Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Oct 15, 2024
Open Peer Review Period: Dec 18, 2024 - Feb 12, 2025
Date Accepted: Mar 4, 2025
(closed for review but you can still tweet)
Greater improvements in vaccination outcomes from a digital health intervention among Black young adults in the United States South with vaccine-resistant attitudes: A latent profile analysis of a randomized control trial
ABSTRACT
Background:
Negative attitudes towards vaccines and suboptimal vaccination rates among African American and Black (Black) Americans has been well documented due to a history of medical racism and human rights violations in the United States (US). However, digital health interventions (DHIs) have been shown to address racial disparities in several health outcomes. The Tough Talks COVID (TT-C) study was a randomized controlled trial of a DHI designed to empower Black young adults (YA) in the US South to make informed, autonomous decisions about COVID-19 vaccine uptake by addressing structural barriers and misinformation about vaccines.
Objective:
Our objective was to identify subgroups of Black YA with different vaccine attitudes at baseline and determine for which subgroups the TT-C DHI was most impactful.
Methods:
Black YA aged 18-29 years in Alabama, Georgia, and North Carolina who were unvaccinated or insufficiently vaccinated against COVID-19 completed three online surveys over three months (N=360). Latent profile analysis was used to identify subgroups based on general vaccine attitudes at baseline including hesitancy, confidence, knowledge, conspiracy beliefs, and mistrust. Logistic regression was used to examine the associations between latent profiles and vaccine uptake, and linear regression was used to examine changes in vaccines attitudes at 3 months post-randomization. Modification of the TT-C DHI’s effects were assessed by latent profiles.
Results:
Three latent profiles emerged: vaccine-receptive (n=124), vaccine-neutral (n=155), and vaccine-resistant (n=81). Political affiliation, income, social support, and recent flu vaccination differed significantly between the three subgroups (P<.05). Vaccine uptake was not significantly different by subgroup and the TTC-DHI did not have differing effecting on uptake across subgroups. However, the DHI had the strongest effect – with statistically significant (P<.05) measures of association and interaction P-values (P<.10) – among the vaccine-resistant and vaccine neutral subgroups at baseline compared to the vaccine-receptive subgroups in improving vaccine hesitancy, confidence, and conspiracy beliefs at 3 months [vaccine-resistant diff: -0.40 (-0.76, -0.37), 0.39 (0.02, 0.75), and -0.47 (-0.86, -0.09); vaccine neutral diff: -0.36 (-0.52, -0.19), 0.35 (0.18, 0.51), and -0.24 (-0.44, -0.03)]. The DHI had no effects on these outcomes among the vaccine-receptive subgroup.
Conclusions:
Our findings revealed subgroups of Black YA in the US South with different vaccination attitudes, for which the TT-C intervention had differing effects. Black YA who are vaccine-resistant or vaccine-neutral may experience larger gains from a digital vaccine intervention. Future work aimed at improving vaccination outcomes could target these populations to maximize resource efficiency and drive the biggest improvements in vaccine outcomes. Clinical Trial: ClinicalTrials.gov NCT05490329
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