SSM - Qualitative Research in Health 2 (2022) 100045

Contents lists available at ScienceDirect

SSM - Qualitative Research in Health

Exploring vaccine hesitancy determinants during the COVID-19 pandemic:

A R T I C L E I N F O A B S T R A C T

Keywords: On January 20, 2020, the CDC reported its first case of the novel coronavirus in the United States. Almost a year
Vaccine hesitancy and a half after the first COVID-19 vaccine was given in the U.S., efforts to vaccinate individuals in the hopes of
COVID-19 vaccines achieving herd immunity continue. Despite the amounts of scientific breakthroughs to create and disseminate the
Vaccine hesitancy determinants
vaccines, people continue to express hesitancy. Existing research has explored vaccine hesitancy through survey
Qualitative methods
data, restricting an in-depth understanding for why people remain hesitant. As a result, this research aimed to
In-depth interviews
understand in-depth reasons for vaccine hesitancy as well as what finally got those who, although hesitant, went
through with getting inoculated. In addition, we also wanted to know how the vaccine hesitant received infor-
mation about the vaccine. Using in-depth interviews, we identified key elements that influenced vaccine hesitancy
which include social pressure to not get vaccinated and lack of trust in the healthcare system. We also identified
reasons why vaccine hesitant individuals ultimately decided to receive the COVID-19 vaccine. These reasons
included becoming informed, getting back to normal, and societal pressure. Finally, we sought to understand what
served as venues for COVID-19 information and those were media sources like traditional news outlets/legacy
media (e.g., TV) and digital/social media, and interpersonal sources like family, friends, and co-workers. In
revealing these factors through in-depth interviews, we show how complex vaccine hesitancy is and the elements
public health practitioners need to take into consideration when constructing vaccine-related information/
messages.

1. Introduction control the spread of the virus and the goal of herd immunity.
Vaccine hesitancy is defined as “the delay in acceptance or refusal of
While the ongoing COVID-19 pandemic is starting to see some decline vaccination despite availability of vaccination services” (MacDonald,
around the world, one cannot dismiss the over 5 million deaths and close 2015, p. 4161). Among the U.S. population, the degree of uncertainty
to 300 million reported cases worldwide, as of January 2022 (World- varies among those who are hesitant about the vaccine. One segment of
ometers, 2022). Facing such a threat, attempts to ease the effects of the this population, known as anti-vaxxers, firmly refuse to receive a vacci-
virus, its variants, and its health and socio-economic impact center pri- nation of any kind and lobby against any efforts that support getting
marily on prevention. With that in mind, the scientific community and vaccinated. Another portion of the population are undecided on the issue.
pharmaceutical industry, together with government support (federal and Unlike anti-vaxxers, these individuals are skeptical of the vaccine but
state), focused their efforts on developing efficient and safe vaccines such there is still a chance that they eventually will become vaccinated.
as the Pfizer-BioNTech, Moderna, Johnson & Johnson, and To better understand those who are hesitant about the COVID-19
Oxford-AstraZeneca to fight against SARS-CoV-2 (Conte et al., 2020). vaccine and develop a better strategy to address this challenge,
Despite scientific evidence indicating that the vaccines are safe and numerous studies have been conducted to gain an understanding of what
effective, and health message dissemination efforts to the general public makes people hesitant to get the COVID-19 vaccine. These studies have
about the vaccines' development, safety, and efficiency, doubt continues documented the socio-demographic, psychological, and media (espe-
to be embedded in people's minds. This hinders continued efforts to cially focused on the spread of misinformation) factors that may

* Corresponding author. Communication Sciences Building , Main Office Room 304 , 1405 International Mall , P.O. Box 30001, MSC 3W , Las Cruces, NM, USA.
E-mail address: [email protected] (G.I. Morales).

