COVID-19 Vaccine Booster Hesitancy among Hispanic Adults: A Cross-Sectional Study from the Puerto Rico Community Engagement Alliance against COVID-19 Disparities (PR-CEAL)

Hispanic/Latino communities have suffered a disproportionate burden of the COVID-19 pandemic. Although Puerto Rico has one of the highest COVID-19 primary series vaccination rates nationwide, this estimate contrasts with the reported booster doses' low uptake. This study aimed to assess health belief correlates of COVID-19 vaccine booster uptake. Using a convenience sampling approach, the Puerto Rico-Community Engagement Alliance (PR-CEAL) conducted a cross-sectional study where 787 participants were recruited using online and in-person strategies between December 2021 and February 2022. Participants were adults 18 years or older, Spanish-speaking, and residents of Puerto Rico. The Health Belief Model was used to evaluate attitudes and beliefs. A total of 784 participants were used in this analysis. Adjusted Poisson regression models were used to estimate prevalence ratios (PR) and 95% confidence intervals (CI) of booster refusal. Overall, 22% of participants refused the vaccine booster or had not gotten it yet. Adjusted models showed that (i) participants who disagreed that getting the booster dose either made them feel less worried about COVID-19 or (ii) felt that the vaccine decreased their chances of getting COVID-19 presented higher booster-refusal prevalence ratios (PR = 4.20, 95% CI: 3.00, 5.90; PR = 3.70, 95% CI: 2.64, 5.18). Moreover, participants that (iii) reported having concerns for booster side effects [PR = 2.47; 95% CI = 1.73, 3.51], (iv) booster efficacy [PR = 2.50; 95% CI = 1.75, 3.58], and (v) booster safety [PR = 2.80; 95% CI = 1.96, 3.99] were significantly more likely to refuse the booster. In conclusion, booster vaccination refusal was associated with lower perceived vaccine benefits and greater barriers among adults in Puerto Rico. These results informed the development of PR-CEAL's targeted community outreach strategies and public health campaigns to increase booster vaccine uptake.