"At the End of the Day, the Decisions Were Ultimately Up to Them:" Collectivism and Community Care as Underliers of COVID-19 Vaccine Uptake Among Older Asian American Immigrants in the United States.

Despite early successes, vaccine uptake for COVID-19 has considerably slowed. In light of the serious implications of COVID for population health, especially within older adults, we must better understand lessons arising from early successes from community organizations. In this research, we present findings from in-depth interviews with bilingual, bicultural professionals within community-based programs serving older Asian immigrants with LEP to explore experiences and strategies regarding vaccination promotion. In-depth interviews were conducted with bicultural and bilingual Asian outreach specialists, recruited in 2020–2021 through purposive sampling from one major United States city (N = 10). Through a constant comparative method, we refined our theoretical frameworks and coding schemes, building an interpretative structure and conceptual model that situates multiple, integrated behavior change theories into a community-centered and culturally specific framework. Results highlight how community workers, typically from the same ethnic/cultural background as their clients, mobilized tight-knit service provision, community engagement, social cohesion, and empowerment to build vaccine acceptance among their clients. Behavioral change strategies workers used (perceived susceptibility, severity of the disease, benefits of vaccination, and self-efficacy) were situated within a collectivist ethos: community-centered motivators such as reciprocal determinism, observational learning, and reinforcements were essential. Findings point to the need to understand health behavior within and across multiple, mutually dependent levels of influence by workers embedded within specific communities, highlighting the importance of long-lasting, culturally specific, community-based programs for public health emergencies. [ABSTRACT FROM AUTHOR]