Recently, Dr. Kim Bullock overheard a curious conversation in her urgent care center. One patient said, ‘I’m not getting the COVID-19 vaccination. Who knows what’s in it? You could get COVID from it.’ But a vaccine recipient heard them, and they told them it wasn’t true—“they’d gotten a dose, and they were fine.” The skeptical patient said they would keep it in mind while they waited to be seen for an urgent care issue. When Dr. Bullock saw them, “I asked if they’d reconsidered. And they had.” Those patient-to-patient conversations to build vaccine trust during COVID-19 are crucial —and health centers, urgent care clinics, and other facilities can take meaningful steps to create the “informal public health forums” that allow these discussions to grow.
Medical Director at Providence Urgent Care Center in Washington, D.C., and Associate Clinical Professor in the Department of Family Medicine at Georgetown University, Dr. Bullock has been on the frontlines of COVID-19 since it began. Along the way, she watched an “informal public health forum” emerge amongst her patients at Providence that she believes organizations across the U.S. can replicate to help overcome vaccine hesitancy.
When Providence opened the doors of its vaccination clinic, it saw over 100 patients in its first day. But it wasn’t the large influx that surprised Dr. Bullock—it was the dynamic that emerged as patients spoke amongst each other, gradually building vaccine trust in informal conversations. A key factor in this was how Providence set up its vaccination center to foster patient conversations for vaccine trust.
“Structurally, we set up our COVID clinic in the same vicinity, separated by doors, to the urgent care. And in the waiting area, patients were still in the same overall physical space. Over time, we saw people come in who knew each other—one to vaccinations, the others to urgent care. And it would generate a discussion.” Before patients received their vaccines, Providence engaged them in detailed Q&As with a nurse practitioner to address misinformation. Additionally, when patients sat for observation after their vaccination, observing medical students spoke with them about why they decided to be vaccinated and about vaccine skepticism in their community. The result is that when patients left, they often spoke to their peers entering urgent care, allowing the clinic to build true community-oriented, peer-to-peer educational outreach for vaccine trust.
How can community health centers and other organizations replicate this success? Dr. Bullock offers four helpful tips.
Capitalize on Your Organization’s Social History
The longest-running hospital in Washington, D.C., Providence has always been deeply embedded in the community. Over the years, many of its patients—who are typically older and predominantly African American or Latinx—came to see Providence as their medical home, even when they already had primary care physicians. But while that community-involved history gave Providence an edge in patient trust, every institution—from community health centers to urgent care clinics—can do what Dr. Bullock calls “capitalizing on your social history” to build vaccine trust.
Organizations must be open to patient input, offer meaningful services to the community, and show concern even in small ways during COVID-19 testing and vaccinations. When Providence began testing, many patients visited as soon as they could leave quarantine. “We saw so many of the ‘worried well,’” Dr. Bullock said. “They were overwhelmed from being alone for so long, from the lack of information, from the entire pandemic. In some cases, they came not so much for testing as for a sense of being heard.” Providence responded accordingly. “You’ve got to make the care personal. We purposefully told staff to do everything they could to explain the testing process compassionately and address patients’ concerns without rushing them.”
Maximize the Chance for Safe Patient-to-Patient Conversations for Vaccine Trust
In addition to offering community-connected care, health centers and other organizations should think about how they can structure their COVID clinics to encourage safe interactions between vaccine recipients and other patients. When Providence began vaccinations, it made sure to allow for an open, socially distanced setting where patients entering or leaving vaccination visits could safely congregate with patients entering urgent care.
“We didn’t put up any structural barriers or rework hallways, so people ended up taking different paths from a common area,” said Dr. Bullock. When people who knew each other met in that space, the vaccinated patients could serve as peer educators. “It doesn’t matter what the setting is,” said Dr. Bullock, “It depends on how that setting is managed. There are always ways to maximize the chance for meaningful conversations.”
Create Patient Vaccine Trust Champions
Healthcare facilities can also use patient education and interactions to build patients’ ability to advocate for vaccine trust in their communities. Organizations should take every chance to interact with patients and bolster their knowledge of the vaccine, why they received their vaccination, and what their community thinks about COVID-19.
Observation periods following vaccinations offer one important chance. “Clinicians at every COVID clinic spend 15-20 minutes observing vaccinated patients for adverse reactions,” said Dr. Bullock, “How can you use that downtime as an interactive space? We had medical students speak to them about vaccine trust in their community during that time.”
Even if organizations lack sufficient staff to do this, they can utilize volunteers. The results, Dr. Bullock says, will be obvious: “Over time, patients shared with friends and family that it was a good experience for them. ‘They actually sat down with me and answered my questions.’ This is just one way that organizations can serve as hubs for patient interaction.”
Understand Medical Racism—and What It Personally Means to Patients
Cultural competency is also critical. In an era of widespread vaccine hesitancy in African American, Latinx, and other BIPOC populations, understanding the history of institutional racism is even more important for providers. And as Dr. Bullock notes, it is equally critical to providers to ask themselves a key question: “What does racism personally mean to the patient in front of you?”
“We always bring up Henrietta Lacks or Tuskegee as examples of racism in care,” said Dr. Bullock. “These flashpoints do factor in, but what’s most real to patients is their own experiences. We have to understand their personal histories: it’s the microaggressions and lack of respect they’ve experienced that chips away most at their trust in providers—and their willingness to listen to vaccine messaging.”
In each interaction, providers must remember the myriad reasons that may lead BIPOC patients to distrust physicians. Before you encourage people to receive a vaccine, Dr. Bullock states, ask yourself: How much of a rapport do we have? What personal racism have they seen? And what social determinants of health—from housing issues to financial instability—impact them?
As one African American patient who had often been ignored by doctors told Dr. Bullock, “‘I’m just searching for a physician who will listen to me.’”
Further Resources on Patient Conversations for Vaccine Trust and Equity and More from ACU
In addition to collecting COVID-19 resources for clinicians working with underserved communities, the Associations of Clinicians for the Underserved is partnering with Pfizer in a new initiative to improve health and vaccine equity for the underserved in the wake of the pandemic.
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