Description
Introduction - Objectives: The intersection of migration, health equity, and COVID-19 vaccination plays a vital role in mitigating global health inequalities. Somali communities in Minnesota and Norway, confronted with migration-induced challenges such as language barriers and socio-economic limitations, exhibit a reluctance to accept vaccinations. This reluctance, known as vaccine hesitancy, where individuals delay or decline available vaccines, poses a significant obstacle in these communities. Consequently, targeted efforts have been made to overcome this hesitancy and enhance vaccine acceptance among them. Addressing vaccine hesitancy is crucial for the health and welfare of migrant populations and is in line with the universal health coverage objectives and the World Health Organization's emphasis on the health of migrants. This study aimed to explore community actions and initiatives related to COVID-19 vaccine hesitancy in Somali immigrant communities in Minneapolis and St. Paul, MN, US, and Bergen, Vestland, Norway. Additionally, it sought to understand trust factors in these collaborative efforts and explore the unique and shared challenges in managing vaccine hesitancy in these migrant communities.
Methodology: A qualitative collective case study with a phenomenological approach was conducted. This study conducted fourteen individual, in-depth interviews with key informants knowledgeable about COVID-19 vaccine hesitancy initiatives, including eight Minneapolis and St. Paul participants and six Bergen participants. Data were analyzed using NVivo 12, with thematic analysis grounded in the Bergen Model of Collaborative Functioning.
Results and Discussion: The study found that more successful initiatives were marked by trust-building strategies sensitive to the unique migrant experiences, including considerations of previous healthcare encounters, community leadership roles, strategic location of vaccination sites, and effective communication that leveraged cultural and religious assets. In contrast, broken trust was a major issue due to negative contextual realities impacting the Somali community, such as fear surrounding the pandemic and vaccination, experiences of racism and xenophobia, and a lack of effort to acknowledge these experiences.
The application of Bronfenbrenner's Model of Collaborative Functioning in addressing COVID-19 vaccine hesitancy revealed key insights. Primarily, effective communication transcends mere translation, as evidenced in the Norwegian context, where simple language conversion failed to address deeper cultural and literacy nuances. In contrast, Minnesota's approach, involving high-profile community leaders publicly receiving vaccines, proved more successful. This strategy increased visibility and trust and directly engaged with the community's microsystem. These findings underscore the complexity of vaccine hesitancy, highlighting the necessity of contextually nuanced, culturally sensitive approaches that go beyond conventional communication methods.
Conclusion: The study reveals that contextual factors influenced the success of COVID-19 vaccine initiatives in Minneapolis, St. Paul, and Bergen Somali communities, emphasizing the need to consider context and socioecological levels in intervention design and implementation. It highlights the necessity of tailoring health interventions to migrant experiences, ensuring cultural sensitivity, and building trust. These insights are crucial for future global and public health strategies, particularly in addressing vaccine hesitancy among migrant groups, and contribute to the broader discourse on migrant health equity as championed by the World Health Organization and other international forums.
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