Abstract
BACKGROUND AND OBJECTIVES: The study aimed to identify key drivers of vaccine hesitancy among healthcare workers (HCWs) employed at long-term care facilities (LTCFs) within selected states. It also sought to determine which interventions, policies, and programs effectively reduced HCW vaccine hesitancy for coronavirus 2019 disease (COVID-19) and influenza. RESEARCH DESIGN AND METHODS: The study employed a mixed methods approach, combining secondary analysis of the Behavioral Risk Factor Surveillance System (BRFSS) data, survey research, and focus groups. BRFSS data on influenza and COVID-19 rates informed the selection of states for qualitative sampling frames. HCWs from LTCFs (i.e., skilled nursing facilities and nursing homes) were recruited to complete a survey based on the sampling frame. Additionally, administration and nursing management from participating facilities were invited to participate in focus groups. RESULTS: Survey results (N = 199 from 23 facilities) showed vaccine hesitancy among HCWs in LTCFs is a complex issue influenced by several factors, such as lack of knowledge, misinformation, and doubts about vaccine safety, efficacy, risks, and benefits. Focus groups (N = 25 from 15 facilities) revealed a spectrum of vaccine hesitancy, ranging from acceptance to outright refusal. The survey and focus groups identified effective interventions to reduce HCW vaccine hesitancy, including educational campaigns, onsite vaccination, and vaccine recommendations from trusted nursing staff. DISCUSSION AND IMPLICATIONS: This study provides important insights into addressing vaccine hesitancy among HCWs in LTCF. It highlights the moral and ethical responsibility for targeted interventions to improve vaccine uptake in the healthcare sector.