COVID-19 vaccination intention and activation among health care system employees: A mixed methods study.



Achieving high COVID-19 vaccination rates among employees is necessary to prevent outbreaks in health care settings. The goal of the study was to produce actionable and timely evidence about factors underlying the intention and decisions to obtain the COVID-19 vaccine by employees.


The study was conducted from December 2020 - May 2021 with employees from a VA health care system in Southeastern US. The study used a convergent mixed methods design comprising two main activities: a cross-sectional survey conducted prior to COVID-19 vaccine distribution, and semi-structured interviews conducted 4-6 months after vaccine distribution. Data were collected about participant characteristics, vaccination intention prior to distribution, vaccination decision post-distribution, determinants of vaccination intention and decision, activating factors, sources of information and intervention needs. Data from the survey and interviews were analyzed separately and integrated narratively in the discussion.


Prior to vaccine distribution, 77% of employees wanted to be vaccinated. Post vaccine distribution, we identified 5 distinct decision-making groups: 1) vaccine believers who actively sought vaccination and included those sometimes described as "immunization advocates", 2) go along to get along (GATGA) individuals who got vaccinated but did not actively seek it, 3) cautious acceptors who got the COVID-19 vaccine after some delay, 4) fence sitters who remained uncertain about getting vaccinated, and 5) vaccine refusers who actively rejected the COVID-19 vaccine. Participants identifying with Black or multiple races were more likely to express hesitancy in their vaccination intention.


The findings of our study highlight distinct decision-making profiles associated with COVID-19 vaccination among employees of a VA health care system, and provide tailored recommendations to reduce vaccine hesitancy in this population.





Published Version (Please cite this version)


Publication Info

Vasudevan, Lavanya, Rebecca Bruening, Anna Hung, Sandra Woolson, Adrian Brown, Susan N Hastings, Tammy Linton, Genevieve Embree, et al. (2022). COVID-19 vaccination intention and activation among health care system employees: A mixed methods study. Vaccine, 40(35). pp. 5141–5152. 10.1016/j.vaccine.2022.07.010 Retrieved from

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Lavanya Vasudevan

Adjunct Associate Professor of Global Health

Lavanya Vasudevan is an adjunct associate professor at the Global Health Institute at Duke University. Her research focuses on studying the timeliness of vaccinations, identifying vaccination barriers, and understanding the role of misinformation in driving vaccine hesitancy. In addition, she works on developing and evaluating novel interventions, including those that leverage digital health technologies, for health information or service delivery. In her research, Dr. Vasudevan seeks to study and alleviate the complex challenges with vaccination delivery and uptake in low resource settings and in populations experiencing health disparities. In the context of these challenges, Dr. Vasudevan is interested in the use of multidisciplinary collaborations, mixed methods and implementation science frameworks. Dr. Vasudevan completed her doctoral training in molecular biology and genetics at Cornell University and received her Master’s degree in public health from the Johns Hopkins Bloomberg School of Public Health. Dr. Vasudevan is Certified in Public Health by the National Board of Public Health Examiners.


Anna Hung

Assistant Professor in Population Health Sciences

Anna Hung, PharmD, PhD, MS is a pharmacist and health services researcher interested in payer and patient decision making related to pharmacy benefits. Previously, she collaborated with the Defense Health Agency to evaluate the budgetary impact of their antidiabetic drug formulary changes. She has also worked with a variety of managed care organizations to assess their drug utilization and clinical management programs. Her methodological research interests include health care cost evaluations, quasi-experimental study designs, and stated preference research.

Dr. Hung received her Doctor of Pharmacy, Master of Science, and Doctor of Philosophy from the University of Maryland. Her PhD is in pharmaceutical health services research, with concentrations in pharmacoeconomics, comparative effectiveness research, and patient-centered outcomes research. Prior to joining the Department of Population Health Sciences, she completed a post-doctoral fellowship at the Duke Clinical Research Institute and served as Co-Chief Fellow.


Susan Nicole Hastings

Professor of Medicine

Christopher James Hostler

Associate Professor of Medicine

Nwora Lance Okeke

Associate Professor of Medicine

Nina Sperber

Associate Professor in Population Health Sciences

My research career has centered on understanding how to improve delivery of new evidence-based practices in health care systems. I work in health services research and development for the VA health care system and have an academic appointment with the Duke University School of Medicine. I create study designs that integrate qualitative and quantitative methods (mixed-methods) and apply Implementation Science and System Science approaches. I currently have a developing body of academic work that uses participatory system dynamics modeling as a strategy to identify system level factors that affect development and implementation of equitable AI tools. For the VA health care system, I direct a cross-functional team that conducts rapid turnaround projects for high priority needs by VHA national, regional, and facility leaders.


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