Exploring the Psychological Drivers and Impact of Public Health Communications on Vaccination Beliefs of Minority Ethnic Groups, 2022

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This project was funded as part of UKRI’s rapid response to COVID-19 to provide real-time data to support the development of tailored public health guidance about the COVID-19 vaccine for ethnic minority communities in the UK. The aim of this study was to understand the impact of public health communications on the experiences and beliefs about COVID-19 vaccinations for minority ethnic groups in the UK. This involved: • A rapid systematic literature review of factors influencing COVID-19 vaccination uptake in minority ethnic groups. • Three waves of in-depth interviews and focus groups with (i) practitioners in local public health and community organisations, and (ii) residents from diverse communities in London and Birmingham were conducted between September 2021 and June 2022. • Collation of COVID-19 vaccine communications targeting Black and Asian audiences in the UK that were released between January 2021 and June 2022. Practitioner interviews identified public health communication challenges relating to the knowledge, skills and capacity required to develop appropriately tailored messages. They also demonstrated the effectiveness of co-produced, two-way local communications using trusted expert sources and communication channels that are preferred by communities. Resident interviews highlighted differences within- and between- minority ethnic group attitudes and experiences. They also indicated that anti-vax messages were being shared via multiple sources with varying impacts, including on community cohesion as well as vaccine behaviours. The longitudinal design revealed that strongly positive and negative vaccine attitudes held over time, but also showed changes in attitudes, risk perceptions and behaviours relating to individual and peer experiences during the pandemic, as well as changes in government and public health responses. These findings suggest that the experience of the COVID-19 vaccine has increased delay or refusal of other routinely available vaccines, due to increased information-seeking and a desire to regain autonomy over health decision-making.

Psychological drivers of behaviour can help explain why individuals engage in protective and risky health behaviours. Understanding behavioural determinants can inform strategies to promote behaviour change and using a theory-driven approach underpinned by behavioural science, facilitates a more detailed understanding of mechanisms of change. Evidence indicates some minority ethnic groups have lower intentions to receive a COVID-19 vaccine. This is of considerable concern given higher COVID-19 incidence, morbidity, and mortality among minority ethnic groups. There is limited evidence of the reasons underpinning vaccine hesitancy in minority ethnic groups in the UK, but emerging evidence indicates it is related to beliefs about vaccine safety/efficacy and issues of mistrust towards formal services, as well as practical barriers such as access. This study will involve three waves of in-depth interviews and focus groups with minority ethnic community members and organisations in London and Birmingham to understand (i) specific barriers and facilitators of vaccine uptake, (ii) changes in COVID-19 vaccination risk perceptions over time, (iii) challenges and strategies for building and sustaining community support for vaccination programmes, and (iv) the impact of public health campaigns on vaccination intention. We will also evaluate national and local campaigns across the UK to identify mechanisms of action of health messages using a behavioural science framework. This will facilitate the rapid development of evidence-based, theoretically informed, tailored health messages that are critical for the ongoing success of the UK mass vaccination programme. It will also support the sustained community engagement that is crucial for optimising public health outcomes.

The communications database was created by conducting a systematic search of national and local authority websites, community organisation websites, social media (e.g. Twitter, Facebook, Tik Tok, Instagram) and video sharing websites (e.g. YouTube, Vimeo). Interviews were conducted with (i) practitioners in local public health and community organisations, and (ii) Black Caribbean and Pakistani residents in Birmingham, and Black Caribbean and Latin American residents in London. Practitioner interviews were recruited via public health networks to identify local public health practitioners and community organisations involved in the communication and delivery of the COVID-19 vaccine. Resident interviews were recruited using purposive and snowball sampling methods, which included sharing invitations via community organisations supporting ethnic minority communities in each city.