Covid, Racial Trauma, and the Loss of Onotological Security

Background and Purpose: This paper explores the complex relationship between the racial identity and well-being of low-income African Americans with initial vaccine hesitancy living in the South as they navigated the response to COVID-19 and the vaccines in their communities, where public health actions were politicized. It examines how African American managed their lives during the pandemic, while continuing to experience interpersonal and structural racism and poverty. At the beginning of the pandemic, especially, African Americans were disproportionately at risk of developing COVID-19 due to higher prevalence of preexisting conditions such as high blood pressure, heart disease, obesity, and diabetes among the population. Even as vaccines were introduced, low-income African Americans living in the South faced barriers to receive the jabs or were hesitant due to historical and structural racism, misinformation, and the politicized nature of the rollout. The aims of this study are to examine how low-income Southern African Americans with vaccine hesitancy:

1. Found and processed information about Covid-19 and the vaccines
2. Developed coping and survival strategies when information and messaging about Covid-19, treatments, and vaccines were inconsistent or unavailable
3. Used word-of-mouth and news and social media sources to make decisions
4. Experienced Covid-19 from an ecological perspective (micro, mezzo, and macro)

Methods: This study includes multiple interviews with 40 (n = 40) African Americans residents of seven Southern states: Ages ranged from 18 to 71. Researchers used a grounded theory and narrative approach. The semi-structures approach was used with narrative to build theory and explore participants’ lived experience between March 2020 and early 2022. Two researchers collected and analyzed the data, using theorizing, comparing, contrasting, aggregating, and ordering as data were collected. Based on earlier conversations with participants, researchers used Theory of Triadic Influence (TTI) as a framework to conduct follow-up interviews to focus on attitudes/beliefs, social influences, and structural barriers in society, including racial barriers. All interviews were conducted over Facetime or Zoom and transcribed by the interviewer.

Results: The results of this study identified three large areas of concerns for participants: Threats to ontological security, mixed effects of social networks and connections, and race-based traumatic events not associated with Covid. There were five types of experiences that served as markers of larger concerns, 1.) Loss and vicarious trauma, 2.) Psychological resilience and high coping, 3.) Specific traumatic experiences with racism, 3.) Misinformation that people were given different vaccines based on their race, 4.) Misinformation caused initial hesitancy, while illness and death helped change minds, 5.) Belief in both main narratives and counter-narratives

Conclusions and Implications: Several implications can be taken from this study. Among them, are that community-based and culturally appropriate approaches to COVID-vaccine information are necessary for greater acceptance and ease of use. COVID-19 is not just a physical or public health issue, but a mental health concern as well. Attention should be paid to recovery from loss and highly stressful experiences related to COVID. Ontological insecurity related to COVID-19 suggests a link to ambiguous loss at the individual and community level.