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Informing Efforts Beyond Tailored Promotional Campaigns by Understanding Contextual Factors Shaping Vaccine Hesitancy Among Equity-Deserving Populations in Canada: An Exploratory Qualitative Study

Nascimento, Lena G., Dubé, Ève, Burns, Kathleen E., Brown, Patrick, Calnan, Michael .W., Ward, Paul R., Filice, Eric, Herati, Hoda, Ike, Nnenna, Rotolo, Bobbi, and others. (2023) Informing Efforts Beyond Tailored Promotional Campaigns by Understanding Contextual Factors Shaping Vaccine Hesitancy Among Equity-Deserving Populations in Canada: An Exploratory Qualitative Study. International Journal for Equity in Health, 22 (1). Article Number 209. ISSN 1475-9276. (doi:10.1186/s12939-023-02025-y) (KAR id:103005)


Background: Vaccine hesitancy exists on a continuum ranging between complete adherence and complete refusal due to doubts or concerns within a heterogeneous group of individuals. Despite widespread acknowledgement of the contextual factors influencing attitudes and beliefs shaping COVID-19 vaccine hesitancy, qualitative research with equity-deserving groups, accounting for unique lived experiences, remains a gap in the literature. We aim to identify and begin to understand and document the unique contextual factors shaping hesitancy by equity-deserving groups as it relates to relationships with government and health authorities.

Methods: Participants were recruited and interviewed between Aug-Dec 2021. Semi-structured interviews using a convergent interviewing technique were conducted with individuals from the general population, as well as individuals who identify as First Nations, Métis, or Inuit, members of the LGBT2SQ+ community, low-income Canadians, Black Canadians, and newcomers. Interviews were audio recorded and transcribed by a team of researchers. Memos were written following interviews and used to complement the thematic analysis of the interview data. Themes are presented in the results section.

Results: The rationale for hesitancy among equity-deserving groups is consistent with literature documenting hesitancy in the general population. Contextual factors surrounding equity-deserving groups’ attitudes and beliefs, however, are unique and relate to a history of oppression, discrimination, and genocide. We identified factors unique to subgroups; for example, religious or fatalistic beliefs among participant who identify as FNMI, fear associated with lack of testing and speed of vaccines’ production among participants who identify as FNMI, Black, and LGBT2SQ+, distrust of the healthcare system for LGBT2SQ+ and Black Canadians, and distrust of the government and opposition to vaccine mandates for participating who identify as LGBT2SQ+, low-income, FNMI, or Black Canadian. Newcomers stood out as very trusting of the government and accepting of COVID-19 vaccination.

Conclusions: While our data on vaccine hesitancy largely mirror concerns reported in the vast body of literature citing rationale for COVID-19 hesitancy in high-income countries, the contextual factors identified in our work point to the need for wider systemic change. Our results may be used to support efforts, beyond tailored promotion campaigns, to support the confident acceptance of vaccines for COVID-19 and the acceptance of novel vaccines as future infectious diseases emerge.

Item Type: Article
DOI/Identification number: 10.1186/s12939-023-02025-y
Uncontrolled keywords: COVID-19, Equity-Deserving Groups, Marginalized groups, Canada, Vaccine Hesitancy, Contextual Factors, Promotional Campaigns, Vaccine Confidence, Qualitative.
Subjects: H Social Sciences > HV Social pathology. Social and public welfare
R Medicine
R Medicine > RA Public aspects of medicine
R Medicine > RA Public aspects of medicine > RA638 Immunity and immunization in relation to public health
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research
Funders: Social Sciences and Humanities Research Council (
Depositing User: Michael Calnan
Date Deposited: 27 Sep 2023 14:40 UTC
Last Modified: 10 Jan 2024 20:12 UTC
Resource URI: (The current URI for this page, for reference purposes)

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