https://doi.org/10.1016/j.ssmqr.2022.100045
Received 3 November 2021; Received in revised form 18 January 2022; Accepted 25 January 2022
Available online 29 January 2022
2667-3215/© 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
G.I. Morales et al. SSM - Qualitative Research in Health 2 (2022) 100045

influence vaccine hesitancy (Abdulmoneim et al., 2021; Troiano & Nardi, southwestern region of the United States and expressed hesitancy about
2021). For instance, ethnicity and education were cited as examples of the COVID-19 vaccine was eligible to participate. The research team
socio-demographic factors that influenced individuals’ intention to not particularly focused on the southwestern region of the United States for
take the vaccine. Black/African individuals were found to have a lower its minority population and fluctuation in COVID-19 cases since the start
acceptance rate of the vaccine as did individuals with low education of the pandemic.
(Troiano & Nardi, 2021). In their study of psychological factors associ- An online advertisement for this study was created and posted to a
ated with COVID-19 vaccine hesitancy and resistance in Ireland and the southwestern public university's Facebook page with their permission.
United Kingdom, Murphy et al. (2021) found that those who were vac- This advertisement was boosted three times to gain a larger audience in
cine hesitant, as well as those who were resistant, were more self-serving, states like New Mexico, Arizona, Nevada, Utah, and parts of California
held strong religious viewpoints, and held an internal locus of control. and Texas. This advertisement was also shared with a Facebook group
Another study from the U.K. that provided examples of other contribu- called the Las Cruces Community Watch, and two Discord communities
tors, cited mistrust in politicians and science (Roberts et al., 2021). called OOTD and Shattered Throne to help increase the study's reach.
Additional factors to vaccine hesitancy, particularly in the U.S., included Snowball sampling was also utilized to recruit participants. An incentive
vaccine safety, vaccine effectiveness, anxiety over potential side effects, in the form of a $15 Amazon gift card was provided for individuals who
and mistrust of the healthcare system and government (Khubchandani completed all parts of the research study, which included filling out the
et al., 2021; Pogue et al., 2020). demographics/screening survey and, if selected, participating in a 30-60-
Some studies have also focused on the influence of social and legacy min one-on-one interview through the videoconferencing platform,
media on individuals’ intention to get the COVID-19 vaccine. Misinfor- Zoom.
mation and disinformation were already a problem pre-pandemic with Interested individuals filled out the 1-min demographic/screening
people sharing erroneous information online that mislead others to not survey and those who met the established criteria were then contacted by
adhere to public health recommendations, and often promoted dangerous the project's two research assistants to set up a day and time for a one-on-
and even fatal alternatives to established medical treatments. One such one interview. These interactions included the use of a semi-structured
example is the conspiracy theory surrounding vaccines and their alleged interview which allowed for the collection of open-ended data, and
side effects causing autism in children. This came as a result of the infa- more inclusive responses from participants. The research assistants
mous, and since withdrawn, article published by the Lancet and written by conducted these interviews via Zoom with guidance from the principal
Andrew Wakefield in which he argued that there was a link between the researchers. With the semi-structured interview format, the research
measles, mumps, and rubella vaccine and autism (Goldenberg, 2021). assistants were able to ask clarifying questions as well as probing ques-
According to Allington et al. (2021) the more an individual relied on social tions when needed. Of the 179 screening surveys collected, 60 met the
media for information on COVID-19, the more likely that individual was to criteria. In all, 20 participants took part in this study from start to finish.
believe conspiracy theories related to COVID-19. Conspiracy theories or Of the 20 participants (all vaccine hesitant) interviewed, 7 said
