Reentry and COVID-19: an examination of the vaccine beliefs and behaviors of Black adults in an urban community

Abstract Background Black individuals who are currently or formerly incarcerated have experienced disproportionate risk of COVID-19 infection and mortality. Yet, COVID-19 vaccine uptake within this population remains shaped by complex multilevel factors. Guided by the Health Belief Model and Social Ecological Model, this study examined how formerly incarcerated Black adults’ perceptions of their incarceration and reentry experiences influence their COVID-19 vaccine-related beliefs and behaviors. Methods Between March 2021 and August 2022, 12 semi-structured interviews were conducted with formerly incarcerated Black adults recruited from a reentry program affiliated with a local health department in the South-Central region of the United States. The study used an Interpretative Phenomenological Analysis (IPA) design, and an interview guide informed by theoretical frameworks guided each interview. Interviews were audio-recorded, transcribed verbatim, and analyzed using IPA procedures. Results Findings are organized around six Health Belief Model constructs: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. Participants' perceptions of susceptibility and severity were shaped by their health status, racial identity, and religious or spiritual beliefs, social networks, and experiences with incarceration. Vaccine acceptance was influenced by underlying health conditions, employment needs, family responsibilities, prior vaccine experiences, and perceived benefits to the Black community. Barriers included limited access to trusted information, concerns about vaccine safety and effectiveness, challenging community conditions, and inconsistent messages from trusted leaders. Conclusions Findings underscore the need for multilevel, culturally informed, and community-engaged health promotion and prevention reentry strategies that address mistrust, improve access to trusted information, and include individuals with lived experience of incarceration as credible messengers.