Abstract
This study aimed to understand vaccine hesitancy and confidence toward the COVID-19 vaccines among Latino adults in Arizona. Latinos (n = 71) aged 18 years or older who resided in Arizona participated in 14 focus groups between February and June 2021. Theoretical thematic analysis was used to examine drivers of these two behaviors, namely, vaccine hesitancy and confidence toward the COVID-19 vaccines, using the COM-B model, comprising capability, opportunity, and motivation factors that generate a behavior. Vaccine hesitancy stemmed from the need for vaccine information (capability factor) and fear of the vaccines, religious beliefs, and perceived barriers stemming from government mistrust (motivation factors). Vaccine confidence arose from trust in science and doctors (capability factor), and a fear of getting sick, protection against COVID-19, getting vaccinated as a civic duty, and a desire to return to normal life (motivation factors). The influence of opportunity factors, such as having access to vaccinations, were not discussed as contributing to vaccine confidence or hesitancy. As predicted by the COM-B model, factors reflecting capabilities and motivations contributed to vaccine hesitancy and confidence, all of which need to be considered in public health messaging. These factors can be targeted to facilitate efforts to promote vaccine uptake and reduce the spread of COVID-19.
Impact Statement
The effects of COVID-19 devastated the Latino community, widening the health disparities in this population. Guided by the Capability, Opportunity, and Motivation–Behavior (COM-B) Model, this study showed that, although capability and motivation factors were identified, the influence of opportunity factors (i.e., the context) on Latinos’ vaccine behaviors (i.e., vaccine hesitancy and confidence) were not discussed among study participants who resided in Arizona. This suggests that, at the onset of COVID-19 vaccine distribution efforts, context-specific factors, such as access to vaccines, were not top of mind for Latinos. The implications of these findings suggest that, despite the intentional efforts by public health entities to address structural barriers (i.e., accessibility) that are known to contribute to vaccine hesitancy in Latino communities, understanding vaccine hesitancy in the context in which Latinos live is critical for developing and disseminating relevant health information and public health messaging.
The COVID-19 pandemic has had a disproportionate impact on the health of socially and economically marginalized communities, including Latino Americans, and (re)exposed the root causes of social inequities these communities continue to face (Page & Miller, 2021; Safo, 2021; Strully et al., 2021). At the time of this study, Arizona, the state with the fourth largest concentration of Latinos (30%) in the United States, ranked fourth in the nation in percentage of deaths among Latinos due to COVID-19 (29%) and fourth for states with the lowest vaccination rates in this population (Arizona Department of Health Services, 2022). This placed Arizona in the top five for states with the widest vaccination disparities between non-Hispanic Whites (59%) and Latinos (42%; Ndugga et al., 2022). Despite the effectiveness of COVID-19 vaccines and boosters, vaccination rates among Latinos in Arizona continue to lag other racial/ethnic groups. In 2022, 47% of Latinos across Arizona received at least one vaccine dose compared with 62% of the White population and 53% of the African American or Black population (Ndugga et al., 2022). Research is needed to determine whether there are specific factors that can influence targeted outreach strategies to affect the widespread vaccine hesitancy among this minoritized and economically disadvantaged population. Identifying malleable targets for health promotion efforts and interventions that reduce health inequities, including those that could help in closing the gap in vaccination disparities, is critical to reducing the immediate and long-term impact of COVID-19 as well as to mitigate future pandemics and promote health equity.
To understand and address factors that contribute to COVID-19 disparities, including vaccine hesitancy and confidence, the National Institutes of Health (NIH) established the Community Engagement Alliance (CEAL) Against COVID-19 Disparities initiative. This initiative funds multiple state-level research consortia, including the COVID-19 CEAL Consortium in Arizona (AC3; Ignacio et al., 2022). The ongoing CEAL initiative leverages academic–community partnerships across academia, health care, and social service agencies and systems. In Arizona, the AC3 brings together local/state organizations in partnership with four institutions: Arizona State University (ASU), Mayo Clinic in Arizona, Northern Arizona University (NAU), and the University of Arizona (UA). The overarching goal of CEAL is to understand factors that contribute to the disproportionate burden of COVID-19 in underserved communities and establish effective, community-engaged strategies to enhance education, awareness, access, and inclusion of underserved communities.
