Covid-19 Vaccine Knowledge, Attitudes, Beliefs and Trusted Information Sources Among Underserved Communities: A Qualitative Study

Vaccination was pivotal in controlling COVID-19 spread during the pandemic, benefiting individuals and communities. However, vaccine ‘hesitancy’ (VH) remains a global issue and a major barrier for to achieving population immunity. Acceptance of the COVID-19 vaccine is complex and influenced by multiple factors including distrust, which often vary among racial and ethnic groups. This in person cross-sectional study included 585 adults who completed a self-administered paper survey. The survey incorporated the adult VH Scale (aVHS) and questions on vaccine status and COVID-19-related knowledge. Zip codes with low vaccine uptake were selected using New York State Department of Health data from Erie and Niagara Counties in Western NY. Researchers collected demographic information along with participants knowledge, attitudes, beliefs, and sources of information about the COVID-19 vaccine. Data was transcribed and analyzed using reflexive thematic analysis and mapped to the Theoretical Domains Framework (TDF). Participants demonstrated limited knowledge about COVID-19 vaccine; 12.7% recognized it as viral, 8.4% as contagious, and only a few knew about respiratory transmission. Attitudes and beliefs about the vaccine and booster varied widely. Trusted sources were health care professionals, government, family, friends, and faith-based organizations. Concerns about vaccine side-effects, distrust, and general hesitancy were frequently mentioned. Findings demonstrated trends in published quantitative research. Mapping responses to the TDF and a 5C Model revealed several factors driving VH and vaccine distrust. Public health strategies must emphasize trusted, fact-based communication, promote vaccine literacy, and support informed decision-making for COVID-19 and broader public health initiatives.