Barriers and facilitators to COVID-19 vaccination in people affected by diabetes in Georgia: A qualitative study applying the COM-B model Open Access
Farrell, Caitlin (Spring 2023)
Abstract
ABSTRACT
Barriers and facilitators to COVID-19 vaccination in people affected by diabetes in Georgia: A qualitative study applying the COM-B model
By Caitlin Farrell
Background: People at risk for diabetes and people living with diabetes have been found to have severe outcomes in cases of COVID-19. The goal of this study was to understand the barriers and facilitators to COVID-19 vaccination among people affected by diabetes, including people living with diabetes, those at risk for diabetes, and caregivers for those living with diabetes in the state of Georgia, US - a state with one of the highest rates of diabetes in the country.
Methods: A theory of behavior change, the Capability, Opportunity, and Motivation determine Behavior (COM-B) model, was used to guide the study from the conceptualization of the project, development of interview guides and analysis of interview data, and presentation of results. The COM-B model includes three components that are theorized to influence behavior: (1) capability, which refers to the ability to perform an action and is comprised of two sub-components, physical opportunity and psychological capability (2) opportunity, defined as the environmental and social factors that contribute to the behavior and is comprised of two sub-components, physical opportunity and social opportunity and (3) motivation, defined as the internal process of decision making, which includes the subcomponents of reflective motivation and automatic motivation. A total of 53 interviews were conducted with 17 people at risk for diabetes, 6 caregivers, and 30 individuals living with diabetes to elicit information about the COM-B components. Rapid data analysis was conducted, which involved Rapid Assessment Procedure (RAP) sheets that summarized each interview transcript. Coding of barriers and facilitators was categorized using the COM-B sub-components. Thick descriptions were created that described the barriers and facilitators identified.
Results: Barriers and facilitators to COVID-19 vaccination were found across the COM-B sub-components and participant types. The most frequently discussed barriers and facilitators to vaccination were worries about the side effects of the vaccine, access to a vaccination sites, pressure of family and friends, knowledge on vaccine development, and the motivation to be and feel protected against COVID-19. The participants’ feelings of trust were also notable as both a barrier and a facilitator to vaccination. Trust was also largely linked to participant knowledge on vaccine development, side effects, and what is in the vaccine. An additional barrier that participants mentioned was distrust in the vaccine due to untrustworthy people’s involvement, such as the US government and Bill Gates.
Conclusions: The most notable barrier to COVID-19 vaccination found across participant types were knowledge-related barriers. A lack of knowledge as a barrier was found to influence other sub-components, especially reflective and automatic motivation. Further, misinformation on the safety, effectiveness, and development of the vaccine had a large impact on the extent to which participants trusted the vaccine. There is an opportunity to develop greater policy and health education initiatives to help increase uptake of the COVID-19 vaccines among people affected by diabetes. Further, as efforts to combat misinformation progress, there must simultaneously be strategies for engaging and building trust in the community.
Table of Contents
TABLE OF CONTENTS
CHAPTER 1: INTRODUCTION 1
CHAPTER 2: REVIEW OF THE LITERATURE 4
CHAPTER 3: METHODOLOGY 13
CHAPTER 4: RESULTS 21
A. Capability
A1. Psychological Capability 22
B. Opportunity
B1. Physical Opportunity 29
B2. Social Opportunity 32
C. Motivation
C1. Reflective Motivation 41
C2. Automatic Motivation 51
CHAPTER 5: DISCUSSION, CONCLUSION, AND RECOMMENDATIONS 61
APPENDIX 78
REFERENCES 150
TABLES AND FIGURES
Figure 1: The COM-B Model of Behavior Change 16
Table 1: Overview of sample sizes for interviews by participant type and timepoint (baseline and follow-up) 19
Table 2: Overview of barriers and facilitators found in psychological capability COM-B component 22
Table 3: Overview of barriers and facilitators found in physical opportunity COM-B component 29
Table 4: Overview of barriers and facilitators found in social opportunity COM-B component 33
Table 5: Overview of barriers and facilitators found in reflective motivation COM-B component 41
Table 6: Overview of barriers and facilitators found in automatic motivation COM-B component 51
About this Master's Thesis
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