Next Article in Journal
Long COVID Is Associated with Severe Cognitive Limitations Among U.S. Adults
Previous Article in Journal
Use of a Multiplex Immunoassay Platform to Investigate Multifaceted Antibody Responses in SARS-CoV-2 Vaccinees with and Without Prior Infection
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
COVID
Volume 5
Issue 4
10.3390/covid5040045
covid-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

“Black People Listen to Black People”: Strategies to Improve COVID-19 Vaccine Confidence Among Black People Living in Canada

by
Aisha Giwa
1,
Delores V. Mullings
2,
Andre M. N. Renazho
3 and
Oluwabukola Salami
4,*
1
Department of Geography, Environment and Geomatics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
2
School of Social Work, Memorial University of Newfoundland, St. John’s, NL A1C 5S7, Canada
3
School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
4
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
*
Author to whom correspondence should be addressed.
COVID 2025, 5(4), 45; https://doi.org/10.3390/covid5040045
Submission received: 11 January 2025 / Revised: 15 March 2025 / Accepted: 21 March 2025 / Published: 24 March 2025
(This article belongs to the Section COVID Public Health and Epidemiology)
Versions Notes

Abstract

:
Background: Compared to other groups of Canadians, Black people have been significantly more affected by COVID-19 and appear to be more hesitant to receive the COVID-19 vaccine. This article identifies approaches or strategies to increase vaccine confidence and uptake among Black people in Canada. Methods: Thirty-six Black people of diverse ethnicities, aged 18 years and above, living in six provinces across Canada were interviewed. An inductive thematic approach was employed to analyze the interview data. Results: Building trust was at the center of the strategies identified and spoke to the meaningful and practical ways the sociocultural realities of Black people living in Canada can be used to inform and implement the most effective health interventions. Identified strategies include public education, building trust through Black-led community engagement, and addressing barriers to vaccine convenience focusing on health literacy and communication. Together, these strategies consider the nuance of the message, diversity of messenger(s), and communication channels and call for a move away from generic health promotion messages to tailored communications grounded in community expertise and the experiences of Black people across all levels of healthcare service provision. Conclusions: Health promotion and public health messages must acknowledge difference, tailor approaches to target audiences, and foster lasting collaborations informed by members of the Black community. Government agencies and healthcare service providers should foster the relationships established during the pandemic, document lessons learned, remove systemic barriers to healthcare, and create an emergency preparedness guide for community engagement and health promotion for Black people living in Canada.

1. Introduction

Vaccination saves millions of lives globally and remains an integral part of disease prevention, health system delivery, and primary healthcare. The COVID-19 pandemic disrupted global vaccination rates, including vaccination against COVID-19 and routine childhood immunizations, and contributed to vaccine hesitancy around the world [1]. Vaccine hesitancy refers to delays in acceptance or refusal of vaccination despite the availability of vaccination services [2]. Individuals who are hesitant to receive vaccines are not limited to the small percentage who refuse all vaccinations without any reservations. Rather, vaccine-hesitant individuals predate the pandemic and encompass a diverse range of people with varying levels of doubts and concerns about vaccination [3]. A growing trend in vaccine hesitancy is seen among Black communities, where people once following vaccination guidelines are now more skeptical [4].
Vaccine hesitancy is related to the three Cs: complacency, confidence, and convenience. Vaccine confidence, the focus of this article, emphasizes trust in (i) people within the healthcare system, i.e., healthcare professionals and policymakers; (ii) the healthcare system, and (iii) vaccine safety and effectiveness [2]. Vaccine confidence is therefore affected by individual experiences; social, systemic, cultural, and religious beliefs; availability; and ability to interpret research findings and political factors. Low confidence can undermine vaccination efforts [5,6,7]. Vaccine hesitancy is not a new phenomenon. The World Health Organization (WHO)’s recommendations for risk communication and community engagement include community leadership, collaboration, strengthening capacity, and local and data-driven solutions [8]. Governments worldwide, including Canada’s, have employed different strategies to address vaccine hesitancy, including for COVID-19. These include the implementation of targeted communication campaigns to disseminate vaccine-related information and address misinformation, community engagement with trusted leaders and influencers, and addressing structural barriers including providing paid time off work for employees to get vaccinated [9,10,11]. Jurisdictions across Canada employed daily press conferences, news releases, social media, and traditional news outlets to communicate public health information about the pandemic, including the availability of vaccines and public health prevention measures [12,13,14]. While these methods were consistent in communicating COVID-19 risk and generally accepted [12], lack of transparency and poor communication to subpopulations and diverse communities, particularly in the early stages of the pandemic, were significant challenges [12,14]. Driedger et al. [15] suggest COVID-19 public health messages mirrored those employed in messaging for routine immunization and failed to recognize the changing landscape of recommendations for COVID-19 vaccinations.
Vaccine hesitancy is more common among groups disproportionately affected by COVID-19, including Black Canadians and frontline workers [16]. However, other research on COVID-19 shows Black Canadians are not significantly more vaccine-hesitant than white Canadians, though systemic barriers exist [17]. Still, the impact of COVID-19 on Black people is pronounced [18,19]. Although 80% of Canadians have received at least two doses of the COVID-19 vaccine, self-identifying Black people (82%) were among the proportion of people who received at least one dose which was lower compared to people of European descent [20,21]. COVID-19 mortality rates were also higher among Black Canadians than other groups of individuals in Canada [22].
Gorman et al. [23] argue COVID-19 vaccine hesitancy occurs in a continuum ranging from people with strong opposition to the vaccine to people who, with reassurance about the efficacy and safety of the vaccine, were inclined towards COVID-19 vaccine acceptance. More recently, vaccine hesitancy has implications for the COVID-19 booster vaccine, more so among Black people due to heightened mistrust of the healthcare system [24,25,26,27]. Many migrants experience inequalities in access to COVID-19 vaccines due to language barriers, fear of deportation, and geographical limitations [28,29,30]. Distrust in the COVID-19 vaccine is rooted in broader historical medical exploitation that extend beyond the context of COVID-19 [31]. Trust, therefore, must be understood within healthcare service governance or stewardship, health systems, and broader social structures and institutions [32] that shape expectations and experiences with health and the healthcare system [33].
Within the North American context, trust in the COVID-19 vaccine must be situated in the sociocultural contexts within which Black people live their lives, including the lingering and/or intergenerational trauma associated with these injustices, such as the memory of the Tuskegee experiments in the US [34]. In Canada, people of African, Caribbean, and Black (ACB) origin show lower levels of vaccine willingness due to a mistrust in and low perceived usefulness of the information provided by the government on COVID-19 [35,36]. Siani and Tranter [37] argue that, among other factors, the speed of COVID-19 vaccine approval and production might have contributed to anti-vax sentiments even among people with pro-vaccination tendencies. Similarly, health literacy impacts vaccine hesitancy and distrust in the healthcare system [38]. Promoting health literacy, particularly with social media, can help combat misinformation and increase vaccine acceptance [39,40,41]. Lowe et al. [14] also suggest health promotion messages that treated Black populations as homogenous decreased the effectiveness of public health messages and measures throughout the pandemic.
Many interventions have been implemented to address vaccine hesitancy and increase vaccine confidence in Black communities, including providing COVID-19 vaccine education and vaccines in community health trucks. Health promotion strategies that focus on the values and perspectives of patients have been used to improve the uptake of both flu and COVID-19 vaccines in Black communities in Canada [42]. Chou and Budenz [43] suggest the use of health promotion messages that focus on the emotions behind vaccine hesitancy—fear, anger, and other negative emotions—in addition to emphasizing COVID-19 vaccine safety and efficacy. Identifying and acknowledging historical mistrust is critical for improving confidence because it influences perceptions about vaccines [19,27,44]. Community-based approaches centered on engaging trusted figures such as religious leaders and healthcare providers have been effective in building trust and promoting vaccines in Black communities [45].
The aim of this study is to identify the strategies to improve the uptake of the COVID-19 vaccine among Black people living in Canada. An intersectional lens was used to understand how intersecting identities such as race, and with it, language and historical violence in the healthcare system, influence COVID-19 vaccine confidence in Black populations in Canada. Intersectionality examines the ways in which anti-Black racism intersects with other social identity markers within systems of power to shape Black women’s experiences of discrimination, violence, and systemic marginalization [46]. Intersectionality has been developed over the years to include considerations of other social categorizations outside of race, such as citizenship [47,48]. To do this, this article applies racial categorization—i.e., African, Caribbean, and Black Canadians—in the analysis. This study contributes to the growing discourse on the unique challenges faced by Black people in accepting the COVID-19 vaccine. The strategies outlined in this article can inform tailored interventions to increase vaccine confidence and offer a more comprehensive framework for addressing other health inequities in diverse populations.

