Break Down Barriers That Prevent People From Getting Vaccinated

Overcoming learned misinformation about COVID-19 vaccines, poor health literacy, and language barriers are the major causes of concern that Elise Phelps, PharmD, faces when caring for community members in Beaverton, Oregon. “Patients are accessing information from a staggering number of sources, and reconciling all of this can be time consuming,” she said about the multitude of media outlets, such as social media, where misleading information can be detrimental to people’s health. “Many of the patients I work with struggle with health literacy, so providing consistent and correct information in patient-friendly language is key.”

Phelps, a clinical pharmacist at Virginia Garcia Memorial Health Center (VGMHC) Beaverton Wellness Center, a Federally Qualified Health Center, focuses on providing high-quality, patient-centered care to vulnerable populations. “Many patients don’t really understand what a virus is, how they catch a virus, and where it exists in the air,” Phelps said. She keeps information to the basics to help patients understand the definition of a virus and what everyone can do to try and prevent infection.

During regular patient consultation appointments, Phelps raises the topic of getting vaccinated against COVID-19 over two or three appointments for patients who are feeling uncertain. At each visit, she asks them where they are in their decision-making process and if they want to talk about the vaccine and receive more information. Phelps actively listens, is open to questions, and offers support, while not being overly forceful in her approach. To help patients realize their gaps in understanding, she asks them open-ended questions about their concerns and lets them talk. She then validates her patients’ expressed concerns, shares why she personally felt getting vaccinated was important, and highlights how the vaccine could help relieve their anxiety related to the impact of COVID-19 in their lives.

Phelps’ biggest success story was working with a patient in her mid-thirties to manage her diabetes. The patient had lost both her mother and maternal grandmother to heart disease a few years ago. She was at high risk for complications from COVID-19 given her diabetes and family history of heart disease. “Over the course of our usual appointments for her diabetes, I was able to share information and my thoughts on the vaccine, allow time for her to reflect, and then circle back to the point where she felt ready to schedule her first vaccine appointment,” said Phelps. “I was able to help this patient make an informed decision we both felt good about.”

VGMHC cares for a significant Hispanic population, observed Phelps. “When they come in for the first dose, they ask many questions about the studies and study designs and why the vaccines made their way so quickly to the market,” she said. It was also important for Hispanic community members to see the vaccine before it was administered to them, putting them more at ease. In addition to Spanish, “I’d say out of ten patients scheduled for appointments with me, seven of those are likely to require an interpreter,” said Phelps who reaches out to onsite interpreters or dials the interpreter service call center Passport to Languages when she has difficulty connecting with her patients due to a language barrier.

The health center also uses mobile vans during the summer to visit migrant seasonal farm worker camps to help those with limited access to health care resources. “We’ve taken mobile vans to farmers markets, migrant camps, and other events to provide vaccines to refugees and others with barriers to obtaining care,” said Phelps. “I think reaching people can sometimes be the hardest part.” Many of the people are low income and are uninsured or underinsured with more than 60 different languages spoken across the population and over half being best served in a language other than English.

To date, Phelps estimates that 40,000 doses have been given as a result of her efforts with VGMHC.

—Clarissa Chan
June 2021