In the context of COVID-19, understanding the factors that negatively affected the overall health of the Latino individual and communities in Arizona (the southwest region) was imperative to closing the gap in vaccination disparities. In addition to individual behaviors, structural and social barriers that contributed to these disparities needed to be considered. For example, unknown fears and concerns often drive individuals’ motivations to resist getting vaccinated although other structural and societal factors (e.g., government mistrust, cost) relevant specifically to Latinos’ may underscore these sentiments (Ignacio et al., 2022; Marcelin et al., 2021; Nana-Sinkam et al., 2021). On the contrary, positive attitudes toward vaccines (i.e., trust in the safety and effectiveness of vaccines, trust in the systems/services/health professionals that deliver vaccines) characterize vaccine confidence (Betsch et al., 2018; Butler et al., 2022; Carson et al., 2021).
The Capability, Opportunity, and Motivation–Behavior (COM-B) model is a framework for understanding behavior and behavior change (Betsch et al., 2018; Habersaat & Jackson, 2020; Hastall et al., 2022; Michie et al., 2011; Thomson et al., 2016; While, 2021; World Health Organization, 2014). These components, capabilities, and opportunities interact with motivation to generate a behavior. This behavior can in turn influence these components (Michie et al., 2011). Based on the COM-B model, we posited that individuals’ vaccination behaviors (e.g., decisions) were influenced by three factors: their capabilities (e.g., health literacy, knowledge about the COVID-19 vaccines, and perceived severity of the disease), their structural opportunities (e.g., access to the vaccines), and their personal motivations (e.g., emotions, intentions, and beliefs about the vaccines; Habersaat & Jackson, 2020; Vallis et al., 2022). Given the lagging COVID-19 vaccination and booster rates in Arizona among Latinos, it is important to understand their knowledge or capacity to acquire the necessary information to get vaccinated, the opportunities or barriers to getting vaccinated, the specific types and range of motivations Latino individuals had toward the COVID-19 vaccines, how these factors influenced their behavior, and how these factors may inform nuanced and targeted health outreach strategies.
Method
Data came from 14 focus groups with 71 individuals who identified as “Hispanic/Latino/a.” Data were collected between February and June 2021, during the initial three phases of the COVID-19 vaccination distribution (Figure 1). With assistance from the AC3 Community Taskforce, convenience and snowball sampling were used to recruit participants, using email distribution lists, flyers, and through word-of-mouth. The research team also encouraged the initially recruited participants to invite family or friends for the focus groups. This approach was considered culturally appropriate as many participants lived in intergenerational households and the focus of COVID-19 and decisions around getting vaccinated likely affected entire families and households. Recruitment was conducted in four counties across Arizona (i.e., Maricopa, Coconino, Pima, and Santa Cruz) to capture the experiences of Latinos across the state. To be eligible for the study, participants had to be at least 18 years of age, self-identify as Hispanic/Latino/a, have internet access, and reside in Arizona. Protocols to ensure the safety of participants were established and allowed for all focus groups to be conducted using a university-secured and password-protected virtual video conferencing platform (i.e., Zoom). In total, nine focus groups were conducted in English and five in Spanish. Two facilitators, who identify as Latino/a, led focus group discussions using a semi-structured question guide (Table 1). Participants were asked about their experiences during the COVID-19 pandemic, including the effects of the pandemic on themselves, their family, and their community; their perceptions and feelings about the COVID-19 vaccines; sources of information they trusted to learn about the vaccines; and the types of information and public health messaging participants perceived were needed about the COVID-19 vaccines. Focus groups were audio-recorded and averaged between 60 and 90 minutes. Participants received a US$45 electronic gift card that was sent to their email address. Participants were also asked to complete an online survey, prior to participating in a focus group, to collect demographic data, participants’ vaccination status, reasons for or against getting vaccinated for COVID-19, and trusted sources for COVID-19-related information. The institutional review board at the UA approved all protocols for this study.
