Background
Methods
Study context
Approach
Recruitment and participant description
Interview guide & data collection
Data analysis
Results
Participant information
Findings
Theme/Sub theme | Representative Quotes | Participant |
---|---|---|
Successive policy changes complicate | ||
Erratic changes | Sometimes there were some last minute changes that made it challenging. All of a sudden we’re going to make some changes. I didn’t feel there was enough lead time for people to adjust | Non-profit social care enterprise manager |
Communicating policy, that's something we struggled with all the time. People need time to prepare. The information is so quick that two or three days after an announcement or NACI comes out with a recommendation almost feels like it's too late so we try to keep up with that in terms of relevance. You have to be constantly evaluating your policy and how you're communicating it. The environment changes very quickly around you | Professional body advocate | |
When you try and do them all in rapid sequence you've got complexity of what's out of date? How quickly will we able to change online resource? We’re beginning to be out of date and the complexity was because each thing had so much volume. Pivoting to the next one was made more complex because it was almost like you had to unpick the last policy decision. That was the complexity | Director of communication | |
Disconnect with frontline communication | Even giving a 24 h or 48 h gap in between a change in policy and communication to the public would be very helpful, and it would really help to improve the trust that people have. Then they wouldn't be encountering those situations where policy has changed, but the actual professionals who are responsible for administering that policy don't know about the change | Pharmacy manager |
They should have said the vaccine is 95% effective for at least two months. Instead the narrative was so narrow it didn’t allow for the changing reality | Rural community outreach worker | |
What the public sees is that I’m confused. The messaging changes. Also the consistency with which you are able to deliver on some of those messages is challenging | Urban pharmacist | |
Information would change rapidly so it became very challenging to have updated information for everybody. Helping them communicate accurately to the community was an exercise in frustration | Non-profit social care organization director | |
Policy change fuels misunderstanding | ||
Confusion over changes | We come out with one of the first statements from any health professional group to say that we were disappointed with the messaging about changing AZ vaccine policy. Not necessarily disappointed with the science, but the way they had framed it. It was damaging and unclear and caused confusion and caused unnecessary panic | Professional body advocate (Federal) |
Initially, priority groups, as to who qualified to get the vaccine, was super confusing. It changes, it’s just never been concrete. It's just confusing | Physician | |
There are of course going to be those who are really confused and concerned because the news may be different to what we're saying, but it's simply because those students, those patients are not up to date with the most [recent] NACI guidelines or whatnot or Health Canada's recommendation | Nurse practitioner | |
Emotional discourse | The time between vaccines changed, people were like ‘Why?’ Why are you coming out telling us very strongly this is the vaccine sequence and now you changed it. What am I supposed to believe? Do you actually know what you're doing? | Non-profit social care enterprise manager |
Trying to tell people that they had to get one Astra Zeneca and then an mRNA or the mixed mRNA [vaccines]. That was that was brutal. It was so frustrating because people were so against it. I don't know what they were believing. They were just thinking that we were going to try and kill them | Nurse practitioner | |
The mixed dose regimens and keeping people from travel; change is another thing that has caused a lot of people angst | Vaccine clinic manager | |
Unintended negative consequences | ||
Complicated implementation | It would be nice to have had a heads up on things prior to press releases. Oh my God, that would have helped us a lot | Community pharmacist |
Eligibility criteria were slightly different from province to province. The vaccines were rolled out in pharmacies at different rates in different provinces | Professional body advocate (Federal) | |
The way the province regulates intervals for the indigenous community was they had urban indigenous and rural Indigenous. They changed the dose interval at one point just for urban Indigenous. Three weeks later, the provincial guidance changed so we had to rework all of our clinics | Vaccine clinic team lead | |
I would tell you that the vaccine rollout has been challenging because the rules keep changing. It's been that way from the start. Most of that has come down from our provincial government around who is eligible and who can get the vaccine [and] when have been very hard to enact. We never get enough notice so that we can't plan. There's no planning in this and it's incredibly confusing for the general population | Vaccine clinic manager | |
The poor people, they're probably scrambling to get all this together so that by Monday morning we've got what we need to tell us the new parameters. Another thing was when you get your booster shots, so the change in duration between shots. That policy keeps like flipping out and changing | Rural community pharmacist | |
When guidance gets announced there’s a catch up. We don't have enough time to plan and to make sure that we are really ready to go when these policy announcements happen…It became chaotic | Professional body advocate (Provincial) | |
Vaccine passports, how those policies [worked], that was one of the most nerve-wracking times for our team about clarity. That’s a whole thing we continue to navigate | Non-profit social care organisation director | |
Growing resentment | A lot of people have questions about the vaccine where they feel like they’ve been lied to. It’s because the reality shifted and the communication didn’t shift in lockstep with it. It took a while for communication to catch up and during that period a lot of cracks emerged and people lost trust with a lot of policy in general | Rural community outreach worker |
I think when everything is so up in the air, the one thing that we really need is consistent messaging and if NACI, is saying one thing, and healthcare is saying another and then Ontario does its own thing, I think that's going to cause people a lot of confusion and a distrust towards the system as a whole. Waiting for information to filter down is extraordinarily infuriating | Nurse practitioner | |
Policy communication? Confusion frustration yeah, eventual lack of trust, inconsistency, constantly changing these are more terms, but these are things that I feel like we were hearing from people coming to us, yeah | Public health worker |
Successive policy changes complicated communication
“The highly changeable circumstances led to simple policies being more difficult to communicate because they changed so quickly. When you do them in a rapid sequence, you’ve got complexity--what's out of date?” (Director of Communication)
“We got out what we could, where we could, as fast as we could, then everything else lagged behind. I wish we had more resources to make it consistent across the board…it felt difficult to say to people, ‘Oh, the translations are coming’.” (Vaccination Clinic Lead)
“The hardest thing has been just how quickly everything changes and how it's often hard, too hard for people to keep on top of the latest iteration.” (Rural Hospital Physician)
“A lot of the information they get is from their news channels, directly from India, Pakistan or wherever they're from. A lot of the information from there doesn't actually coincide with what's happening here.” (Urban Hospital Physician)“Not all areas, or public health units, or municipalities have the capacity to translate information. You end up with piecemeal information that's translated and being shared without people knowing the source of the information or the accuracy of the information.” (Public Health Community Outreach Worker)
“The most difficult thing to communicate was helping patients navigate the different criteria and eligibility and helping health professionals understand that. It was a very complex the way we went about rolling out the vaccines. It made it complicated for people to understand and made it very complicated for pharmacies and pharmacists to understand and keep track of and to stay up to date.” (Community Pharmacist)“The biggest challenge is that the rules change every day, all the time. How do we communicate that clearly to everybody and help make people understand? Obviously, we try our best but if somebody doesn’t watch the news, read the paper, listen to the radio, how do we get that message to them?” (Regional Vaccine Clinic Manager)
“There are times when we find out a few hours before. There’s not enough time to make sure we are ready to go when these announcements happen…In terms of eligibility, that has changed more times than I can count...it feels like roughly weekly, we’ve issued a new communication.” (Provincial Professional Body Advocate).
