Our Team Projects' History

Origins of the Group:

The group was born in 2019 from the idea of Purnima Madhivanan (MBBS, MPH, PhD / Associate Professor at the Mel and Enid Zuckerman College of Public Health) and Carlos Perez-Velez (MD / then Deputy Chief Medical Officer at the Pima County Health Department) to revive an MPH student’s internship project from 2017. Alison Rosario (MPH) was studying reasons why Pima County residents might or might not choose to get vaccinated against seasonal influenza. She adapted a survey to ask 56 random patients in a clinic waiting room about their reasons for getting vaccinated or not. The data she collected found that only 38% of her participants did not want to get the flu vaccine. Top reasons for not getting the vaccine which were listed included:

  1. not having enough time
  2. not having insurance 
  3. not knowing where to go


Purnima and Carlos decided to work with an undergraduate Public Health student, Jacob Marczak, to further adapt and refine Rosario’s survey to collect more recent data on seasonal flu vaccination in Pima County. They wanted to collect more information about the issue and provide the survey to the health department to be used on a yearly basis to continually monitor this issue of vaccine hesitancy and factors associated with it in Pima County. In the months to come, as a few other students joined the team, the COVID-19 pandemic was growing and it became clear that it may be important to assess vaccine attitudes and intention for the new respiratory disease which was overtaking the world.


With COVID-19 being a new worldwide pandemic, the team decided to take a longer approach to studying vaccine intention in the two diseases: flu and COVID. They planned to start with focus group discussions to get an idea of what people in Pima County thought about the two illnesses and their vaccines, and then use that information to create a survey to release in Pima County to get more information from more people, before doing more focus groups or interviews to help refine the survey one last time before presenting the survey to the health department. The Pima County Health Department would be able to continue to use the survey annually, hopefully with minimal revisions, after this process.


A few projects we have completed and/or are working on now:

Focus Groups with Pima County Adults:

Eleven focus group discussions (FDG) were conducted between September and October 2020 to explore factors affecting Pima County residents’ intention to vaccinate against COVID-19 and seasonal influenza. Discussions were conducted in both English and Spanish stratified by gender and race/ethnicity: African American (AA), Latino, White. All FGD participants were residents of Pima County, Arizona. FGDs were conducted via Zoom and then transcribed. 


Some FGD participants were fearful of contracting COVID-19 because they said they feared they would be hospitalized and isolated. This fear appeared to be more prevalent among white participants. AA participants were also concerned about being hospitalized, but appeared less concerned about dying, often expressing the belief that it was not up to them whether they survived or not. A common theme for all FGD participants was a fear they might  make others sick and worried that this might cause suffering or death among those they loved.  


Some AA participants expressed fears of becoming test subjects thus developing an unwillingness to vaccinate against COVID-19. Based on further comments, this fear stems from a historical trauma due to a distrust in the research community. Several AA participants claimed that learning about the side effects and health consequences for this demographic would positively influence their comfort level about receiving the COVID-19 vaccine. As a result, many Hispanics and AAs claimed hesitancy to vaccinate against COVID-19 until they witnessed or heard of others in their networks getting it without any adverse effects and could verify the vaccine research process had been conducted with multiple races and ethnicities. Throughout focus group discussions the issue of politics compromising the trust in the vaccine’s effectiveness and/or safety was mentioned. In general, FGD participants had worries and fears about the hidden interests politicians may have regarding the role-out of the COVID-19 vaccine. Furthermore, FGD participants had worries and fears about trust of information and the efficacy of  the vaccine because of politics. 


Across all racial groups there was a concern for the cost of vaccines and whether they are covered by insurance; however, AA participants were most concerned about the cost. All racial groups in FGDs had concerns about the setting/location vaccinations would take place. More white participants discussed getting vaccinated at their place of employment. FGD participants also mentioned local pharmacies (CVS and Walgreens) as their choice of location for “easy” places to get vaccinated. Availability of the vaccine at said locations was of concern. Hispanic participants were concerned about the availability of vaccines in low income communities and rural areas. White participants expressed experiences of vaccine shortages the most. Among all racial groups in the FGDs, most participants got vaccinated as a requirement for work. Some participants expressed that if the COVID-19 vaccine was required for work, then they would get it. Among all participants who were older in age evaluated themselves to be at greater risk of contracting COVID. Some FGD participants believed they were at high risk for disease based on their social circles and risk of contracting COVID-19 from someone in their network. As compared to others believing they were at low risk as a result of their own personal protective behaviors such as social distancing, handwashing, wearing masks, and avoiding groups of people. More white participants expressed they had low risk of getting COVID-19 due to their good health. Whereas, more Hispanics talked about being low risk due to their natural immunity. Among those that had faith and fatalism influence their vaccination behavior, AA participants were the majority. Whereas Hispanic/Latino individuals had the least influence from faith/fatalism on vaccination behavior. For instance, some participants believe that there are certain things that are out of their control, such as death. These participants felt at peace that it is out of their control, however they still attempt to protect themselves. 




In the Spring of 2021, the survey was adapted based on the focus group discussions and previously used measures reasons for vaccine intention or hesitancy. Over 1000 responses were collected in Pima County. Some findings from the survey are summarized below:


COVID Worries Infographic


COVID-19 worries infographicFlu InfographicFlu Worries


Trust Sources


Interviews with Health Care Workers:

The research group has also collaborated with a class in qualitative research methods taught by Priscilla Magrath, PhD at MEZCOPH to conduct interviews with healthcare workers in Pima County on how they, their co-workers and their communities feel about the COVID-19 vaccine. This project is especially important because healthcare providers are often one of the most trusted sources of information about vaccines and can be incredible influencers. We have found that some health care workers also are skeptical of the vaccine and can at times create more mistrust in the COVID-19 vaccine. This makes it a very pressing issue to understand concerns of health care workers in order to help create more trust in the community in the vaccines.

Future Directions:

The research group is currently working on further analysis of the data collected from the survey, and are planning to conduct more focus group discussions in the Fall of 2021. This final round of research will be used to finalize the survey which will be presented to the Pima County Health Department. The team is also looking at other avenues of research in the field of vaccine hesitancy including HPV vaccine intentions, COVID vaccine intention among parents and teens, and more. The team has also been conducting informational workshops on the COVID-19 vaccine and hopes to continue to provide such information to the public to help debunk myths and increase confidence in vaccines. The research team continues to grow and includes students and professors from different disciplines, as well as partners and collaborators from outside of the University of Arizona. We hope to continue to grow and collaborate with more community partners in the future in order to discover the root causes of vaccine hesitancy and try to find new ways to address that hesitancy.