Latino/a Focus Groups Conducted in Arizona in 2021 During Statewide Vaccine Distribution Phases in Arizona.
Overview of Focus Group Questions.
Audio recordings of all focus groups were transcribed verbatim. Spanish focus group recordings were first transcribed in Spanish, and then translated to English by certified translators. The co-facilitators conducted a theoretical thematic analysis of focus group data. Theoretical thematic analysis is a deductive approach that applies a preexisting framework to guide the coding (Braun & Clarke, 2006; Maguire & Delahunt, 2017; Naeem et al., 2023). For this study, key constructs of the COM-B model (capabilities, opportunities, motivations, and behaviors) guided the coding and the themes that were developed (Labra et al., 2020). First, a codebook was created a priori, using the theoretical understanding of the COM-B model. The coders read transcripts thoroughly to gain familiarity with participants’ discussions. Using Dedoose (Sociocultural Research Consultants, LLC), a qualitative data management software and analytical tool, they proceeded to code the transcript separately and compared and discussed the codes, which resulted in refining the initial set of codes (e.g., clarifying codes, defining codes). After coding the remaining transcripts, codes were attributed to a primary theme and further categorized into subthemes. Saturation was achieved after coding produced no new information or changes to the analysis (Aldiabat & Le Navenec, 2018). Themes and subthemes were further reviewed to assess the coherence of the data (Maguire & Delahunt, 2017). Any disagreements regarding codes, themes, and subthemes were discussed and resolved by consensus among all coders.
Results
Participants’ Survey Results
Focus group participants were socio-demographically diverse. On average, they were aged 41 years and most identified as female (68%). About one fourth (26%) had less than a high school degree, 28% had completed high school, and 45% had a college degree (associate’s degree or higher). About 31% had an annual household income of less than US$25,000 per year and a total of 58% of the participants had an annual household income below US$50,000, all below the median household income for Arizona (US$62,055; U.S. Census Bureau, 2020). About 36% of participants were uninsured, 11% had Medicaid, whereas all other participants had some other source of health insurance (e.g., private health insurance, insurance through government exchange, or Medicare). Additional participant demographic information is presented in Table 2.
Descriptive Statistics of Focus Group Participants Who Completed the Survey (n = 71).
Note. Options for transgender female or trans woman, and transgender male or trans man were given but no responses were reported for these options by participants. GED = General Educational Development.
Based on responses to the supplemental survey, vaccine hesitancy was moderate among Latino/a participants in this study (Table 2). Although less than half of participants (39%) were already vaccinated against COVID-19, the majority (53%) of the unvaccinated participants indicated that they would be “very likely” to get the vaccine in the future. One fifth (21%) reported they were “not at all likely” to get it. Among unvaccinated participants, the motivations to get the COVID-19 vaccine were to keep their family safe (66%), to keep their community safe (47%), and to feel safe around others (47%). The most frequently cited reasons for not getting vaccinated were not knowing enough about how well the COVID-19 vaccines work (47%), concern about side effects (37%), and not trusting that the vaccines will be safe (32%).
Focus Group Findings
Analysis of themes and subthemes from the focus group data were mapped onto the COM-B model. The findings were separated into the COM-B factors that contributed to Vaccine Hesitancy, followed by the COM-B factors that contributed to Vaccine Confidence. The need for vaccine information was a capacity-related factor that contributed to participants’ indecisiveness to get vaccinated. Opportunity factors (e.g., lack of available appointments to get vaccinated) were rarely mentioned. Motivational factors keeping participants from getting vaccinated stemmed from COVID-19-specific fears about the safety of the vaccines, religious beliefs that did not encourage vaccination, as well as perceived barriers stemming from government mistrust.
