Understanding uptake of the COVID-19 vaccination among the homeless: A mixed methods evaluation

Background: Ensuring effective access to vaccinations for people experiencing homelessness is crucial to protecting the health of a vulnerable, yet often overlooked population. Reaching this goal takes more than a one size fits all approach. This study evaluates how a dedicated health team collaborated with multiple agencies to register and deliver the COVID-19 vaccine to people experiencing homelessness.

Methods: This is a mixed methods study co-designed with the Adult Homeless Integrated Team, a multi-disciplinary team who work with local agencies to provide care to people experiencing homelessness in Cork, Ireland's second largest city. Quantitative data collected at the point of vaccine registration described socio-demographics of the population. To explain the quantitative findings, eleven agencies involved in provision of homeless services were invited to participate in interviews. A manager in each of the agencies acted as a gatekeeper to clients. Interviews explored experiences with the pandemic and the delivery (staff) or receipt (clients) of the COVID-19 vaccine. Interviews were recorded and transcribed, transcriptions were thematically analysed.

Results: There were 728 vaccine doses administered to people experiencing homelessness during the first roll-out of vaccines; 401 first doses and 325 second doses. Of those who received a vaccine, the majority were male (76%), and more than half were Irish (55%). Ten semi-structured interviews, seven staff members and three clients, were conducted. There were three themes that provided further insights into the quantitative findings: Adapting to unprecedented times, Misinformation causing vaccine hesitancy and The importance of building relationships.

Conclusions: This study provides valuable insights into how a multidisciplinary approach resulted in a successful well received vaccination programme among a traditionally hard to reach group.