conspiracy beliefs are defined as “the tendency to assume that major public “probably yes”, 6 said “I don't know/unsure,” and 7 said “probably no”
events are secretly orchestrated by powerful and malevolent entitles acting when asked about their willingness to take the COVID-19 vaccine. There
in concert” (Douglas et al., 2019, as cited in; Allington, Duffy, Wessely were more female (75%) than male participants (25%). As our data
et al., 2020). In addition, higher rates of conspiracy beliefs and greater collection was conducted in southwestern parts of the U.S., Hispanic/
reliance on social media were linked with lower levels of preventative Latino participants made up the highest proportion of the sample (45%),
behaviors during the COVID-19 pandemic. followed by White/Caucasian (30%), Asian (10%), others (10%), and
When it comes to legacy media, Allington, McAndrew, Moxham, and Black (5%). Lastly, in terms of party affiliation, 50% identified as either
Duffy (2021) state “it is notable that existing US-based research has Republican or leaning toward Republican, and the remaining 50%
found a substantial negative correlation between knowledge about identified as either Democrat or leaning toward Democrat.
Covid-19 and trust in Trump-supporting media outlets Fox News and The
Hill” (p. 2602). However, Piltch-Loeb et al. (2021) proposed that “pat- 2.1.1. Analysis
terns of homogenization, polarization, and targeted marketing have Using Zoom, the research assistants applied the Live Transcript option
created a ‘one-step flow’ of persuasion in legacy media” (p. 2) that while when conducting each of the interviews. Because Live Transcript pro-
scarce in research as it pertains to misinformation, cannot be ignored. duces transcripts through artificial intelligence, the research assistants
Piltch-Loeb et al. (2021), found that the use of legacy media (e.g., local conducted a post-interview clean-up to ensure that what was said was
and national television and newspapers) played a role in increasing the reflected in the transcripts. Once that was completed, thematic analysis
use of vaccines because of their use of credible information that come (Braun & Clarke, 2006) was used to examine the data. The research team
sources like healthcare, government, and academic data. (both principal researchers and research assistants) followed several
Yet, despite the large volume of studies, previous research on the phases of thematic analysis.
topic of vaccine hesitancy has mostly been conducted using survey data First, the research team collectively read through the transcripts.
(see meta-analysis by Troiano & Nardi, 2021). Although survey research Shared understanding of the data was needed to proceed through the
provides us with a large number of respondents and generates statisti- various phases of thematic analysis so meetings between the principal
cally analyzable data, it also restricts the depth of the research. researchers and research assistants were held to ensure understanding
Against this background, the present study examines a) what makes and discuss any concerns or questions. Second, the researchers engaged
people hesitant to get the COVID-19 vaccine, and b) through what channels in generating initial codes by examining the transcripts line-by-line
(considering both media and interpersonal sources) people consume (Charmaz, 2006), focusing on what aspects were interesting from the
COVID-19 vaccine information. The study does this through a series of semi- data set (Braun & Clarke, 2006), and creating a spreadsheet with these
structured, in-depth interviews conducted in the U.S. Doing so allowed us to codes to be shared among the group. Third, the researchers grouped the
understand the reasons for vaccine hesitancy as well as explore effective codes into “significant concepts that link substantial portions of the data
channels through which experts can reach out to this group. together” (DeSantis & Ugarriza, 2000, as cited in Nowell, Norris, White,
& Moules, 2017, p. 8). Fourth, these conceptual categories were merged
2. Method into larger themes as the researchers ensured the emerging themes were
grounded in the data. Emerging themes were revised several times during
2.1. Sample this stage and the themes were also labeled. Finally, the research team
discussed the generated themes once again and wrote narratives around
For this research, anyone over the age of 18 who resided in the each of the themes, supported by exemplars from the data.

