People Who Use Drugs (PWUD) have lower vaccination uptake than the general population, yet disproportionately experience the burden of harms from vaccine-preventable diseases. We conducted a national qualitative study to: (1) identify the barriers and facilitators to receiving COVID-19 vaccinations among PWUD; and (2) identify interventions to support PWUD in their decision-making.
We conducted in-depth qualitative interviews with n=78 PWUD from across Canada and found that many partially or unvaccinated participants reported lacking knowledge about the COVID-19 vaccine, particularly in terms of its usefulness and benefits. Some participants reported lacking knowledge around potential long-term side effects of the vaccine, and the differences of the various vaccine brands. Distrust towards government and healthcare agencies, the unprecedented rapidity of vaccine development and skepticism of vaccine effectiveness were also noted as barriers. Facilitators for vaccination included a desire to protect oneself or others and compliance with government mandates which required individuals to get vaccinated in order to access services, attend work or travel. To improve vaccination uptake, the most trusted and appropriate avenues for vaccination information sharing were identified by participants to be people with lived and living experience with drug use (PWLLE), harm reduction workers, or healthcare providers working within settings commonly visited by PWUD.
Our results suggest PWLLE should be supported to design tailored information to reduce barriers and address mistrust regarding vaccinations. Resources addressing knowledge gaps should be disseminated in areas and through organizations where PWUD frequently access, such as harm reduction services and social media platforms.
Motivational Interviewing (MI) has been identified as an effective strategy in changing behaviors related to vaccination uptake among both marginalized and nonmarginalized communities. MI is defined as a brief conversational approach that seeks to enhance an individual’s motivation for behavioral change. It is participant-centered and goal-oriented, focusing on exploring individuals' own desire, ability, and reasons for change. MI was originally developed to treat addictive behaviors and has been shown to be successful in addressing illicit substance use, inferring that it may be an appropriate strategy in working with PWUD. MI has also been used with several other marginalized populations including HIV-positive, acialized, and women involved within the criminal justice system. With respect to vaccination, MI has led to increases in infants’ vaccine coverage, Human Papillomavirus (HPV) vaccination rates among adolescents, influenza vaccination rates among college students, Hepatitis B vaccinations among adults with diabetes, among others.
View the training video we developed for key motivational interviewing strategies to promote COVID-19 Vaccine Confidence among PWUD here:
View a recording of the Motivational Interviewing Workshop we hosted online for service providers across Canada here.