COVID-19 vaccinations among incarcerated populations in North America: a mixed-methods systematic review
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Correctional facilities are susceptible to infectious disease outbreaks, as evidenced during the COVID-19 pandemic. Achieving a high and sustained rate of COVID-19 vaccination is essential to control future outbreaks and safely resume normal activities within correctional facilities. This mixed-methods systematic review synthesized the literature on the associated social determinants of health, the facilitators, and the barriers of COVID-19 vaccination in incarcerated populations in North America. A search of five databases was performed on October 11th, 2023. Peer-reviewed, primary quantitative, qualitative, and mixed-methods studies published in English in the years following 2020, focusing on COVID-19 vaccination in incarcerated populations in North America were included in the review. A total of 15 studies were included in the review. Data from the included studies was extracted and synthesized using a segregated approach to data synthesis. The quantitative findings include two individual and group-level determinants, three health-related determinants, four correctional determinants, and one policy-level determinant of COVID-19 vaccination. According to the review’s findings, target groups for COVID-19 vaccination interventions should include younger and healthier adults, Black/African American and Indigenous individuals, those who recently refused the Influenza vaccine and who report low medical trust, individuals in jail facilities who are single-celled and have a medium to maximum-security classification, and populations not prioritized for early vaccination in vaccination policies. The qualitative findings include seven synthesized findings on the barriers and facilitators of vaccination in incarcerated populations and the correctional setting. Barriers of vaccination include vaccination-programme related factors, a lack of vaccine knowledge, social pressure and negative social norms, universal distrust, risk perceptions, beliefs about health and immunity rendering vaccination unimportant, and not perceiving one’s vaccination as impactful. Facilitators of vaccination include the right type of vaccine recommendation, positive social norms, belief in the protective benefits of vaccination, and vaccine incentives.