2
G.I. Morales et al. SSM - Qualitative Research in Health 2 (2022) 100045

3. Results I started thinking about like other research in the past that the U.S.
has done towards like minority communities and how they have been
This study sought to understand reasons for vaccine hesitancy as well like the guinea pigs. And so I did think like if they're like really
as the channels through which the vaccine hesitant get information about focusing on trying to get like minorities to get this vaccine … I
COVID-19 vaccines in the United States. In terms of vaccine hesitancy, questioned that ‘cause you know historically, like the U.S., they've
several themes emerged from the data analysis that helped us understand done some messed up things to minorities. So that was the thing …
why vaccine hesitancy remains an issue for many and why some opted to those were my first fears.
get vaccinated despite their hesitance. Aspects of our participants' lives
Some spoke about being suspicious of the vaccine itself and its
such as social pressure to not get vaccinated, not trusting the government
potentially harmful ingredients and effects. Participant 1 shared not
and health agencies and organizations, and the vaccine's untested nature
wanting to become a “virus factory” as a result of being injected with
addressed vaccination hesitancy; while themes such as becoming more
RNA. Participant 3 compared their experience getting the flu shot with
informed, getting back to normal, protecting family, and the social
what could potentially happen if they were to get the COVID-19 shot:
pressure around getting vaccinated addressed opting to be inoculated
despite hesitancy. I myself don't get the flu vaccine because the few times that I've gotten
it, I've gotten really sick, as well as my daughter, my younger
3.1. Reasons for vaccine hesitancy daughter. But I've never been diagnosed with the flu illness, with or
without the vaccine in my life. And far as sick as I got with the flu, I'm
3.1.1. Social pressure to not get vaccinated also worried about that with the vaccine, with the COVID vaccine
Some participants cited pressure from family and friends as a reason now, to have that happen.
to not get vaccinated. They recalled hearing during conversations with
family and friends some concerns over what is in the vaccine and whether The lack of FDA testing and approval also contributed to participants'
or not these ingredients are safe: For example, Participant 1 said: hesitancy of the COVID-19 vaccine. Participants expressed concern about
how fast the vaccine was made available to the public and mentioned
… my folks are planning to visit me here very soon, and even though I that they might consider getting it until it's gone through more “thorough
had talked to my mother about, you know, her, you're an adult, you research” (Participant 17). Surprisingly, one participant, Participant 20,
know, obviously, but you should make an informed decision. Before mentioned knowing the vaccine was safe, but expressed individual body
you put this in your body, you really should know what it is. response as a concern that was stronger than the actual vaccine itself.
Some participants spoke about their role in providing information
that warned family and friends about the vaccine, but ultimately allow-
3.2. Consideration of the vaccine
ing them to make up their mind about the effectiveness of the vaccine.
Participant 3 expressed reading information that shared the “negatives”
While our first research question focused on understanding why
of the vaccine and sharing that with others in their social circle:
people were hesitant about the COVID-19 vaccine, we also wanted to
… I'll send a few links to them. They can read it and they can make a know why our participants, even with their hesitancy, ended up getting
decision for themselves. So I don't try and hit them over the head with inoculated. With numbers showing an increase in individuals being
it and make them believe it … vaccinated in the U.S. as a result of the Delta variant (Mendez, 2021), our
participants discussed reasons they considered for being vaccinated. It is
Overall, social pressures highlighted the duality of the vaccine important to note that this was before the rise of the Delta variant and
contributing to participants’ hesitancy. Their conversations with others now Omicron.
often presented the “good thing” and “bad thing” about the vaccine.
Participant 17 said: 3.2.1. Becoming informed
I definitely have both sides of the spectrum when it comes to just the Some participants provided insight into why they considered being
immediate people around me that are arguing specifically, saying, vaccinated despite their hesitancy. Knowing more about the vaccine
hey, like the vaccine is a good thing, you know, go ahead and get it, swayed some to feel more confident about it. Participant 5 was an
and then I have other aspects of that that are saying, hey, this vaccine example of this viewpoint:
is a bad thing, don't take it. So, it, I believe it's very 50-50. I haven't committed to anything yet but I have no good reason, I guess
Through the participants' responses, we can see how some partici- you can say, I'll end up getting it.
pants’ hesitancy toward vaccines is shaped by their conversations with Others cited noticing that more and more people were receiving the
others. vaccine and that making them feel more at ease with it. Additionally,
having more information on the seriousness of COVID-19 and how many
3.1.2. Lack of trust people fell ill and even died as a result of getting it, made some partici-
Our participants also expressed lack of trust as a factor that contrib- pants more aware and willing to take the vaccine, with some already
uted to their hesitance for the COVID-19 vaccine. Specifically, partici- being vaccinated with one dose of the vaccine.
pants cited suspicion of the government as a reason for not wanting the
vaccine. Some expressed not wanting to be “controlled” by the govern- 3.2.2. Getting back to normal
ment, while participants who self-identified as a minority or as a person Another contributing factor for our participants considering or having
of color, cited the racist and discriminatory history of the government's taken the vaccine, was getting back to normal. The participants’ normal
involvement with public health. For instance, Participant 14 expressed was defined as going back to their life pre-COVID or to as much of the life
this concern: they had as possible. Participant 2 mentioned this as a reason for
The government has been tied to too many experiments in minori- considering the vaccine:
tized communities, and so I'm concerned about that. But, you know, a friend of mine mentioned, well, if I want to get my
Participant 12 had a similar response regarding their suspicion of the life back and go back to some version of normal, this is the way to do
government's involvement: it. And, to an extent, he's not wrong.