2. Materials and Methods

This article is part of a wider qualitative study that used semi-structured interviews to explore ways to improve COVID-19 vaccine confidence among Black people living in Canada. After obtaining ethical approval to conduct this study (Ethics ID: Pro00115777), members of the Black community including community leaders and organizations across Canada began to engage in the research. Purposive sampling was used to recruit participants for the study based on variables like age and race categorization—i.e., African, Caribbean, and Black Canadian. Participants were recruited virtually through an established list of Black people, community leaders, and organizations focused on Black people living in Canada that was collated and maintained as part of a previous research project on Black people in Canada and contained the names of those who consented to participate in future research. A snowball technique was further employed by these individuals, organizations, and other collaborators in the study to share the invitation to participate among their networks. Social media was used to increase participation in the study. Flyers and posters with details of the study were also distributed virtually through our networks on LinkedIn, WhatsApp (e.g., WhatsApp groups of Black communities in different jurisdictions), and Twitter (now X). A total of 150 organizations and individuals were sampled within the data collection period of the study.
Based on the response, thirty-six (36) interviews were conducted with participants aged 18 years and above across six provinces in Canada (Table 1). Interviews were conducted with participants of varying Black ethnicity, income, location, and immigration status, among other variables, who consented to participate in this study. This allowed for environmental triangulation within the study [49].
Due to COVID-19 restrictions, all interviews were conducted (and audio and video recorded, with consent) using Zoom teleconferencing software (version 5.12). Interviews took place between February and May 2022 and lasted between 45 and 90 min. Following the interviews, participants received a CAD 25 gift certificate in consideration of their time. The interviews were conducted by a postdoctoral fellow who took detailed notes to augment the transcripts from the sessions. Participants responded to the following question—what strategies would you recommend improving your confidence and members of your ethnic community’s confidence in and increase uptake of the COVID-19 vaccine?
A general inductive approach was used for data analysis [50]. After transcribing the interviews, the data were cleaned without compromising the meaning to increase comprehension. A coding framework was developed and reviewed by two researchers by reading transcripts, creating codes, sub-codes, and categories, highlighting multiple meanings and key themes in the data, and holding regular peer debriefings or meetings to refine codes and meanings throughout the analytic stage [51]. After the themes most relevant to the research questions were identified, another researcher not involved in the study validated and evaluated these themes [52]. The data were thematically analyzed using NVivo 12 analytic software considering the intersections of ethnicity. Quotations included in this article are used to justify or illustrate our findings and deepen understanding of the research questions. Quotations are also woven into the narration of our findings to include many perspectives and add nuance to the interpretation of the data [53]. All participants are anonymized throughout this article to ensure confidentiality.

3. Results

3.1. Demographic Data

A total of 36 interviews were conducted, transcribed, and analyzed. The sample comprised 22% (n = 8) Black Caribbean (people who identify as Black and of Caribbean descent), 75% (n = 27) Black African (people who identify as Black and of African descent), and 3% (n = 1) Black American individuals (people who identify as Black, of American descent and Canadian). Most participants were Canadian citizens (56%, n = 20), followed by temporary residents (28%, n = 10) and permanent residents (17%, n = 6). Demographic details of participants are provided in Table 1.

3.2. Strategies to Improve Vaccine Confidence and Uptake

Increasing vaccine confidence in populations with heightened vulnerabilities and risks of being infected by COVID-19 can be challenging, particularly among groups with geopolitical histories that shape their relationship and interaction with healthcare systems. Still, several approaches were identified as strategies to reduce vaccine hesitancy and increase uptake of the COVID-19 vaccine among Black people living in Canada. Building trust is at the center of these strategies and speaks to the meaningful and practical ways the sociocultural realties of Black people living in Canada can be used to inform and implement the most effective health interventions. Thematically, these strategies include building trust through culturally tailored public education and Black-led community engagement as illustrated in Table 2.

3.2.1. Addressing Mistrust Through Public Education

One priority area for building confidence in the COVID-19 vaccine among Black people is public education. Building trust and confidence in the COVID-19 vaccine through racially and culturally tailored public education puts emphasis on the commitment of the government and health systems to improve health equity. As illustrated below by Participant 12 [P12], the government needs to demonstrate trustworthiness and transparency to increase the uptake of the vaccine among Black people.
‘Education would be one of the strategies and making the community to trust the government too and not hiding any—I’m not saying that they’ve [government] been hiding, just be open to them [Canadians], let them see what is going on’.
[P12–32—Male]
Most participants identified public education as a good strategy to improve vaccine confidence, which can be accomplished through workshops, webinars, and virtual public events focusing on building trust and transparency, addressing issues and concerns related to COVID-19 illness and vaccination, and using diverse languages to convey COVID-19 health promotion messages. One participant noted that addressing misinformation about COVID-19 and humanizing the cases and people affected by the virus can increase vaccine confidence and reduce the effect of misinformation in vaccine decision-making.
‘The first step is to identify which proportion of the population has misinformation about COVID-19. Then the second step would be, [to ask] what can we do? The things that the government can do. It could arrange for providing free education on issues about COVID-19.’.
[P21–48—Female]
Addressing misinformation and building trust should involve providing medical/scientific information about the side effects of the vaccine and long-term effects of COVID-19: ‘just show the effects, the long-term effects of COVID like with long COVID or show a family you know, devastated because someone has died’ [P36–50-Female]. However, it should also acknowledge the rapidly changing landscape of COVID-19 research globally and within Canada. Combined, transparent public education and communications may increase vaccine confidence and uptake of the vaccine among Black people in Canada.
‘I think more transparency was more important for me and I think it would have been better had people just said we don’t know everything. And if that messaging had come through clearer and louder, you know at this moment—those are the things that I think would have made a difference’.
[P3–49—Female]