Vaccine Hesitancy
Capability Factors
The Need for Vaccine Information
Participants’ capacity to discern information about the COVID-19 vaccines contributed to their vaccine hesitancy. For example, some participants expressed having conversations about the vaccines with family and friends, and being confused about what they were hearing from government officials or reading in the news.
[My sister and I], we’ve had multiple conversations of this vaccination. . . . like [we] can’t trust what [we] hear, or [we] read things [that] contradict other things. The CDC websites were always changing, every day new information, like I’m unsure about [the] vaccine and I felt that way . . . I’m not going to get it. So I wasn’t comfortable not knowing exactly what information was true, which one was right. It just seemed like it kept on changing, so I was uncomfortable with it.
Another participant said, They have bombarded us with good and bad information, but we do not know. Anyway, we don’t know, even yesterday I heard a comment that it seems that vaccines have a magnet, that if you put a magnet on it, it sticks to you. So, yes there are many myths that exist . . . but I do feel that we need information . . . more information needs to be published.
Motivation Factors
Fears Toward the COVID-19 Vaccines
Fears about vaccine safety, ingredients, and negative long-term effects on health were salient themes that motivated participants from getting the COVID-19 vaccines. For example, one participant expressed their concern about the safety of the vaccines and its ingredients saying, “I am only afraid of an allergic reaction. I heard that a person got it and was previously allergic to a certain chemical, which was like a shock [to the body] with the vaccine and died.” Another participant commented, “I am afraid of the vaccine, in particular, because all organisms, all bodies, are different and . . . I have heard . . . a person got [the vaccine] and died right there.” Many participants identified specific news stories about negative reactions to the Johnson & Johnson vaccine (i.e., blood clots), and stories about vaccinated individuals who suffered from strokes, cardiac arrest, heart attacks, and paralysis shortly after receiving the vaccine. These stories negatively affected participants’ perceptions and added to their fears about the vaccines. Participants also worried about the long-term effects of the vaccines on their own health or their children’s health. For example, once the vaccines became available for children ages 12 to 17, participants discussed their intention to learn more about the side effects after hearing that children who were vaccinated were getting sick.
My sister [has] two children, a girl of eleven and a boy of fourteen. When the news of the vaccine came out, she did want to [get them vaccinated] but then we saw in the news of children who had gotten sick from the vaccine, so we are waiting for more information.
Another participant explained she was afraid to get the vaccine because she was breastfeeding, “I have a baby. . . I breastfeed him; I would not want [the vaccine] to affect me or my baby.” For another participant, their concern was related to how the vaccine may affect their health later in life (i.e., fertility, pregnancy): [How is the vaccine] going to affect us in the long term, especially me being so young . . . I’ve heard a lot of young people taking it and they are like pregnant girls taking it. I want to have a baby soon and I’m not going to be able to.
Religious Beliefs
Participants mentioned that God and religion played a role in their decision not to get vaccinated or said these were reasons why their friends or family members did not want to get vaccinated.
I asked God to just give me a clear-cut sign and direction on what he wanted for me. Now, I know that that doesn’t necessarily work for everybody, but I just asked him for a sign for me on what to do. And when I got that sign, I knew that the vaccine was not for me. . . . So that’s just kind of how I felt about it.
Participants also discussed their family or community members’ resistance to getting vaccinated in relation to religion and God. One participant said, “I have heard many things [from religious people]. Some link it to an apocalypse event.” Another participant explained, “we are a large family. Some of them are Evangelical Christians and they don’t believe in the vaccine.”
Perceived Barriers Stemming From Government Mistrust
Perceived barriers to getting vaccinated were significant motivators contributing to vaccine hesitancy. These perceptions stemmed from government mistrust and highlighted participants’ fear of government control or the government’s infringement on their personal choices. Several concerns were expressed about the government’s role in potentially requiring vaccines to travel, work, access public areas, or send children to school. Participants suggested that these limitations would be placed on individuals (e.g., not allowed to travel) or they would be penalized based on their vaccine status.
