if they were old friends, not as doctors giving medical advice. The result is real people sharing their truths, which we think is the only way to truly connect with patients around the risks and benefits of the vaccine. We are running them on local cable television around the state and on social media. The videos are available on the League website and YouTube pages.

“After the Pandemic” Artists Videos — The final component of the campaign, scheduled for late spring and early summer, is a set of very short videos featuring artists from each community talking about their experience of the campaign and showing an artwork they did to illustrate the theme “After the Pandemic.” These are intended to celebrate each community and motivate those individuals who haven’t gotten vaccinated yet to do so. They will be run on social media.

We are now at an inflection point in the campaign. Many of our patients — older people and those with health conditions — have been relatively eager to get vaccinated. With the opening up of eligibility to anyone over 16— and now 12—we expected that we would encounter more resistance, which seems to be the case. We are now looking to identify pockets of people who are skeptical or still on the fence and engage with them about the vaccine. If you have some of these individuals in your patient populations or have ideas about who they might be and can use our materials to get the conversation started, we welcome your collaboration.

Michael Curry is the president & CEO of the Massachusetts League of Community Health Centers.

3 2.png