3.2.2. Building Trust Through Black-Led Community Engagement

Participants recommended community engagement led by Black people to build trust by addressing concerns and disseminate health promotion messages with cultural/ethnic competency. ‘Black people like to listen to other Black people, we know this’ [P23–54-Female]. Specifically, participants noted the opinion of an influential Black person or leader is most likely to influence vaccine acceptance or vaccine hesitancy.
‘We have a multicultural association in Fort McMurray; you can contact them and they will disseminate the information to the members of the community. So that people will be able to be aware of the importance of getting vaccinated. For some people, they are not going to get it whatsoever. Because of what they believe or what their experiences have been. When those fears can be allayed, they will get vaccinated’
[P18–35—Male]
Engagement involves utilizing trusted individuals and religious leaders to access community members, share information, and address concerns that contribute to vaccine hesitancy among Black people. Black religious leaders have been involved in various vaccination campaigns: ‘a lot of people trust their pastor more than they trust their doctor. You go into the churches, you have town hall meetings where you address people’s concerns, one on one’ [P36–50—Female]. Respected community leaders such as pastors, soccer coaches, and youth mentors can help facilitate ethnically or culturally sensitive conversations about COVID-19. Similarly, churches and other religious sites/locations can be a point of contact for qualified medical personnel or public health officials to access members of the Black community. This, combined with religious presence, in some cases lends credibility to health promotion messages and allows for a more fluid conversation with people in the community.
‘But the better approach, in my opinion, is have a Black person who is qualified who also goes to that church, a trusted member of the community to speak to them. Because you might not necessarily have a lot of faith in the random person that the government sends to speak to you but the person that you grew up with, you know, the person that you see every Sunday you might have a little bit more patience with them to hear what they have to say, and you might feel more comfortable asking them questions’.
[P2–44—Female]
Other Black-led community involvement strategies recommended by many participants include forming a consortium of ACB doctors across Canada to address possible misinformation and vaccine education to build confidence and optimize uptake within the Black community. Considering the quote below, this involves forming a partnership or collaboration with doctors of diverse African heritage each speaking to community members with the same heritage and publicly highlighting the vaccination experiences of trusted doctors.
‘But if there’s a way that we could reach out to the African Centre to say the African Centre can you reach out to the all the African descent communities and let them have representation in the African Centre and bring them to a consortium to say come we need you, we need people from Nigeria, we need people from Cameroon, we need people, now go and reach out so we form a strong consortium. Now bring all the doctors, all the Nigerian doctors, all the Cameroonian doctors, everyone, to say hold a consortium of doctors of African descent and let us talk to our people, you understand, that is vaccine is good, take the vaccine. I am a medical doctor and I have taken it’.
[P13-PNTS—Male]

3.2.3. Addressing Barriers to Vaccine Convenience—Health Literacy and Communication

While public education was lauded as the most effective way to increase access to information about, acceptance of, and uptake of the COVID-19 vaccine, the where and how these messages are communicated will also greatly impact the acceptance of the vaccine amongst participants. The language or languages used in communicating health promotion messages are a vital part of COVID-19 public education. Many participants recommended a move away from generic messaging to a more tailored approach that represents the diversity within the community. ‘Not everyone speaks English, not everyone speaks the same level of English’ [P36–50—Female]. As one participant remarked, language bridges communication gaps and can be an integral factor in boosting COVID-19 vaccine confidence. Considering the scenario below, the requirements for the use of language in communicating messages intersected with the ethnicity of the person speaking the language and the language itself, along with religion.
‘I really want you to recommend, [that] each community have their own, you know, there is a specific language that they understand, right? There is a way that you can communicate with the different communities. So that doctor influenced me because she was Black. She was a Muslim. She is actually a Somali person.’
[P29–30—Male]
Many community leaders held information sessions in the local languages of Black ethnic groups, including Swahili, Somali, Arabic, Ethiopian, and Tigrinya, so that members of these communities could understand the risk of infection to self, family, friends, and other community members. These public education sessions were culturally accessible and acknowledged fears and concerns around COVID-19 illness and increased acceptance of the vaccine. Consequently, community members asked questions related to their own circumstances, including understanding the risk of infection due to their underlying chronic conditions.
‘We’ve been hosting [control] information sessions where we hired activists to explain [about COVID to] our communities in their own languages. For example, in the Somali community session, we had an interpreter and a doctor. They [people] were asking the doctor a lot of questions. Like, for example, I have asthma, can I take the vaccine? I am an elderly person, and I have diabetes. I have all these health issues. Can I take? I am a pregnant woman; can I take? So, it really helped us to help and convince the community to take the COVID-19 vaccine…. we were distributing translated posters as well, to the community. For example, Swahili, Somali, Arabic and Ethiopian, Tigrinya, different kind of languages. So, it helped us actually to sit and explain to the community…’.
[P29–30—Male]
Notably, the location where public education and sensitization about COVID-19 happens is as important as the content of the health promotion messages. Hosting events that are aligned with how and where Black people socialize can help facilitate culturally sensitive conversations with community members.
‘We have to start at the grassroots level. Right, go into the malls, go into the community centers, get local musicians you know, just get to where the people are– because some people don’t want to know they’re in their own bubble. Go into the churches, go into places where people congregate and have the message without being preachy, right, dumb it down’.
[P36–50—Female]
Together with language, ‘using simple [non-medical] words’ [P24–45—Female] helps communicate messages about COVID-19 vaccines in a quick and easy way for Black individuals to understand. A racial and culturally based approach adds nuance to using plain language in health promotion communication. For Black people in this study, such an approach for healthcare providers focuses on self-educating before trying to educate the communities in which they work. One participant shared below how the race of the service providers is important because they can provide unique racially and culturally relevant services. However, Black people are a systemically marginalized group in Canada, which increases the chances that service providers will lack lived experience as a Black person.
‘I think educating themselves. Let’s say a white provider, a white health care provider might not be aware of where Black people are coming from when it comes to their concerns. So, if we see let’s say a Black woman in her sixties who’s highly religious comes into her white doctor to, you know, talk about the vaccine, he might think she’s been absolutely ridiculous because he doesn’t fully understand the role that religion plays in the Black community or how deep it goes, especially in the older generations. So as a white health care provider understanding the different demographics of the people you treat not only on a medical level but on a cultural level so you can kind of get—you can kind of see where they’re coming from and not brush it off as, “Oh, you’re being ridiculous. It just makes sense’.
[P2–44—Female]
Knowing your patients, understanding their needs, and adequately responding to their concerns, particularly when considering people with diverse beliefs, historical relationships with healthcare service provision, age, beliefs, and attitudes is critical for building confidence in the COVID-19 vaccine. People need reassurance.
‘Because sometimes, you know, some people just need that assurance or to see it from—to have it explained from a cultural level. To fully understand where your patients are coming from and not just brush it off as, “Oh, you’re being ridiculous” or “Don’t believe that” because it’s not that simple. I think some [practice of] cultural competence from health care providers, from non-Black health care providers would help’.
[P2–44—Female]
Black people need to feel heard, even more so with a disease such as COVID-19 that intersects with the social, economic, religious, and spiritual aspects of the lives of many Black people in Canada. Working with Black communities using racial and culturally sensitive approaches requires empathy, understanding of the Black experience, confronting personal biases, and shifting preconceived notions of who Black people are and what they need. It is also important to have conversations with Black people rather than speak to or on behalf of Black people.

