Devon Greyson

Background: Although overall vaccination coverage in Canada has been high, vaccine hesitancy, defined as the delay or refusal of vaccines despite availability, persists across certain population groups. While some racialized communities expressed initial hesitancy toward COVID-19 vaccination, East Asian communities, particularly those of Chinese origin, reported high vaccine uptake, underscoring complex and context-specific decision-making. This thesis examines how members of the Chinese community in Greater Vancouver experienced early pandemic public-health measures and how these experiences influenced their vaccination decision-making.Methods: This qualitative study is part of a broader project investigating sociocultural and behavioral influences on community responses to COVID-19 countermeasures in Canada. Focusing on 24 East Asian participants of Chinese origin residing in Greater Vancouver, data were collected through semi-structured interviews conducted via Zoom or telephone between June and November 2021. Data were analyzed using reflexive thematic analysis, guided by the World Health Organization’s Behavioral and Social Drivers (BeSD) framework. Ethical approval for the overarching study was obtained from the University of British Columbia Children’s and Women’s Research Ethics Board.Results: Analysis of the interviews generated three major themes: (1) impacts of COVID-19 public-health measures on physical health and daily life, (2) impacts of COVID-19 public-health measures on mental health, and (3) COVID-19 vaccination decision-making. Taken together, these themes reveal a community that adapted to rapidly shifting public-health measures and disruptions to everyday life, maintained social connection and a sense of safety amid prolonged physical restrictions, and made vaccination decisions informed by both personal and collective responsibility. Participants described how efforts to maintain normalcy during the pandemic led to mixed outcomes, as some found comfort in stronger family ties, the convenience of telehealth, and the flexibility of remote work, while others struggled with loneliness, stress, and the emotional toll of anti-Asian racism.Conclusion: The pandemic highlighted both the resilience and challenges faced by Chinese-origin residents in Greater Vancouver. Participants navigated COVID-19 restrictions with adaptability and maintained high vaccine uptake grounded in strong pro-social values. Their experiences call for public-health strategies that build on such community strengths while ensuring culturally safe, empowering, and inclusive practices.

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Background: While challenges surrounding vaccine acceptance in pregnancy were prevalent prior to the COVID-19 pandemic, this pandemic introduced a different context for pregnant people – including concerns about COVID-19 infection during pregnancy, changes to the format of perinatal care and social support, and the introduction of new vaccines. This thesis aims to examine these new influences on vaccine decision-making during pregnancy.Methods: Using data from a mixed-methods project headed by the University of British Columbia and McMaster University, this research seeks to answer the question, “How does trust influence the decision-making process of pregnant people around vaccination during pregnancy in the context of the COVID-19 pandemic?” Data from semi-structured interviews with 74 participants who gave birth in Ontario or British Columbia from May 1st, 2020 to December 1st, 2021 were analyzed. This process of reflexive thematic analysis was initially conducted with sensitizing constructs from the Theory of Reasoned Action, Theory of Planned Behaviour, and Health Belief Model but came to incorporate Maya J. Goldenberg’s “Crisis of Trust” framework following preliminary analysis.Results: With the role of trust as central to this analysis, an extended “Crisis of Trust” model was created, with three related, overlapping facets identified – trust in prenatal care providers, trust in institutions, and trust in networks. Trust in prenatal care providers was shaped by participants’ goals of alleviating their mental load, differential cultural norms influencing degrees of trust in healthcare providers, and perceived transparency of providers. Trust in institutions focused on overall trust in the government and healthcare system, trust in the goodwill of the pharmaceutical industry (or lack thereof) and perceptions of relationships between these institutions. Finally, trust in networks included social networks as a potent site of (dis)trust, lived experience forming an interpretive lens for prenatal care, and views of COVID-19 vaccines as a moral obligation or source of hope for the broader community.Conclusions: This study demonstrates that vaccine hesitancy in pregnant people extends beyond an informational problem into a deeper deficiency of trust. These insights allow for the implementation of public health policies which target these ideological conflicts to better improve vaccine acceptance.

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​Within the medical research, evidence on the risks and benefits of cannabis use in pregnancy and lactation is lacking. Information that does exist on this topic is often inconclusive or conflicting. Cannabis use is also highly stigmatized and often politicized that is a contextual component that has potentially significant effects on an individual’s information seeking and informed decision-making process. A deeper exploration of information seeking behaviour and decision-making relating to cannabis use in pregnancy and lactation can help practitioners who seek to support their patients in informed decision-making. This study asks: 1) what are the information needs of individuals considering cannabis use in pregnancy and lactation and how adequately are these needs met by existing resources, and 2) in what ways are information triangulation, or other information seeking behaviours, used to meet identified information needs? This study is a secondary analysis of data collected through phone interviews with 23 participants in 2020 and applies qualitative deductive and inductive coding that is grounded in Reflexive Thematic Analysis. Four overarching themes were developed and explored, contributing to the development of a novel information behaviour model of ‘Everyday Triangulation’ that is proposed in this thesis. Everyday Triangulation (ET) is situated within the current literature as an information behaviour that is distinct from other information behaviours and established forms of triangulation in academic research. ET is a complex information behaviour that combines several layered information behaviours in an iterative process that is performed in response to a complex information need.

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