Applying the Hornik & Woolf Approach to Identify Messaging Themes and Improve COVID-19 Vaccine Confidence Among Federally Qualified Health Centers’ Workforce in Wisconsin

Abstract

The Federally Qualified Health Centers (FQHCs) in Wisconsin serve the most under-resourced communities in the state and are trusted sources in local communities. Although healthcare workers can be leveraged to champion COVID-19 vaccines, existing vaccine hesitancy among the FQHC workforce itself calls for research to identify promising messaging themes that can boost their vaccine confidence. In spring 2021, through a partnership with the Wisconsin Primary Health Association, we took a community-engaged approach to develop and field a survey including 46 beliefs (Ms = 1.36–4.25, SDs = 0.81–1.46, all on 5-point Likert scales) among employees of 10 out of the 17 FQHCs in Wisconsin. In total, 347 clinical team members and 349 non-clinical staff members (a) indicated their levels of (dis)agreement with all 46 belief items and (b) reported vaccine acceptance (dichotomized, acceptance = 77.6%) as well as recommendation intentions (dichotomized, yes = 73.9%). We carried out the Hornik & Woolf analyses in a multilevel logistic regression framework with bootstrapping to rank order all beliefs, segmented by subgroup and behavioral outcome. Our results suggest that communication-based interventions should promote beliefs such as those related to perceived safety and efficacy, rather than normative pressure from peers, while aiming to reduce doubts about information withholding and manipulation, the safety of the mRNA technology, the approval process, and “unnatural” ingredients in the vaccines. Subgroup-specific belief rankings are also provided. This study demonstrates the usefulness of incorporating the H&W approach into community-engaged research with local healthcare systems to improve health messaging for vaccine promotion.

Acknowledgments

We want to acknowledge the contribution of leadership of the Wisconsin Primary Health Care Association and the staff of the individual FQHCs that collaborated on this study. This work would not have been possible without their efforts and thoughtful feedback.

Ethics Approval

This study has been approved by the Institutional Review Boards at the University of Wisconsin Madison.

Consent to Participate

Participants all consented to participated in the study.

Authors’ Contributions

SY oversaw the study design, data collection, statistical analyses, and manuscript drafting, and hence taking the final responsibility for the paper as the first and the corresponding author. LS conducted data analyses and prepared drafts for reported tables and figures. SG and BP facilitated data collection and coordinated collaboration with participating FQHCs. DFE and SRP helped secure funding.LS, SG, BP, DFE, and SRP have edited manuscript drafts and have contributed to all aspects of the reported research.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was made possible by the UW-Madison Institute for Clinical & Translational Research (UW ICTR) and strategic grant funding from the UW SMPH Wisconsin Partnership Program (WPP 4358). UW ICTR is supported by NIH-NCATS Clinical and Translational Science Award (CTSA) #1UL1TR002373. Other support for this research was provided by the University of Wisconsin-Madison Office of the Vice Chancellor for Research and Graduate Education with funding from the Wisconsin Alumni Research Foundation (#MSN231886).