Others, like Participant 7 who had already been inoculated with at

3
G.I. Morales et al. SSM - Qualitative Research in Health 2 (2022) 100045

least one of the doses of the vaccine, mentioned: Everything from Facebook to YouTube, anything that's kind of come
across the airwaves. I consume a lot of media and a lot of different
Moving forward, the hesitancy was still there, but I kind of felt as a
channels, so it's just kind of a hodgepodge.
society that was something I had to do moving forward.
Another participant said:
For other participants, getting back to normal also emphasized being
around loved ones. Participant 14 said: Um, okay yeah, Facebook, but the stuff that I see on Facebook I'll
research it myself. I'll go back and look. I'm not going to believe
I'll get a vaccine if it means I can go see my dad.
everything that's on the internet. You don't believe everything that's
Another participant also shared a story of her best friend's husband on Facebook. (…) I'll go research it but I do keep an eye on the CDC
passing and wanting nothing but to give her best friend a hug: website and New Mexico Department of Health website.

I'd be vaccinated in a second for the opportunity to give her a hug. Some participants specifically reported using social media platforms
to get information about COVID-19 and/or the COVID-19 vaccine, but
only one of them solely relied on social media to get such information.
3.2.3. Societal pressure Many of the participants still relied on legacy media to get COVID-19
Some participants cited societal pressure as a factor that could or did news, but most of them used it along with social media (rather than
contribute to them getting the COVID-19 vaccine. Among those partici- exclusively relying on legacy media).
pants, some expressed feeling discriminated against for not getting the For legacy media users, news channels’ ideological orientations did
vaccine. Participant 3 stated how this discrimination extended to their not play a major role in determining which television news outlet they
children: got their information from; only two people (out of all the participants
I've had my kids feel bad, and say well I don't know if they want me who reported using legacy media to get COVID-19 information) said they
consume COVID-19 information exclusively from Fox News. Many of
around because I'm a kid, and they say I have germs. Everybody has
germs so anybody can get the virus anywhere … and just in general, them reported that they consume information in a balanced way. For
instance, Participant 19 said:
we're going to be not wanted around, either we don't get the vaccine
and ensure still, if we even do get the vaccine all of us together people I actually do get a pretty good balanced diet of, I guess you could say
are still going to say oh, you have your kids? Oh, I don't know if you like Fox News, CNN, and then I do watch some of the standard
guys should come back. channels ABC, NBC, so I do get it from, you know, TV but I also seek
out print news.
For another participant, societal pressure was more than enough of a
reason to be vaccinated, stating “I felt like I had to get it” (Participant 7). Overall, our results show that people tend to consume various media
Participant 15, who also felt the societal pressure to get vaccinated, sources – channels (e.g., legacy media, social media, internet sources,
shared: etc.), news markets (local vs. national news), and ideology (e.g., right-
I mean I was fully vaccinated in February. That's how shocking all of wing sources, left-wing sources, and neutral sources like the CDC).
this was. I didn't even want it, I'll sign up to shut everybody up.

