New Guide Helps Build Trust With Nursing Home Staff Regarding COVID-19 Vaccines

A new research-based guide is available to boost uptake of the COVID-19 vaccine among nursing home workers. Invest in Trust: A Guide for Building COVID-19 Vaccine Trust and Increasing Vaccination Rates Among CNAs addresses concerns and challenges nursing home workers have expressed and outlines the most effective approaches to build trust in the vaccine and make it easier for them to get vaccinated.

The University of Florida’s Center for Public Interest Communications produced the guide for the National Nursing Home COVID-19 Action Network, a partnership between the Agency for Healthcare Research and Quality (AHRQ) and Project ECHO, The University of New Mexico’s signature tele-mentoring program.

Invest in Trust provides insights from social, behavioral and cognitive science and primary research and includes the voices of nursing home workers who have gotten vaccinated or who are still considering receiving the vaccine. The guide constitutes the type of evidence-based tools and resources that the network has created to help nursing home leaders implement evidence-based infection prevention and safety practices to protect residents and staff.

“To fully protect nursing home residents and staff from COVID-19, the best thing we can do is continue to increase vaccination rates, especially among certified nursing assistants, who are the backbone of the nursing home workforce,” said David Meyers, MD, acting director of AHRQ. “That means understanding where they’re coming from and meeting them where they are with messages that address their concerns and practical interventions that help them get vaccinated.”

Across the United States, research has found that significant numbers of frontline nursing home workers have still not been vaccinated against COVID-19 because they are in “wait-and-see” mode, do not want the vaccine, or have encountered barriers like lack of transportation or paid time off.


Sanjeev Arora, MD
If we want to understand what’s keeping workers from getting vaccinated, we need to go to the experts – the frontline workers themselves.”
Sanjeev Arora, MD


“If we want to understand what’s keeping workers from getting vaccinated, we need to go to the experts – the frontline workers themselves,” said Project ECHO founder and director Sanjeev Arora, MD. “The incorporation of frontline wisdom and insight, paired with what we know from science, is what makes this guide so unique and valuable.”

A recent survey of 233 U.S. nursing home and long-term care employees informed the guide and revealed that nursing home workers often face significant challenges to getting vaccinated. The findings suggest that employers may increase vaccination rates by offering paid time off for staff to get the vaccine and to recover from any short-term side effects, offering transportation or child care vouchers, and holding worksite vaccination drives.

The network found that the most effective messages for building vaccine confidence is to appeal to workers’ desire to protect others from getting the virus and prevent the spread of infectious disease across society.

Among CPIC survey respondents who were hesitant about the vaccine, most-trusted sources of information included (in order), “my family,” “local health care professionals,” “my closest friends,” “my faith leaders,” and the Centers for Disease Control and Prevention. Least trusted were “my employer” and “political leaders.”

Lori Porter, CEO of the National Association of Health Care Assistants, the largest professional association representing the certified nursing assistant workforce, was herself at first hesitant to take the vaccine until a partner organization representing medical directors in long-term care walked her through her concerns.

“I had questions, too,” Porter said. “And when my questions were answered, I came out in support of the vaccine and made my declaration to our members. But someone had to take the time to respect my concerns.”

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