Examining lived experience of older, highly educated Black African women and their attitudes to COVID-19 vaccination: an outlook of England and Scotland

Advances in medicine have extended life expectancy worldwide, creating a growing population of older adults. The United Nations Decade of Healthy Ageing highlights the need for ongoing support for this generation, particularly by ensuring that healthcare systems remain accessible, equitable and responsive to their needs. As the global population continues to age, the demand for effective, inclusive and targeted public health interventions becomes increasingly urgent. In 2020, the World Health Organization declared COVID-19 a global pandemic, prompting the UK and other nations to implement strategies aimed at mitigating its impact. Although a large proportion of the UK population received the COVID-19 vaccine, many remained hesitant or and declined it. Evidence shows that ethnic-minority groups, particularly Black African communities, had lower uptake. Yet, there remains limited understanding of the factors that shape these attitudes, particularly among older educated adults. Given the complexity of vaccination decision-making, examining its multifaceted drivers is vital in improving future vaccination programmes and strengthen responses during health emergencies. This interdisciplinary study positioned at the intersection of social science, communication studies, health policy and public health engagement, applies the 5Cs and the 3Cs Models to examine how educated older Black African women experienced and responded to COVID-19 vaccination. Drawing on qualitative interviews data, the research highlights the relevance of strategic communication built on tailored messaging, co-design techniques and equitable health systems and policies. It also demonstrates the value of context-specific frameworks such as the 7Cs vaccination Model for capturing the nuanced perspectives of diverse populations in times of crisis. The findings highlight the urgent need for disaggregated data and inclusive, audience-focused patient public involvement strategies. They demonstrate that culturally tailored, community-led approaches are essential to improving vaccine uptake and strengthening trust among underrepresented communities. By centring the lived experiences of an overlooked older demographic, this research advances a more inclusive and equitable global health discourse and provides practical insights for designing health systems that truly reflect the diversity of the populations they serve.