The workplace was also presented as a potential source of societal 4.2. Interpersonal sources
pressure that made some individuals take the vaccine even though they
were hesitant about it. Several participants shared the collective effort of Our participants also tend to talk to various people about the COVID-
some workplaces to encourage their workers to get the vaccine by 19 vaccine. Some participants spoke with their family members about the
providing paid administrative leave to get vaccinated. Another partici- vaccine, and others said they spoke to their friends about it. More
pant shared their workplace organizing days in which they brought the importantly, a few participants stated that they spoke about the COVID-
vaccine to the employees. Though this participant did not get inoculated 19 vaccine “exclusively” to either family or friends. Others reported that
right away, they finally did after a few of these opportunities were they spoke about it with their co-workers. For instance, Participant 16
offered. said:
So far, we have analyzed why people were hesitant about the COVID- Well, I talked to my coworkers like other doctors, other nurses in my
19 vaccine and why some who were hesitant ended up getting inocu- workplace. Of course my family friends. Other people on social media
lated. In the following paragraphs, we discuss through what channel — from other friends that I have from like across the globe and other
considering both media and interpersonal sources — people consume countries.
information related to the COVID-19 vaccine.
Overall, we can see that the majority of participants rely on multiple
4. Getting information regarding the COVID-19 vaccine media sources as well as multiple interpersonal sources to get informa-
tion about the COVID-19 vaccine.
4.1. Media sources
5. Discussion
In terms of media sources, participants tend to consume news from a
variety of sources, including traditional news outlets/legacy media (e.g., Vaccination against COVID-19 has been rolled out in many countries,
TV) and digital/social media (e.g., Google, social media platforms, perhaps most aggressively in the United States, as countries race to build
alternative news media). Interestingly, many participants revealed they herd immunity against the virus. And yet despite availability of vaccines
also consume news from the CDC, while some get information from ac- in the United States, some individuals remain hesitant. This study sought
ademic journals. Another important characteristic of this study's partic- to understand reasons for vaccine hesitancy by reaching out directly to
ipants was that they tend to rely on multiple news sources rather than those hesitant, as well as explore the ways these individuals sought in-
solely relying on one or two dominant sources. For instance, Participant 7 formation about COVID-19 vaccination.
said: This study used in-depth interviews, a method that allows partici-
pants to narrate and articulate their own sensemaking, giving us a holistic
Um, just a variety of media everything from local newscasts and
overview of their personal experiences and meaning making. In
broadcasts to national broadcast in the or general CNN format. (…).
analyzing the responses, an overarching theme that emerged is the

