key: cord-0706939-ha8smbrx
authors: Jasuja, Guneet K.; Meterko, Mark; Bradshaw, Ledjona D.; Carbonaro, Richard; Clayman, Marla L.; LoBrutto, Lara; Miano, Danielle; Maguire, Elizabeth M.; Midboe, Amanda M.; Asch, Steven M.; Gifford, Allen L.; McInnes, D. Keith; Elwy, A. Rani
title: Attitudes and Intentions of US Veterans Regarding COVID-19 Vaccination
date: 2021-11-03
journal: JAMA Netw Open
DOI: 10.1001/jamanetworkopen.2021.32548
sha: b05af34a90c8c5f24c5d4f8b4dbdd53483f601ef
doc_id: 706939
cord_uid: ha8smbrx

IMPORTANCE: Compared with the general population, veterans are at high risk for COVID-19 and have a complex relationship with the government. This potentially affects their attitudes toward receiving COVID-19 vaccines. OBJECTIVE: To assess veterans’ attitudes toward and intentions to receive COVID-19 vaccines. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional web-based survey study used data from the Department of Veterans Affairs (VA) Survey of Healthcare Experiences of Patients’ Veterans Insight Panel, fielded between March 12 and 28, 2021. Of 3420 veterans who were sent a link to complete a 58-item web-based survey, 1178 veterans (34%) completed the survey. Data were analyzed from April 1 to August 25, 2021. EXPOSURES: Veterans eligible for COVID-19 vaccines. MAIN OUTCOMES AND MEASURES: The outcomes of interest were veterans’ experiences with COVID-19, vaccination status and intention groups, reasons for receiving or not receiving a vaccine, self-reported health status, and trusted and preferred sources of information about COVID-19 vaccines. Reasons for not getting vaccinated were classified into categories of vaccine deliberation, dissent, distrust, indifference, skepticism, and policy and processes. RESULTS: Among 1178 respondents, 974 (83%) were men, 130 (11%) were women, and 141 (12%) were transgender or nonbinary; 58 respondents (5%) were Black, 54 veterans (5%) were Hispanic or Latino, and 987 veterans (84%) were non-Hispanic White. The mean (SD) age of respondents was 66.7 (10.1) years. A total of 817 respondents (71%) self-reported being vaccinated against COVID-19. Of 339 respondents (29%) who were not vaccinated, those unsure of getting vaccinated were more likely to report fair or poor overall health (32 respondents [43%]) and mental health (33 respondents [44%]) than other nonvaccinated groups (overall health: range, 20%-32%; mental health: range, 18%-40%). Top reasons for not being vaccinated were skepticism (120 respondents [36%] were concerned about side effects; 65 respondents [20%] preferred using few medications; 63 respondents [19%] preferred gaining natural immunity), deliberation (74 respondents [22%] preferred to wait because vaccine is new), and distrust (61 respondents [18%] did not trust the health care system). Among respondents who were vaccinated, preventing oneself from getting sick (462 respondents [57%]) and contributing to the end of the COVID-19 pandemic (453 respondents [56%]) were top reasons for getting vaccinated. All veterans reported the VA as 1 of their top trusted sources of information. The proportion of respondents trusting their VA health care practitioner as a source of vaccine information was higher among those unsure about vaccination compared with those who indicated they would definitely not or probably not get vaccinated (18 respondents [26%] vs 15 respondents [15%]). There were no significant associations between vaccine intention groups and age (χ(2)(4) = 5.90; P = .21) or gender (χ(2)(2) = 3.99; P = .14). CONCLUSIONS AND RELEVANCE: These findings provide information needed to develop trusted messages used in conversations between VA health care practitioners and veterans addressing specific vaccine hesitancy reasons, as well as those in worse health. Conversations need to emphasize societal reasons for getting vaccinated and benefits to one’s own health.

The VA would like to better understand Veteran attitudes toward the current Coronavirus pandemic and COVID-19 vaccination. Your answers to the questions in this survey will allow VA to provide more helpful information to Veterans and better serve their healthcare needs.

Your answers will be combined with those from many other Veterans whenever the results of this survey are reported. Your responses will never be reported in a way that makes it possible to identify you individually.

Your participation is completely voluntary. If you decide not to complete the survey, that will have no effect on the health care you receive, your eligibility for VA benefits, or your access to the COVID-19 vaccine.

We hope you will choose to take the survey. Thank you in advance for helping VA ensure the health and safety of all Veterans who receive care at the VA. Second presentation: If 4 or more selected, display the subset of items that were selected in the same order they were first presented. Instruction:

Of the sources you selected, which are the ones that you trust the most to provide correct information about COVID-19? You may select up to 3 as your most trusted.

If 3 or fewer sources selected from initial presentations, then no second presentation. If "none of the above" selected, then no second presentation. The list will be presented twice.

(1) first presentationfull list, instruction: Please check all that apply. Order of presentation of options will be randomized across respondents.

(2) Second presentationonly the subset of previously selected items, presented in same order as in first presentation. Second presentation instruction:

Of those that you selected, which are the ones that you prefer the most as ways to learn more about COVID-19 vaccines? You may select up to 3 as your most preferred. 

It's the best way to prevent me from getting sick from COVID-19

It's the best way to prevent others from getting COVID-19

I have a health condition that makes me more at risk from COVID-19

The VA or Military recommends getting it

People may think less of me if I don't get it

My healthcare provider recommended it

The next questions ask about your healthcare overall, both in the VA and in general. 43 . A primary care provider (PCP) is the healthcare provider you usually see if you need a check-up, want advice about a health problem, or get sick or hurt. Which of the following describes your PCP?  A VA provider that I see at a VA facility  A non-VA provider in the community paid for by VA  A non-VA provider in the community not paid for by VA  I don't currently have a PCP (