What worries me is the whole vaccine card and how it might become like the only way for you to travel or to get in places or to go places. Why does everybody need to know who has and who has not been vaccinated? That’s what scares me, is when you’re almost going to get penalized for the decisions you make, despite this being, you know, America. That’s where it gets scary, where it seems like it’s no longer going to be an option, even though [the government] present[s] [it] as one. Because in order for you to go back to work or to travel or to enter public areas, it’s going to be required, and that’s kind of scary.
Another participant commented, A neighbor of mine was given the vaccine and now [the government] [is] detecting [them] by means of a chip. . . because the government wants to control us, and I don’t know . . . all that kind of misinformation keeps you from accepting the vaccine.
Vaccine Confidence
Despite some participants’ hesitancy to get the vaccines, others talked about why they chose to get vaccinated or why they would get vaccinated in the future. Participants’ capacity to learn about the COVID-19 vaccines (capability factor) contributed to their vaccine confidence. Opportunity factors contributing to vaccine confidence were rarely mentioned by participants. Motivations for getting the vaccines included the fear of getting sick, protection against COVID-19, getting vaccinated as a civic duty, and a desire to return to a normal life.
Capability Factor
Trust in Science and Doctors
Participants’ perceived trust in science, scientists and doctors, and their perceived understanding about the advances made in technology were based on their capacity to process information about the COVID-19 vaccines. After reading an article in the local newspaper, one participant explained, [The article] just kind of gave validity to all those myths and I thought we have to stick to the science. We have to stick to the science. I’m not a scientist, but if it were not for scientists, we’d still be dealing with smallpox. If not for scientists, we’d still be dealing with Polio. Polio happened in our lifetime. It’s been for the most part eradicated. So I just don’t understand that mistrust [in] science.
Participants also mentioned discussing the vaccines with their primary care doctors or hearing from other doctors on the radio or on television. As one participant commented, “I trust the doctors, I am constantly listening to what the doctors say and that is why I got the vaccine.” For another participant, their perception of advances in technology contributed to their confidence in the vaccines.
I want people to understand that you do not need to be scared of the vaccine. I know people were scared of how quickly they were developed. Our science and our technology [are] so much further advanced than when like other vaccines were developed.
Motivation Factors
Fears of Getting Sick
The fears of getting infected, becoming severely ill, or dying from COVID-19 were important motivating factors contributing to participants’ decision or desire to get vaccinated. One participant explained, “I don’t want to get sick and go to a hospital ward, intubated. I don’t want that for my life.” Participants also feared the long-term effects of COVID-19 on their own health, and their family members’ health, and/or the financial strain (e.g., lost wages, layoff) it could have on their families. One participant explained, “I want to get vaccinated because in my family there are people with health issues such as asthma, or people whose health is compromised by cancer and I would not like to get it and harm them.” Another participant said, I choose [to get vaccinated] because I want to be healthy for my kids, I want to be [there] for them. I have to work to pay all the bills, so if I get sick, I’m not going to be working. So maybe that’s why I decided to get the vaccine.
These fears motivated participants to get vaccinated so they could remain healthy for their families. This was a common concern for participants who worked in health care settings or who had family members who were exposed to COVID-19 at work.
My main reason [for getting vaccinated] probably was for my Nana, who is high risk and my family . . . and my child that I didn’t want to get sick . . . from what I read—[the vaccine] lowers your risk of getting it or your symptoms or if you do get it.
Protection Against COVID-19
Participants were motivated to get vaccinated because it would offer “protection” from harm, sickness, or death to themselves, their families, and their community. One participant said, “I have already decided to get vaccinated . . . because I want to be protected,” and another participant commented, “to protect the family and other relatives, in particular, I would get it.” Among those who lived with or were caregivers for family members with chronic health conditions, older parents, or younger children, the idea to protect them was a significant topic of discussion, as one participant explained, “[The vaccine] is to protect my family, to protect my parents, my children [. . .] I want to protect them, for me, and for them.”