4. Discussion

This article synthesizes data from qualitative interviews on strategies to increase COVID-19 vaccine confidence among Black people living in Canada. The findings parallel other published research that discussed vaccine hesitancy and Black-focused hesitancy specifically [2,45]. Key recommendations for increasing uptake include public education, building trust through Black-led community engagement, addressing barriers to vaccine confidence, and focusing on health literacy and communication. Black people living in Canada have diverse experiences and backgrounds that intersect with their Blackness, including factors such as ethnicity, language, class, education, religion, and age. These intersections can impact their relationship with healthcare service provision, their perception of risk, and attitudes and beliefs towards COVID-19 [42]. Therefore, health promotion messages targeting Black people, as suggested by participants, must be nuanced. COVID-19 health promotion interventions implemented through the lens of the target population receiving such messages are reported to improve uptake of the COVID-19 vaccine [8,42,43]. Language was reported to be a key feature of public education in this study and others [30], as earlier campaigns elsewhere that lacked a multilingual approach to health promotion fell short with respect to reaching minority ethnic groups, increased vulnerability to COVID-19, and increased vaccine hesitancy [54]. Language fosters inclusion or exclusion in health promotion for behavior change and must be understood and applied within the context of structural racism in healthcare such as limited opportunities for Black-led healthcare services to improve trust and access [36,55,56].
Black people’s mistrust around COVID-19 pandemic has been explored and strategies, including suggested messaging, mirrors recommendations from participants in this study [4,6]. Transparent messaging was recommended considering the history of medical mistrust and racial discrimination in healthcare and perceptions about vaccinations, particularly around vaccine safety, efficacy, and side effects [57]. Our findings support research highlighting the relationships between misinformation; lack of timely, consistent, and transparent information; and language barriers and vaccine hesitancy among Black people in Canada [12,41,58]. Our findings are also consistent with Etowa et al. [35,36] who encourage policymakers and public health officials to foster trust with ACB communities by incorporating community-specific messaging that acknowledges past and ongoing experiences of discrimination and injustices within the healthcare system. Lei and Guo [59] and Etowa et al. (62) call for a more holistic approach to address the systemic issues present within the healthcare system beyond COVID-19 in Canada, which includes the implementation of an anti-racist education model based on critical race theory. Health education programs that reinforce health literacy in Black communities have implications for reducing vaccine hesitancy for COVID-19 as well as other vaccine-preventable diseases [17]. Therefore, public health agencies at all levels of government must adapt interventions that address mistrust and re-examine the color-blind approach applied to healthcare research and other systemic barriers [17,18,19,59].
Trust-building through Black-led initiatives is critical. Privor-Dummn and King [45] found that pastors as community leaders can help address vaccine hesitancy. Community and religious leaders can lead culturally responsive dialogues and help address misinformation. These trusted figures, along with healthcare professionals, play a central role in fostering vaccine acceptance [30,44,60,61]. Barmania and Reiss [60] point out the ways in which societal norms and religion operate at a cellular level to inform health-seeking behaviors. As community partners, community and religious leaders may not necessarily change health behavior [15] but, they can foster dialogue, promote vaccine education, reassure members of the community, and decrease vaccine hesitancy [15,30]. Our participants identified Black physicians, public health officers, and other healthcare professionals as trusted resources and communication channels. Utilizing trusted, local figures who support vaccines is especially valuable when reaching individuals from specific or underserved communities, particularly those who may have historical reasons for distrusting government or centralized authorities [10,12,15]. Together with religious leaders, these Black leaders are positioned at core and peripheral levels of influence in the community. They are part of the problem as they are positioned with a healthcare system that reinforces a Western episteme, but also part of the solution as leaders positioned to innovate, re-imagine, or re-envision existing approaches to health promotion and health equity for Black people [56,62].
Black-led community engagement speaks to a cultural understanding of the ability of community leaders to help build trust within the community and facilitate acceptance of the COVID-19 vaccine. Cultural relevance—a feature of communication as identified in this study—speaks to who is delivering health promotion messaging. Turhan, Dilcen, and Dolu [38] identified the importance of health literacy to mediate mistrust; building on that premise, our findings emphasize the role of Black people in leading community engagement. However, this study also recognizes the realities of healthcare service provision in societies where Black people are systemically disadvantaged; this results in this population having a small number of highly skilled healthcare professionals and who likely receive healthcare services from providers who are not Black. Leitch et al. [56] and Etowa et al. [62] argue this lack of representation affects adequate service provision for Black people; we also argue that culturally relevant equity and justice education is important in providing holistic care to Black communities. This is particularly important due to the history of neglect and false beliefs about pain thresholds, biological differences, and poor treatment recommendations for Black people in general [63]. Our findings also consider the format or medium used in COVID-19 health promotion campaigns by highlighting the need for plain language and engagement at a grassroots level.
Overall, communication as a strategy for building COVID-19 vaccine confidence among Black people in Canada is multifaceted. Effective communication brings together several factors that contribute to vaccine hesitancy among Black people—mistrust in healthcare systems, misinformation, health and social inequities, and concerns about vaccine safety and efficacy—and addresses them with these questions: who can or should speak with Black people?; what can be said to Black people about COVID-19 vaccine?; and where and how should these conversations happen to influence health-seeking behaviors and increase uptake of the COVID-19 vaccine?

