Abstract
BACKGROUND: In most countries, lower rates of COVID-19 vaccination have been observed in foreign-born individuals, yet little is known about the underlying reasons, especially as reported by these individuals themselves. This exploratory interview study investigated lack of information access and hesitancy towards taking the COVID-19 vaccine among foreign-born individuals in Sweden. METHODS: We used purposive sampling to recruit foreign-born adults who expressed being hesitant towards getting vaccinated, as well as health guides and doulas who were assigned to spread COVID-19 related information in immigrant-dense urban areas. Data were collected using semi-structured focus group interviews, which were transcribed verbatim and analysed according to systematic text condensation. RESULTS: Three focus group interviews were conducted with altogether eleven participants. One group consisted of health guides/doulas, while the participants in the other groups were gainfully employed in other jobs, or full-time students, or housewives. Four main themes emerged: (1) Language barriers and sociocultural differences, (2) Consequences of not using official Swedish information, (3) Decision-making on COVID-19 vaccination, and (4) Suggestions to improve information dissemination. The lack of information in other languages than Swedish and lack of effective information channels resulted in that most participants barely used information from official Swedish health care and public health institutions. Instead, they relied on social media, social contacts and international media, through which contradictive and negative information about the vaccine was spread. The decision to get vaccinated or not became a process fraught with insecurities about the effectiveness and side effects of the vaccine, which was balanced against wishing to be protected and to contribute to the battle against COVID-19. The participants suggested that information dissemination could be improved by producing a multilingual information outreach and to increase the use of transmission through social interaction with trusted persons and platforms. CONCLUSIONS: An inadequately adapted information strategy prevented some members of the society from making fact-based decisions about getting vaccinated. Several suggestions for improving dissemination were brought forth that can be tested in future communication strategies.