Education, trust, and likelihood to vaccinate against COVID-19 among patients with diabetes in the American South

Objective: The purpose of this study was to explain the relationship among education, likelihood to vaccinate for COVID-19, and trust in healthcare providers among patients living with diabetes in the American South. Methods: Explanatory iterative sequential mixed methods design combined retrospective chart review, self-report surveys, and qualitative interviews. Results: Analysis of covariance revealed that severity of diabetes was not linked to vaccine acceptance. Overall, patients reported higher likelihood to vaccinate if their healthcare providers strongly recommend the vaccine. People with “some college” education reported lowest likelihood to vaccinate, before and after their healthcare providers’ strong recommendation. Integrated analysis revealed the complexity of patient-provider trust and vaccination decisions. Conclusions: In the context of COVID vaccination, particularly as conspiracy theories entered the mainstream, measures of trust in the system may be a clearer indicator of vaccine decision making that trust in personal physician. Practice implications: The nonlinear relationship between education and likelihood to vaccinate challenges providers to talk to patients about knowledge and understanding beyond a superficial, quantitative screening question about education. Health systems and public health officials need to find strategies to build trusting relationships for patients across systems, such as community health workers.