Investigating the Intersectionality of Race, Community and Older Age on Preventive Health Behavior and Vaccination Practices during COVID-19 Among Black and White Americans Aged 65+

Background and Purpose: The COVID-19 pandemic has posed a significant health threat to populations of U.S. older adults and racial and ethnic minorities. The primary objective of this study is to explore how older age, racial identity and social support have affected older Americans’ experiences of the pandemic with a focus on preventive health practices and access, orientation toward vaccinations, and public trust. Public health critical race praxis (PHCRP) is the theoretical orientation of the study, paying particular attention to the contributions of race and racism in older Black or African American adults’ experiences relative to older white adults.

Methods: This study leveraged a cross-sectional, mixed methods design. Seventy-five participants were purposively sampled from the southeastern U.S. and stratified into a series of virtual focus groups on the basis of age, racial/ethnic identity, COVID-19 vaccination status, and relationships in a local community. Community-based participatory methods were utilized in this study. A 113-item pre-group questionnaire and 120-minute, semi-structured focus group data were collected in November 2021. Focus group moderators mirrored racial identity characteristics of participants. Focus group data were coded by line by four coders in multiple rounds of coding using an inductive, grounded theory orientation. Focus group findings were triangulated with the quantitative pre-group questionnaire data.

Results: The majority of participants were aged 65-74 (60%) and 47% were in community-based groups. 79% of participants were vaccinated against COVID-19 compared to 23% unvaccinated. 48% of participants identified as African-American or Black and 52% identified as white. Inductive categories included the pandemic’s impact on healthcare access, including on COVID-19 vaccination, engagement in preventive health behaviors and COVID-19-related risk mitigation, participants’ ideas about community, information-seeking processes, and systemic trust. From the data emerged a theme that with age came the wisdom and knowledge to make sense of health information for one’s self. This concept was sounded more frequently and intensely among unvaccinated participants. Community served as a protective factor in participants’ healthcare access. Community-based groups described more exchanges of information compared to non-community groups. Vaccine status created clusters of community in that vaccinated participants surrounded themselves with others who were vaccinated, and likewise for those unvaccinated. Participants who were unvaccinated more often strictly limited their in-person interactions compared to vaccinated participants. Focus group discussions about race were nuanced. Black participants touched on some different themes around COVID-19, including, for example, theories about whether COVID-19 had been created to ‘kill off Black people.’ These kinds of informational data played out differently across community embeddedness and vaccination status. Unvaccinated participants were more likely to cite these as contributors to vaccine hesitancy.

Conclusions and Implications: Findings highlight opportunities for social workers to take an intersectional lens in helping clients access vaccination and preventive health services and combat related misinformation. Social workers are uniquely positioned to leverage the therapeutic relationship to build trusted alliances with clients and within communities. This session will also discuss the methodological considerations of amplifying Black or African American and white older adult voices through intersectional, community-based research.