"They were saying that it's the end of the world": Experiences of COVID-19 and beliefs about the COVID-19 vaccine among refugees in Rhode Island, US.

Refugees face multi-level barriers to seeking healthcare, making them vulnerable to poorer health outcomes. An estimated 100 to 345 refugees from 20 to 30 different countries settle in Rhode Island (RI) each year. In collaboration with refugee-serving organizations in Providence, RI, this qualitative study investigated refugees' experiences of the COVID-19 pandemic and their beliefs about the COVID-19 vaccine. In 2023, we conducted eight focus group discussions (FGDs) in English, Spanish, Swahili, and Arabic with refugees from three world regions (Africa, Latin America, Middle East). Community advisory board input informed the FGD guide and recruitment efforts. Most participants had been in the United States (US) for less than one year. The sample (N = 60) consisted of 37 women and 23 men, with a mean age of 44.4. Data were analyzed using thematic analysis, and the National Institute of Minority Health Disparities (NIMHD) Framework was used as an organizing framework. Four themes with subthemes emerged: (1) The COVID-19 pandemic as a difficult, stressful, and fear-inducing experience; (2) Feelings of mistrust regarding the COVID-19 virus and vaccine; (3) Health concerns about the COVID-19 vaccine; and (4) The COVID-19 vaccine as protective and beneficial. These results suggest that feelings of mistrust surrounding the COVID-19 virus and its vaccine may have served as a crucial barrier to vaccine uptake. Study findings can inform culturally tailored interventions to promote better understanding of COVID-19 and other vaccines, and improve vaccine confidence and vaccine uptake among refugee communities.