Getting Vaccinated as a Civic Duty
Federal or state guidelines or recommendations were motivating factors to get vaccinated for some participants, whereas others expressed their general acceptance of vaccines and considered themselves advocates for immunization, especially COVID-19 vaccines. An example of this was described by one participant in the following way: I’m also a very strong advocate for any vaccination. So I guess I am an optimist when it comes to that. But if [the government] told me today, like, hey, bring your kids, they can get a vaccine, I’d probably be one of the first people in line.
Along with these sentiments, participants felt strongly about complying with the Centers for Disease Control and Prevention (CDC) and the state recommendations to get vaccinated, either waiting to be eligible for the vaccines or getting in line when it was made available to them. For several participants, this sentiment complied with doing one’s civic duty and wanting to lead by example, as one participant expressed, “I got vaccinated to comply.” Another participant commented, “I think personally, your civic duty to the rest of your community, just to be a responsible person and a responsible adult is to get vaccinated when it becomes available to you.”
Return to Normal Life
Participants were motivated to get vaccinated if it would allow them to return to normal life, as one participant commented, “Mine are pretty selfish reasons. I really just want things to go back to normal as soon as possible. And if giving me a shot, like does that in any way, I am all for it.” Others expressed reassurance that the vaccines would provide a return to normal life. One participant expressed, “I hear from confident people, people who once the vaccine was put into their body felt safer to go out.” One parent commented their desire for going back to a normal life in the following way: I have the vaccination . . . because I have a child that I can’t hold back and hold prisoner at home that I need to let him go out and be a teenager and play his sports and have time with his friends, that myself and my husband and my mom are covered with the vaccination so that if he was to bring it home, we would be okay.
In summary, results show that capacity-related factors (e.g., lack of credible information about vaccines) and motivation factors (e.g., fears about the safety of the vaccines, religious beliefs) increased Latinos’ vaccine hesitancy. Trust in science and doctors (capability factor) and fear of getting sick, perceived need for protection against COVID-19, getting vaccinated as a civic duty, and a desire to return to normal life (motivation factors) contributed to vaccine confidence. Opportunity factors, such as access to vaccine sites, the availability of vaccine appointments, or free vaccines, were not mentioned by participants.
Discussion
The AC3 study team conducted 14 focus groups (both in English and Spanish languages) to understand the factors that contributed to vaccine hesitancy and confidence among adult Latinos in Arizona, a state that has a large Latino population and has experienced one of the widest COVID-19 vaccination disparities in the country. Consistent with the COM-B model, capacity-related factors, such as confusing and contradictory vaccine information, contributed to vaccine hesitancy, whereas perceived trust in science and knowledge about how the vaccines were developed increased participants’ confidence to get vaccinated. This study also found motivation factors among Latinos in Arizona that contributed to both vaccine hesitancy (i.e., fears toward the vaccines, religious beliefs, and perceived barriers stemming from government mistrust) as well as confidence (i.e., fear of getting sick, protection against COVID-19, getting vaccinated as a civic duty, and a desire to return to normal life). Opportunity factors directly related to getting or refusing the COVID-19 vaccines were not discussed among participants.
