Understanding COVID-19 Vaccine Hesitancy Among Black and Afro-Latinx Pregnant Individuals: A Mixed-Methods Approach Utilizing Focus Groups and Social Media Ad Reaction

Abstract Pregnant individuals have a greater susceptibility to severe disease from the coronavirus 2019 disease (COVID-19). Pregnant people 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 ads promoting COVID-19 vaccination could influence vaccination likelihood among pregnant and recently pregnant participants who self-identified as Black or African American. Participants were interviewed individually or in focus groups to explore their attitudes about vaccination and to ask them to rate their COVID-19 vaccination likelihood after seeing a panel of ads featuring different messengers (e.g., doctor, peer, elder, faith leader) and content types (e.g., social proof, text-heavy, fear-based, activation). Ad ratings were analyzed using linear mixed models to examine the effect of vaccination status, ad messenger, and ad content type. Interviews were coded and analyzed for qualitative themes. Ad scores differed significantly by vaccine status, with vaccinated participants rating ads as more likely to inspire vaccine uptake, while unvaccinated participants rated ads negatively. No specific messenger or content type was rated as more probable to motivate vaccination. There was a significant interaction between faith-based messengers and COVID-19 vaccination status, with faith leaders perceived as more favorable by unvaccinated participants (p=0.008). Vaccine-hesitant respondents cited mistrust of healthcare providers and fears of medical racism. Although we did not identify content types that might be helpful in a public health vaccine campaign targeting Black pregnant people, faith leaders may be a trusted messenger for unvaccinated individuals.