Limitations

The pandemic limited efforts to recruit participants across all thirteen provinces and territories of Canada. This qualitative study had participants from six provinces but lacked representation from francophones, three of the four Atlantic provinces, the three northern territories, and those living in rural communities. Participants represented heteronormative gender and sexual identities and only two religious and spiritual affinities. To address these limitations, further studies must consider longer data collection periods to improve the chances of hearing the stories and perspectives of Black people at various intersections in Canada. Also, future studies could consider a regional or jurisdictional focus to provide a more comprehensive picture of the health inequities experienced by Black people and context-specific interventions in these locations. This study also acknowledges the risk of sampling errors due to the use of purposive and snowball sampling. The strengths of this study lie in the inclusion of Black people across various intersections including ethnicity, education, and immigration status. However, participants were recruited through established networks, community leaders and organizations focused on Black people living in Canada, and only participants who were familiar with these networks or accessed our social media advertisement were used as points of entry to reach the community and were likely to be included in the research. Hence, more studies are required to replicate these findings in other Black communities particularly in jurisdictions not included in the study.

5. Conclusions

This research highlights several key findings that are relevant to improving Black people’s confidence and uptake of the COVID-19 vaccine. Trust building was identified as a central strategy that considers the realities of Black lives in Canada and is used to inform meaningful, practical, and effective health interventions. These strategies include public education, health promotion, and communication unique to the Black experience and move away from generic messaging to ones that consider and include Black-led community engagement, nuanced messaging, and the diversity of those providing the messaging.
Health promotion and public health messages must acknowledge difference, tailor approaches to target audiences, and foster lasting collaborations informed by members of the Black community. Government agencies, non-governmental organizations, and public health agencies across all jurisdictions should foster the relationships established during the pandemic, document lessons learned and create an emergency preparedness guide for community engagement and health promotion for Black people living in Canada. Our findings also support policy and practice recommendations aimed at removing barriers to healthcare and improving health outcomes for Black people living in Canada.

Author Contributions

Conceptualization, A.G., D.V.M., A.M.N.R. and O.S.; Methodology, A.G., D.V.M., A.M.N.R. and O.S.; Software, A.G.; Validation, A.G., D.V.M., A.M.N.R. and O.S.; Writing—Original Draft Preparation, A.G.; Writing—Review and Editing, A.G., D.V.M., A.M.N.R. and O.S.; Supervision, O.S.; Funding Acquisition, O.S. All authors have read and agreed to the published version of the manuscript.

Funding

This research is funded by the Canada Research Chairs (CRC) Tier 1 program awarded to Dr. Bukola Salami, with support from the Canadian Institutes of Health Research (CIHR) (Application #CRC-2022-00289, ResearchNet ID 46091.3).

Institutional Review Board Statement

The authors obtained ethical approval from the University of Alberta Research Ethics Board to conduct this study (Ethics ID: Pro00115777; Date of Approval: 1 October 2022).

Informed Consent Statement

The authors affirm that consent was obtained for the publication of the data.