4
G.I. Morales et al. SSM - Qualitative Research in Health 2 (2022) 100045

important role that social groups play in fostering, reinforcing, as well as to a more nuanced understanding of vaccine hesitancy during the COVID-
in breaking vaccine hesitancy. When asked for their reasons for being 19 pandemic. This data can inform our academic understanding of vac-
hesitant, most respondents referred to not fully trusting the government cine hesitancy, as well as interventions specific to COVID-19 vaccination
as well as having doubts on the safety and efficacy of the vaccines. Such at a time when countries around the world are trying to get as much of
lack of trust stems from, or was reinforced, by conversations they have the population vaccinated.1 In the US, where vaccine supply is not a
with family and friends. Similarly, those who admitted to being hesitant problem unlike in many countries in the Global South, vaccine hesitancy
about the vaccine, but taking it nonetheless, also cited social pressure as is a crucial concern. We hope that our findings can help address this.
an important consideration. Some were afraid of being discriminated
against by peers or in the workplace; others highlighted wanting to be Declaration of competing interest
able to visit and be around family members and getting vaccinated was
one way to make this happen. The authors declare that they have no known competing financial
The salience of social groups also emerged when we explored the interests or personal relationships that could have appeared to influence
ways the vaccine hesitant get information about COVID-19 vaccines. The the work reported in this paper.
majority of participants rely on multiple media sources, with some
accessing the CDC site directly. Many of them also highlighted how they Ethical statement
get information from interpersonal interactions such as informal or brief
conversations with friends and family members. These findings are This manuscript represents original work and went through the
consistent with the recent findings that unlike vaccine resistant in- Institutional Review Board process at New Mexico State University.
dividuals, vaccine hesitant people consume a great amount of COVID-19
information (Murphy et al., 2021). Our findings here also support what CRediT authorship contribution statement
others have claimed that despite initial talk on filter bubbles online,
where algorithms supposedly limit users only to perspectives aligned Gabriela I. Morales: Methodology, Formal analysis, Writing – orig-
with their own, many individuals actually get exposed to a diverse set of inal draft, Writing – review & editing, Supervision. Sangwon Lee:
views (Scharkow et al., 2020). Some participants shared how they access Conceptualization, Formal analysis, Writing – original draft, Writing –
multiple news channels, news and government websites, as well as social review & editing, Supervision. Amanda Bradford: Investigation. Adam
media to get or come across information about COVID-19. But given the De Camp: Investigation. Edson C. Tandoc: Writing – original draft,
important role of interpersonal sources, it is also crucial to investigate in Writing – review & editing.
future studies whether vaccine hesitant individuals engage only with
those having similar perspectives as them, or if they also discuss with References
different-minded individuals. We see a snapshot of this in this current
study as several of the interviewees who admitted being hesitant but Abdulmoneim, S. A., Aboelsaad, I. A. F., Hafez, D. M. H., Almaghraby, A., Alnagar, A.,
ended up getting vaccinated (or are now willing to get vaccinated) shared Shaaban, R., & Elrewany, E. (2021). Systematic review and meta-analysis on COVID-
19 vaccine hesitancy. medRxiv. https://doi.org/10.1101/2021.05.15.21257261
that this was due to social pressure. From this we can surmise that these Allington, D., Duffy, B., Wessely, S., Dhavan, N., & Rubin, J. (2020). Health-protective
vaccine hesitant individuals also engaged in interpersonal interaction behaviour, social media usage and conspiracy belief during the COVID-19 public
with pro-vaccination individuals, and that vaccination was a topic during health emergency. Psychological Medicine, 51(10), 1763–1769. https://doi.org/
10.1017/S003329172000224X
these conversations. Allington, D., McAndrew, S., Moxham-Hall, V. L., & Duffy, B. (2021). Media usage
The results reported here must be contextualized within a set of predicts intention to be vaccinated against SARS-CoV-2 in the US and the UK.
limitations. First, while our findings provide an in-depth understanding Vaccine, 39(18), 2595–2603. https://doi.org/10.1016/j.vaccine.2021.02.054
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research
of the range of reasons for vaccine hesitancy, these are not generalizable
in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
to the U.S. population, nor to the southwest region where we recruited CDC. (2021, August 4). COVID-19 timeline. https://www.cdc.gov/museum/timelin