Policy changes fuelled confusion and misunderstanding
“We pointed out to the federal government that each province is coming out with a completely different level of eligibility; age ranges were different from province to province. We tried to help bring cohesion.” (Federal Professional Body Advocate)“Whenever the province is not giving us clear policies and clear mandates and local regions must make decisions, it is very, very, challenging for us to deal with it. Then of course it is more confusing for people, right?” (Regional Vaccine Clinic Manager)
“Political decision-making hasn't really been in tune with what the health care professionals are saying... confusingly, the doctors were saying this, but [the Premier of Ontario] is doing that. So, what's really going on?.........for vaccines or mandates, it should all be evidence-based because your evidence ‘for’ is pretty consistent…. We wouldn't have as much trouble. Our policies are swindled by political decisions or pressures from business.” (Urban Hospital Physician)
“There was so much angst and anger and upset about that because people so desperately wanted to get the vaccine and didn't have trust that getting a second dose of Moderna was going to be safe and effective and allow them to travel.” (Regional Vaccine Clinic Manager)
“I've struggled with just being in my profession now because I've always prided myself on being a resource for people. It took me many, many months to not feel anxious because of all those changes. I just felt, ‘What if I say the wrong thing?’ or ‘Am I going to catch up?’ You can barely catch a thought before the phone rings again.” (Rural Community Pharmacist)
“It added so much stress because patients were calling, and pharmacy teams didn't have answers. It fractured the relationship and the trust, especially in an environment that was already so confusing and stressful and layered with this information and personal beliefs.” (Pharmacy Association Advocate)
“Our patient population has been extremely appreciative of the messaging and timely response, of doing what we’ve been able to do to get them vaccinated as soon as possible.” (Nurse Practitioner)
Policy changes had unintended negative consequences
“Every time they open up a new age group of eligibility, suddenly we have to figure out, OK, now we're going to have to open up more vaccine clinic time slots. Who's going to staff that?” (Family Physician & Hospitalist)
“It can look a lot like nobody knows what they're talking about. Last week they said it was like this, and now they're saying it's like that. It’s unsettling for people and shook their confidence.” (Family Physician & Hospitalist).
“At times, we look like we don't know what we're doing, whether that's between the policies being too complicated or not communicated with enough time, or not flowing the way they're intended to flow. We look foolish, and we’re disappointing people. That has a negative impact on how they perceive us….It’s frustrating. Then, you get frustration from the patients. Yes, I got yelled at” (Community Pharmacist)
“We did have…some anger or pushback when the dose intervals changed. The way the province regulates dose intervals for the Indigenous community - they had Urban Indigenous and Rural Indigenous. They changed the dose interval at one point just for Urban Indigenous… three weeks later, the provincial guidance changed, so we had to rework all of our clinics.” (Vaccine Clinic Lead).“The changing messaging and community not understanding why decisions were made in the first place…that caused a lot of confusion and potentially mistrust.” (Public Health Community Outreach Worker).
“It’s still a choice in Canada. If it as ever law they would get vaccinated but when it's their choice, they would feel that it's coming from government and they would be quite hesitant.” (Community Care Manager)
“Hospitals are restricting unvaccinated visitors from coming in, but our government isn't giving any directive in senior-living. We’re required to still let unvaccinated visitors come in.” (Long-term Care Home Manager)“There are ones who are saying ‘I’m not convinced, if I play into it then I’m just adding to the problem of government control” (Non-profit Health Communications Expert)“In unionized environments, the unions were like ‘No! You can’t do that as an employer!’” (Urban Physician)
“A year ago, we were all gung-ho because we were going to be able to be vaccinated and then everything would be fine again. That hasn't been the outcome at all.” (Community Group Coordinator)
“A lot of people became vaccine negative because they felt like the vaccine no longer provided them with what they thought it was going to. They felt tricked or something like that. I even got this from vaccinated people when I was talking to them.” (Community Outreach Worker)“They are now going to be more mistrustful of other types of vaccines. Just because of how much a part of their political and social identity has become marked by their stance on COVID vaccination or their objection to being coerced into getting this vaccine.” (Family Physician & Hospitalist)