Data Availability Statement

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to ethical review policies at the University of Alberta.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Stephenson, E.; Butt, D.A.; Gronsbell, J.; Ji, C.; O’Neill, B.; Crampton, N.; Tu, K. Changes in the top 25 reasons for primary care visits during the COVID-19 pandemic in a high-COVID region of Canada. PLoS ONE 2021, 16, e0255992. [Google Scholar] [CrossRef]
  2. MacDonald, N.E. Vaccine hesitancy: Definition, scope and determinants. Vaccine 2015, 33, 4161–4164. [Google Scholar] [CrossRef] [PubMed]
  3. Benin, A.L.; Wisler-Scher, D.J.; Colson, E.; Shapiro, E.D.; Holmboe, E.S. Qualitative analysis of mothers’ decision-making about vaccines for infants: The importance of trust. Pediatrics 2006, 117, 1532–1541. [Google Scholar] [CrossRef] [PubMed]
  4. Rusoja, E.A.; Thomas, B.A. The COVID-19 pandemic, Black mistrust, and a path forward. EClinicalMedicine 2021, 35, 100868. [Google Scholar] [CrossRef] [PubMed]
  5. Larson, H.J.; Schulz, W.S.; Tucker, J.D.; Smith, D.M. Measuring vaccine confidence: Introducing a global vaccine confidence index. PLoS Curr. 2015, 7. [Google Scholar] [CrossRef]
  6. Ekwebelem, O.C.; Yunusa, I.; Onyeaka, H.; Ekwebelem, N.C.; Nnorom-Dike, O. COVID-19 vaccine rollout: Will it affect the rates of vaccine hesitancy in Africa? Public Health 2021, 197, e18. [Google Scholar] [CrossRef]
  7. Nuwarda, R.F.; Ramzan, I.; Weekes, L.; Kayser, V. Vaccine hesitancy: Contemporary issues and historical background. Vaccines 2022, 10, 1595. [Google Scholar] [CrossRef]
  8. World Health Organization. COVID-19 Global Risk Communication and Community Engagement Strategy, December 2020–May 2021: Interim Guidance, 23 December 2020 (No. WHO/2019-nCoV/RCCE/2020.3); World Health Organization: Geneva, Switzerland, 2021. [Google Scholar]
  9. Thompson, A.; Stall, N.M.; Born, K.B.; Gibson, J.L.; Allen, U.; Hopkins, J.; Laporte, A.; Maltsev, A.; McElroy, R.; Mishra, S.; et al. Benefits of paid sick leave during the COVID-19 pandemic. Sci. Briefs Ont. COVID-19 Sci. Advis. Table 2021, 2, 1–13. [Google Scholar]
  10. Adebisi, Y.A.; Rabe, A.; Lucero-Prisno, D.E., III. Risk communication and community engagement strategies for COVID-19 in 13 African countries. Health Promot. Perspect. 2021, 11, 137–147. [Google Scholar] [CrossRef]
  11. Chen, A.Z.; Park, C.; Darkwa, A.; Holliday, R.C.; Best, M.L. “We’re not in that circle of misinformation”: Understanding community-based trusted messengers through cultural code-switching. In Proceedings of the ACM on Human-Computer Interaction, Honolulu, HI, USA, 11–16 May 2024; Volume 8, pp. 1–36. [Google Scholar]
  12. Dubé, È.; Labbé, F.; Malo, B.; Pelletier, C. Public health communication during the COVID-19 pandemic: Perspectives of communication specialists, healthcare professionals, and community members in Quebec, Canada. Can. J. Public Health 2022, 113 (Suppl. S1), 24–33. [Google Scholar] [CrossRef]
  13. Fields, M.; Spence, K.L. Content analysis of official public health communications in Ontario, Canada during the COVID-19 pandemic. Int. J. Environ. Res. Public Health 2024, 21, 351. [Google Scholar] [CrossRef] [PubMed]
  14. Lowe, M.; Harmon, S.H.; Kholina, K.; Parker, R.; Graham, J.E. Public health communication in Canada during the COVID-19 pandemic. Can. J. Public Health 2022, 113 (Suppl. S1), 34–45. [Google Scholar] [PubMed]
  15. Driedger, S.M.; Capurro, G.; Tustin, J.; Jardine, C.G. “I won’t be a guinea pig”: Rethinking public health communication and vaccine hesitancy in the context of COVID-19. Vaccine 2023, 41, 1–4. [Google Scholar]
  16. Choi, K.; Chang, J.; Luo, Y.X.; Lewin, B.; Munoz-Plaza, C.; Bronstein, D.; Rondinelli, J.; Bruxvoort, K. “Still on the fence:” a mixed methods investigation of COVID-19 vaccine confidence among health care providers. Workplace Health Saf. 2022, 70, 285–297. [Google Scholar]
  17. Cénat, J.M.; Farahi, S.M.M.M.; Bakombo, S.M.; Dalexis, R.D.; Pongou, R.; Caulley, L.; Yaya, S.; Etowa, J.; Venkatesh, V. Vaccine mistrust among Black individuals in Canada: The major role of health literacy, conspiracy theories, and racial discrimination in the healthcare system. J. Med. Virol. 2023, 95, e28738. [Google Scholar]
  18. Cénat, J.M.; Noorishad, P.-G.; Bakombo, S.M.; Onesi, O.; Mesbahi, A.; Darius, W.P.; Caulley, L.; Yaya, S.; Chomienne, M.-H.; Etowa, J.; et al. A systematic review on vaccine hesitancy in Black communities in Canada: Critical issues and research failures. Vaccines 2022, 10, 1937. [Google Scholar] [CrossRef]
  19. Cénat, J.M.; Farahi, S.M.M.M.; Broussard, C.; Dalexis, R.D. The state of COVID-19 vaccine confidence and need in Black individuals in Canada: Understanding the role of sociodemographic factors, health literacy, conspiracy theories, traumatic stressors and racial discrimination. Vaccine 2024, 42, 960–968. [Google Scholar]
  20. Public Health Agency of Canada. Canadian COVID-19 Vaccination Coverage Report. Ottawa: Public Health Agency of Canada. Available online: https://health-infobase.canada.ca/covid-19/vaccination-coverage/ (accessed on 9 December 2022).
  21. Public Health Agency of Canada. COVID-19 Vaccine Uptake and Intent: Canadian Community Health Survey (CCHS) Insight Ottawa: Public Health Agency of Canada. Available online: https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/covid-19-vaccine-uptake-intent-canadian-community-health-survey.html (accessed on 10 December 2022).
  22. Gupta, S.; Aitken, N. COVID-19 Mortality Among Racialized Populations in Canada and Its Association with Income. StatCan COVID-19: Data to Insights for a Better Canada. Catalogue no. 45-28-0001. 2022. Available online: https://www150.statcan.gc.ca/n1/en/pub/45-28-0001/2022001/article/00010-eng.pdf?st=2tGr_r04 (accessed on 16 December 2022).
  23. Gorman, J.M.; Gorman, S.E.; Sandy, W.; Gregorian, N.; Scales, D.A. Implications of COVID-19 vaccine hesitancy: Results of online bulletin board interviews. Front. Public Health 2022, 9, 2269. [Google Scholar]
  24. Corsten, C.; Vang, Z.M.; Gold, I.; Goldenberg, M.J.; Juarez, F.P.-G.; Weinstock, D.; Smith, M.J.; Krajden, O.; Solomonova, E. Understanding COVID-19 vaccine hesitancy in Canada. Vaccine 2023, 41, 7274–7280. [Google Scholar]
  25. Massaquoi, N.; Mullings, D.V. Africentric social work practice from a health perspective. In Africentric Social Work; Mullings, D.V., Clarke, J., Bernard, W.T., Este, D., Giwa, S., Eds.; Fernwood Publishing: Halifax, NS, Canada, 2021; pp. 228–252. [Google Scholar]
  26. Cénat, J.M. Racial discrimination in healthcare services among Black individuals in Canada as a major threat for public health: Its association with COVID-19 vaccine mistrust and uptake, conspiracy beliefs, depression, anxiety, stress, and community resilience. Public Health 2024, 230, 207–215. [Google Scholar]
  27. Olanlesi-Aliu, A.; Kemei, J.; Alaazi, D.; Tunde-Byass, M.; Renzaho, A.; Sekyi-Out, A.; Mullings, D.V.; Osei-Tutu, K.; Salami, B. Evidence synthesis-COVID-19 among Black people in Canada: A scoping review. Health Promot. Chronic Dis. Prev. Can. 2024, 44, 112–125. [Google Scholar] [PubMed]
  28. Abba-Aji, M.; Stuckler, D.; Galea, S.; McKee, M. Ethnic/racial minorities’ and migrants’ access to COVID-19 vaccines: A systematic review of barriers and facilitators. J. Migr. Health 2022, 5, 100086. [Google Scholar] [PubMed]