participants. Generalization, however, is not the main goal of qualitative e/covid19.html#:∼:text¼January%2020%2C%202020%20CDC,18%20in%
20Washington%20state.
exploration, but depth of understanding. Through our interviews, we
Charmaz, K. (2006). Constructing grounded theory. A practical guide through qualitative
were able to get our participants to narrate in their own words their analysis. London: Sage.
sensemaking about vaccination, allowing us to document and examine Conte, C., Sogni, F., Affanni, P., Veronesi, L., Argentiero, A., & Esposito, S. (2020).
their reasons and justifications—something that quantitative approaches Vaccines against coronaviruses: The state of the art. Vaccines, 8(2), 309. https://
doi.org/10.3390/vaccines8020309
are not designed to uncover. Thus, our results can help inform future DeSantis, L., & Ugarriza, D. N. (2000). The concept of theme as used in qualitative nursing
studies that seek generalizability. Secondly, in our survey demographics research. Western Journal of Nursing Research, 22(3), 351–372. https://doi.org/
section, we did not offer an open-ended section for participants to 10.1177/019394590002200308
Douglas, K. M., Uscinski, J. E., Sutton, R. M., Cichocka, A., Nefes, T., Siang, Ang, C., &
disclose their race and/or ethnicity. Therefore, we were unable to know Deravi, F. (2019). Understanding conspiracy theories. Political Psychology, 40, 3–35.
how those who picked “other” identified as. Third, while we achieved Goldenberg, M. J. (2021). Vaccine hesitancy: Public trust, expertise, and the war on science.
theoretical saturation in our analysis, our sample is relatively small and University of Pittsburgh Press.
Khubchandani, J., Sharma, S., Price, J. H., Wiblishauser, M. J., Sharma, M., & Webb, F. J.
confined to a certain geographic region. This also meant that we were not (2021). COVID-19 vaccination hesitancy in the United States: A rapid national
able to draw comparisons between individuals with varying levels of assessment. Journal of Community Health, 46(2), 270–277. https://doi.org/10.1007/
hesitancy. In addition, those who oppose vaccines generally opt to not s10900-020-00958-x
MacDonald, N. E. (2015). Vaccine hesitancy: Definition, scope and determinants. Vaccine,
participate in research that deals with the topic, making recruitment a
33(34), 4161–4164. https://doi.org/10.1016/j.vaccine.2015.04.036
challenge. Fourth, as the pandemic is ongoing at the time of study, the Murphy, J., Vallieres, F., Bentall, R. P., Shevlin, M., McBride, O., Hartman, T. K.,
situation remained fluid. For example, the Delta variant and now the McKay, R., Bennett, K., Mason, L., Gibson-Miller, J., Levita, L., Martinez, A. P.,
Stocks, T. V. A., Karatzias, T., & Hyland, P. (2021). Psychological characteristics
Omicron variant have spread and continued to ravage the United States
associated with COVID-19 vaccine hesitancy and resistance in Ireland and the United
after our interviews, and attitudes toward vaccination may have changed Kingdom. Nature Communications, 12(1), 1–15. https://doi.org/10.1038/s41467-
following this surge in cases. 020-20226-9
Despite these limitations, we hope that our results here can contribute Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis:
Striving to meet the trustworthiness criteria. International Journal of Qualitative
Methods, 16(1), 1–13. https://doi.org/10.1177/1609406917733847
Piltch-Loeb, R., Savoia, E., Goldberg, B., Hughes, B., Verhey, T., Kayyem, J., Miller-
1 Idriss, C., & Testa, M. (2021). PLoS One, 16(5). https://doi.org/10.1371/
We also acknowledge that the efforts for vaccines should not be over- journal.pone.0251095
estimated. For example, in the South African countries rates of vaccination Pogue, K., Jensen, J. L., Stancil, C. K., Ferguson, D. G., Hughes, S. J., Mello, E. J.,
remain under 10%. Burgess, R., Burges, B. K., Quaye, A., & Poole, B. D. (2020). Influences on attitudes

5
G.I. Morales et al. SSM - Qualitative Research in Health 2 (2022) 100045

regarding potential COVID-19 vaccination in the United States. Vaccines, 8(4), 1–14. Scharkow, M., Mangold, F., Stier, S., & Breuer, J. (2020). How social network sites and
https://doi.org/10.3390/vaccines8040582 other online intermediaries increase exposure to news. Proceedings of the National
Roberts, C. H., Brindle, H., Rogers, N. T., Eggo, R. M., Enria, L., & Lees, S. (2021). Vaccine Academy of Sciences, 117(6), 2761–2763. https://doi.org/10.1073/pnas.1918279117
confidence and hesitancy at the start of COVID-19 vaccine deployment in the UK: An Troiano, G., & Nardi, A. (2021). Vaccine hesitancy in the era of COVID-19. Public Health,
embedded mixed-methods study. Frontiers in Public Health, 9, 745630. https:// 194. https://doi.org/10.1016/j.puhe.2021.02.025
doi.org/10.3389/fpubh.2021.745630 Worldometers. (2022). Coronavirus cases. Retrieved January 5, 2022, from https://www
.worldometers.info/coronavirus/.