Beyond Trust

Abstract

Few studies have examined drivers of healthcare trust and vaccine hesitancy in the context of low- and middle-income countries (LMIC) where healthcare systems are most fragile. This study focuses on healthcare trust and vaccine hesitancy in Sierra Leone, a country that has a history of infectious disease outbreaks. This study examines drivers and impacts of healthcare mistrust in caregivers of children and Covid-19 vaccine intention and behavior both for caregivers and for their children. This study also examines current community members trust in healthcare providers, including doctors, nurses, and traditional healers. This study uses two data sets: quantitative data for Aim 1 and Aim 3 come from a two-wave longitudinal NICHD-funded study (#R01HD096699; PIs: Thomas M. Crea, PhD, MSW and John S. Schieffelin, MD) and includes a sample of EVD-infected (n=222), EVD-affected (n=208), and control children (n=233) and their caregivers (n=663). Qualitative data were used for Aims 2 and 3 and were collected in August of 2023 in Freetown, Sierra Leone, as part of a study funded through Boston College Vice Provost Office (PI: Oladoyin Okunoren, LCSW). This study has three specific aims: AIM 1: Examine the influence of mental health and healthcare trust on Covid-19 vaccine behavior and intention among caregivers. AIM 2: Explore healthcare perceptions, utilization, and trust in Sierra Leone, and implications for vaccine uptake and intention. AIM 3: Explore community and healthcare worker perceptions of traditional healers within healthcare interventions before and after EVD.