  29. Boyd, R. Black people need better vaccine access, not better vaccine attitudes. New York Times, 5 March 2021; 5. [Google Scholar]
  30. Dada, D.; Djiometio, J.N.; McFadden, S.M.; Demeke, J.; Vlahov, D.; Wilton, L.; Wang, M.; Nelson, L.E. Strategies that promote equity in COVID-19 vaccine uptake for Black communities: A review. J. Urban. Health 2022, 99, 15–27. [Google Scholar]
  31. Beagan, B.L.; Bizzeth, S.R.; Sibbald, K.R.; Etowa, J.B. Epistemic racism in the health professions: A qualitative study with Black women in Canada. Health 2024, 28, 203–215. [Google Scholar] [PubMed]
  32. Luhmann, N. Social Systems; Stanford University Press: Redwood City, CA, USA, 1995. [Google Scholar]
  33. Aboueid, S.E.; Herati, H.; Nascimento, M.H.G.; Ward, P.R.; Brown, P.R.; Calnan, M.; Perlman, C.M.; Meyer, S.B. How do you measure trust in social institutions and health professionals? A systematic review of the literature (2012–2021). Sociol. Compass 2023, 17, e13101. [Google Scholar]
  34. Wilson, Y. Is trust enough? Anti-Black racism and the perception of Black vaccine “hesitancy”. Hastings Cent. Rep. 2022, 52, S12–S17. [Google Scholar]
  35. Etowa, J.; Ghose, B.; Etowa, E.; Dabone, C. COVID-19 vaccine willingness among African, Caribbean, and Black people in Ottawa, Ontario. COVID 2023, 3, 693–702. [Google Scholar] [CrossRef]
  36. Etowa, J.; Ghose, B.; Etowa, E.; Dabone, C.; Luc, M.; Jacques, A.; Roelofs, S.; Unachukwu, U.; Brown-Shreves, D.; Osandatuwa, G.; et al. Factors associated with the usefulness of public health communication in the context of COVID-19: Lessons learned from the African, Caribbean, and Black communities in Ottawa, Ontario. Infect. Dis. Rep. 2023, 15, 518–526. [Google Scholar] [CrossRef]
  37. Siani, A.; Tranter, A. Is vaccine confidence an unexpected victim of the COVID-19 pandemic? Vaccine 2022, 40, 7262–7269. [Google Scholar] [CrossRef]
  38. Turhan, Z.; Dilcen, H.Y.; Dolu, İ. The mediating role of health literacy on the relationship between health care system distrust and vaccine hesitancy during COVID-19 pandemic. Curr. Psychol. 2022, 41, 8147–8156. [Google Scholar] [PubMed]
  39. Montagni, I.; Ouazzani-Touhami, K.; Mebarki, A.; Texier, N.; Schück, S.; Tzourio, C.; Confins Group. Acceptance of a COVID-19 vaccine is associated with ability to detect fake news and health literacy. J. Public Health 2021, 43, 695–702. [Google Scholar]
  40. Rotolo, B.; Dubé, E.; Vivion, M.; MacDonald, S.E.; Meyer, S.B. Hesitancy towards COVID-19 vaccines on social media in Canada. Vaccine 2022, 40, 2790–2796. [Google Scholar] [CrossRef]
  41. Kemei, J.; A Alaazi, D.; Tulli, M.; Kennedy, M.; Tunde-Byass, M.; Bailey, P.; Sekyi-Otu, A.; Murdoch, S.; Mohamud, H.; Lehman, J.; et al. A scoping review of COVID-19 online mis/disinformation in Black communities. J. Glob. Health 2022, 12, 05026. [Google Scholar] [CrossRef] [PubMed]
  42. Eissa, A.; Lofters, A.; Akor, N.; Prescod, C.; Nnorom, O. Increasing SARS-CoV-2 vaccination rates among Black people in Canada. Can. Med. Assoc. J. 2021, 193, E1220–E1221. [Google Scholar] [CrossRef]
  43. Chou, W.Y.S.; Budenz, A. Considering emotion in COVID-19 vaccine communication: Addressing vaccine hesitancy and fostering vaccine confidence. Health Commun. 2020, 35, 1718–1722. [Google Scholar]
  44. Feifer, R.A.; Bethea, L.; White, E.M. Racial disparities in COVID-19 vaccine acceptance: Building trust to protect nursing home staff and residents. J. Am. Med. Dir. Assoc. 2021, 22, 1853–1855. [Google Scholar] [PubMed]
  45. Privor-Dumm, L.; King, T. Community-based strategies to engage pastors can help address vaccine hesitancy and health disparities in Black communities. J. Health Commun. 2020, 25, 827–830. [Google Scholar]
  46. Crenshaw, K. Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. Univ. Chic. Leg. Forum 1989, 1, 8. [Google Scholar]
  47. Hill Collins, P. The tie that binds: Race, gender and US violence. Ethn. Racial Stud. 1998, 21, 917–938. [Google Scholar] [CrossRef]
  48. Hill Collins, P. On violence, intersectionality and transversal politics. Ethn. Racial Stud. 2017, 40, 1460–1473. [Google Scholar] [CrossRef]
  49. Stahl, N.A.; King, J.R. Expanding approaches for research: Understanding and using trustworthiness in qualitative research. J. Dev. Educ. 2020, 44, 26–28. [Google Scholar]
  50. Thomas, D.R. A general inductive approach for analyzing qualitative evaluation data. Am. J. Eval. 2006, 27, 237–246. [Google Scholar] [CrossRef]
  51. Vaismoradi, M.; Jones, J.; Turunen, H.; Snelgrove, S. Theme development in qualitative content analysis and thematic analysis. J. Nurs. Educ. Pract. 2016, 6, 100. [Google Scholar] [CrossRef]
  52. Hosmer, R. Discussing the Dead: Patterns of Family Interaction Regarding Lost Family Members. Ph.D. Thesis, University of Denver, Denver, CO, USA, 2008. [Google Scholar]
  53. Corden, A.; Sainsbury, R. Using Verbatim Quotations in Reporting Qualitative Social Research: Researchers’ Views; University of York: York, UK, 2006; pp. 11–14. [Google Scholar]
  54. Sengupta, P. Language, communication, and the COVID-19 pandemic: Criticality of multi-lingual education. Int. J. Multiling. 2022, 21, 346–359. [Google Scholar] [CrossRef]
  55. de Moissac, D.; Bowen, S. Impact of language barriers on access to healthcare for official language minority francophones in Canada. Health Manag. Forum 2017, 30, 207–212. [Google Scholar] [CrossRef]
  56. Leitch, S.; Corbin, J.H.; Boston-Fisher, N.; Ayele, C.; Delobelle, P.; Ottemöller, F.G.; Matenga, T.F.L.; Mweemba, O.; Pederson, A.; Wicker, J. Black Lives Matter in health promotion: Moving from unspoken to outspoken. Health Promot. Int. 2021, 36, 1160–1169. [Google Scholar] [CrossRef] [PubMed]
  57. Khubchandani, J.; Macias, Y. COVID-19 vaccination hesitancy in Hispanics and African-Americans: A review and recommendations for practice. Brain Behav. Immun. Health 2021, 15, 100277. [Google Scholar] [CrossRef]
  58. Kemei, J.; Tulli, M.; Olanlesi-Aliu, A.; Tunde-Byass, M.; Salami, B. Impact of the COVID-19 pandemic on Black communities in Canada. Int. J. Environ. Res. Public Health 2023, 20, 1580. [Google Scholar] [CrossRef]
  59. Lei, L.; Guo, S. Beyond multiculturalism: Revisioning a model of pandemic anti-racism education in post-COVID-19 Canada. Int. J. Anthropol. Ethnol. 2022, 6, 1. [Google Scholar] [CrossRef]
  60. Barmania, S.; Reiss, M.J. Health promotion perspectives on the COVID-19 pandemic: The importance of religion. Glob. Health Promot. 2021, 28, 15–22. [Google Scholar] [CrossRef]
  61. Mweemba, O.; Matenga, T.F.L.; Corbin, J.H. Authorship and partnerships in health promotion research: Issues of erasure, ownership and inequity in knowledge production. Health Promot. Int. 2019, 34, 1071–1077. [Google Scholar] [PubMed]
  62. Etowa, J.; Abrha, G.; Etowa, E.; Ghose, B. Healthcare during COVID-19 in Canada: Need for strengthening providers’ capacity for best practices in African, Caribbean and Black community service provision. Am. J. Public Health Res. 2021, 9, 52–56. [Google Scholar] [CrossRef]
  63. Hoffman, K.M.; Trawalter, S.; Axt, J.R.; Oliver, M.N. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between Blacks and whites. Proc. Natl. Acad. Sci. USA 2016, 113, 4296–4301. [Google Scholar] [PubMed]
Table 1. Demographic characteristics of participants.
Table 1. Demographic characteristics of participants.
CharacteristicsCount (%)