Furthermore, this study showed how the COM-B model could be used to identify specific factors that needed to be considered for targeting public health messaging and promoting vaccine acceptance. For example, to address motivation (i.e., fears toward the vaccines) and capability factors (i.e., the need for more information), it would be important to disseminate relevant information and address fears related to the vaccines in a transparent way. Moreover, religious beliefs need to be considered in public health messaging for some Latinos, which is a theme that is not frequently discussed among other racial/ethnic groups (e.g., African American/Black, American Indian/Alaska Native; Ignacio et al., 2022). In addition, government mistrust was another important factor as participants perceived their vaccination status may be a means for the government to establish greater control over them, resulting in some to reject the vaccines. It is well-documented that there exists an inherent mistrust toward government among racially marginalized and immigrant groups. This mistrust stems from historical abuses and systemic efforts to exclude minorities’ access to education, employment, health, and other essential services (Strully et al., 2021; Sudhinaraset et al., 2022). For Latinos, especially households with mixed legal statuses, documentation may undermine public health efforts to instill vaccine confidence by discouraging Latinos from seeking the COVID-19 vaccines (Sudhinaraset et al., 2022). Given the state’s demographics, and high percentage of immigrant households, such perceived misconceptions have implications for the health of all Latino/as (Strully et al., 2021). To overcome the issue of government mistrust, efforts to promote vaccine acceptance must be carefully considered and tailored to fit the sociopolitical realities of Latinos who reside in Arizona.
Finally, although capability and motivation factors were identified, the influence of opportunity factors (i.e., the context) on Latinos’ vaccine behaviors were not discussed among study participants. Even when asked about their concerns about getting vaccinated or barriers to getting vaccinated, participants did not mention accessibility or other structural (e.g., transportation, language) barriers. One possible explanation for the omission of opportunity factors could be that the sample consisted of individuals who were relatively well educated, not from a lower socioeconomic background, and had access to health care. Widely publicized vaccine sites and the free cost of vaccines, including Spanish ads on multiple media channels, may have made the information easy to access and not noted as a barrier for participants. Another reason opportunity factors may not have played a role in affecting participants’ behaviors may be attributed to the cultural significance and central role of “familismo” among Latinos, wherein vaccine decisions were determined by how it would benefit the family unit, irrespective of broader issues regarding accessibility, language, cost, or health care insurance (Lynagh, 2023; Sobo et al., 2022). Taken together, these findings support the assumptions underlying the COM-B model at the individual level and underscore the need to better understand the contextual factors that influence Latinos vaccine behaviors.
This study had several limitations. This research used convenience and snowball sampling to recruit participants. Thus, the Latino/a participants who were included in this study represented a subset of the Latino/a community who resided in Arizona and whose lived experiences, as it relates to the COVID-19 pandemic, may not be representative of the experiences of the diversity of Latino/a people and communities in Arizona and other states across the country. There were also limitations to recruit Latino/a participants who resided in rural areas and participants had to a have access to a reliable internet connection or phone line to join the focus group on Zoom, which may have excluded some individuals. Recruitment efforts were made to have participants invite family and friends to the focus group in an effort to reduce sampling bias because of structural inequities (e.g., lacked internet connectivity, geographical digital divide) that already exist in research. Despite these limitations, the study had important strengths. The data were collected over a period of time, during changing ordinances and vaccine availability, which captured evolving viewpoints and the lived experiences of Latinos in Arizona. The study was developed and implemented by two bilingual, bicultural doctorate-level health equity researchers who identified as Latino/a, and who have extensive experience working with the Latino population.
Conclusion
Gaining an understanding of COVID-19 vaccine hesitancy among Latino/as in Arizona is critical for developing and disseminating relevant health information and public health messaging (Vallis et al., 2022). This study, consistent with the COM-B model, identified those capability and motivation factors that contributed to both vaccine hesitancy and confidence; opportunity factors (e.g., access to vaccination sites) were not discussed by focus group participants. By engaging the Latino/a community and listening and learning from their experiences, the scientific community, public health and government officials, and community leaders can better address varied beliefs that contribute to vaccine hesitancy and take concrete steps for targeted messaging and strategies that help advance health equity for this population.
Footnotes
Author Contributions
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by M.M. and G.L. The first draft of the manuscript was written by M.M. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award no. OT2HL156812. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Ethics Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the University of Arizona Institutional Review Board (protocol no. 2011244240).
Consent to Participate and Publication
Informed consent was obtained from all individual participants included in the study.