GenderMale 15 (42%)
Female 21 (58%)
Marital StatusMarried 15 (42%)
Single16 (44%)
Common law1 (3%)
In a relationship 3 (8%)
Separated1 (3%)
ReligionChristian29 (81%)
Muslim1 (3%)
Atheist1 (3%)
Prefer not to say 3 (8%)
Spiritual but not affiliated 2 (6%)
Immigration StatusPermanent resident 6 (17%)
Canadian citizen 20 (56%)
Temporary resident 10 (28%)
Ethnic OriginBlack African 27 (75%)
Black American 1 (3%)
Black Caribbean 8 (22%)
Province Alberta13 (36%)
British Columbia 4 (11%)
Nova Scotia 3 (8%)
Ontario 11 (31%)
Saskatchewan2 (6%)
Manitoba3 (8%)
EducationCollege2 (6%)
High school2 (6%)
Master’s1 (3%)
University (Bachelor’s)30 (83%)
Vocational school1 (3%)
Annual Household Income<CAD 60,00017 (47%)
>CAD 60,00013 (36%)
N/A2 (6%)
Prefer not to say 4 (11%)
Age18–246 (17%)
25–3410 (28%)
35–444 (11%)
45–4411 (31%)
55–642 (6%)
65 and above0
Prefer not to say3 (8%)
Average # of years living in Canada18
Table 2. List of themes and sub-themes illustrating the strategies to improve vaccine confidence and uptake.
Table 2. List of themes and sub-themes illustrating the strategies to improve vaccine confidence and uptake.
Theme 1—Public Education Is a Key Health Promotion Strategy for Building Trust in Black Communities.
Code Sub Code Illustrative Quotes
Public Education (n = 22)
-
Health campaign
-
Webinar or workshops
-
Town hall
“Education would be one of the strategies and making the community to trust the government too and not hiding any—I’m not saying that they’ve been hiding, just be open to them, let them [people] see what is going on. A lot of people, they don’t really put on US news, when I’m going to work, I’m putting on CBC, I’m hearing the news. So, we need to disseminate the information more. Information dissemination is key” [Participant 12]
“It’s more about education. So, some of us have group pages, WhatsApp pages, Facebook groups, community meetings, community centres. So still education. If you have a program, sometimes because of COVID we have online Zoom meetings, Black Caribbean meetings, online. So even if the meeting’s purpose was not a COVID-related meeting, at the end the closing remarks you can just chip in, say let’s all stay safe, put on your mandate and be healthy, live healthy for your family.” [Participant 30]
-
Transparency
“They need to be straightforward. Take the vaccine, and these are the possible side-effects. Let’s discuss, let’s discuss the side-effects. Because it is a fact of life, you know.” [Participant 11]
Theme 2—Community engagement, particularly engagement activities led by Black people, is critical to reducing disparities in health, including COVID-19 health literacy.
Community Engagement—Black-led (n = 19)
-
Black community leaders
-
Religious leaders
-
Pastors
-
Other religious leaders
“Get people of colour in the medical community to come to you know, make a video or go to church, right. Show people OK, this is what the vaccine looks like, this is what it’s made of. It’s not made from fetal aborted tissue, this is an MRNA vaccine this is another vaccine. This is what it does to the body, this is how it—etc. Maybe use visual aids or an animation or clay or something to say this is what vaccines do.” [Participant 36]
“When I go there, I see my kind. They will take the time to explain to me the benefit of it. Some people don’t, and I don’t even trust whether they’re telling me the truth anyways.” [Participant 17]
“Community leaders. Because the black community, we are not isolated at all. We may be isolated are physically, we are also, we’re always connected. And the information can be passed down through the various community leaders. Because we have quite a number of them, either in the council or in the church or the association.” [Participant 18]
-
Black healthcare service providers
“I feel that maybe [pause] Black medicals practitioners should be encouraged to have constant communication with the community…maybe that can guarantee more trust” [Participant 1]
“we do have black people in healthcare and if we can communicate this and—you know, I think that—OK, this has kind of two effects; one, actually educating the black community in ways that they understand… On the other hand, I think that that will really show a lot of younger people that “Hey, there are tons of black people in healthcare; I can do it too”. And all that does is continue to build the repertoire of black people we have in healthcare and the amount of black people who are able to contribute to conversations regarding healthcare in Canada” [Participant 23]
“Like, for people who are deciding to take the vaccine, if their pastors say today that they should take the vaccine, they will take it without asking any questions.” [Participant 25]
Theme 3—Communication as a strategy for building COVID-19 vaccine confidence
among Black people in Canada is multifaceted and emphasizes the importance of using plain language for effective communication.
Communication (n = 28)
-
Information on Side effects
-
Language
-
Cultural sensitivity
“When you are talking about antibodies, some people they didn’t do school, so you are talking antibodies, they don’t know what you are talking about…. So speak current languages with people. Like, not everyone has the same level of education, level of background, level of understanding. Because when you are coming for a workshop or with people, try to use the word that’s [pause] speak child words, that even a five-year-old child who is here will understand what you’re doing, what you’re saying” [Participant 24]
“To deploy more settlement workers who speaks different languages, so that they can at least help the community. Because some people, they feel like, oh, maybe they will not understand me. Or if I call them, they give me a wrong, because we have this, you know, communication barrier, they may give me, you know, different dose that I didn’t want. That was the fear that I have seen. Some people think, I want to get the Pfizer, and they don’t know how to pronounce Pfizer. Maybe then, you know, the healthcare worker may give them Moderna. And then when they come home, they will get upset. Oh, they give me the wrong one. I didn’t ask them this. It’s, you know, a language barrier. So yeah.” [Participant 29]
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Giwa, A.; Mullings, D.V.; Renazho, A.M.N.; Salami, O. “Black People Listen to Black People”: Strategies to Improve COVID-19 Vaccine Confidence Among Black People Living in Canada. COVID 2025, 5, 45. https://doi.org/10.3390/covid5040045

AMA Style

Giwa A, Mullings DV, Renazho AMN, Salami O. “Black People Listen to Black People”: Strategies to Improve COVID-19 Vaccine Confidence Among Black People Living in Canada. COVID. 2025; 5(4):45. https://doi.org/10.3390/covid5040045

Chicago/Turabian Style

Giwa, Aisha, Delores V. Mullings, Andre M. N. Renazho, and Oluwabukola Salami. 2025. "“Black People Listen to Black People”: Strategies to Improve COVID-19 Vaccine Confidence Among Black People Living in Canada" COVID 5, no. 4: 45. https://doi.org/10.3390/covid5040045

APA Style

Giwa, A., Mullings, D. V., Renazho, A. M. N., & Salami, O. (2025). “Black People Listen to Black People”: Strategies to Improve COVID-19 Vaccine Confidence Among Black People Living in Canada. COVID, 5(4), 45. https://doi.org/10.3390/covid5040045

Article Metrics

Back to TopTop