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Public Health

Association of Guideline Complexity With Individuals’ Ability to Determine Eligibility for COVID-19 Vaccination

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Network Open

Published Online: October 4, 2022

Research Letter

Article Information and Disclosures

E. Hanna Schurr, MPH¹;

Nicole Luisi, MS¹;

Travis Sanchez, PhD, DVM¹;

Benjamin A. Lopman, PhD¹;

Heather Bradley, PhD¹;

Patrick S. Sullivan, PhD, DVM¹;

Aaron J. Siegler, MHS, PhD¹

Author Affiliations

¹Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia

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Initial demand for COVID-19 vaccines exceeded early supply, so states created vaccine prioritization guidance. The US Centers for Disease Control and Prevention also released guidance on prioritization.¹ We assessed COVID-19 vaccine guideline complexity and the ability of individuals to identify their eligibility.

This cross-sectional population-based SARS-CoV-2 serosurvey study used a probability sample of addresses in the US from March 3 to April 21, 2021.² The survey measured demographic factors, COVID-19 vaccine eligibility criteria, and perceived eligibility for vaccination. States a priori selected for this analysis based on having greater than 75 participants were the 5 largest states by population and Georgia (Georgia was oversampled). To determine participant vaccine eligibility, vaccine prioritization guidelines of each state were extracted from government communications (eAppendix 2 in the Supplement). We used survey data to classify participants as vaccine eligible or ineligible based on survey completion date and policy effective date and applied state guidelines to participants’ reports of age, occupation, health conditions, and long-term care facility residence. Individuals were excluded if we could not determine vaccine eligibility (eg, imperfect match between survey-reported occupation and guideline occupation category) or individuals had been vaccinated. Guideline complexity was assessed by total word count and number of eligibility criteria (eAppendix 1 in the Supplement). Sensitivity, specificity, positive predictive value, and negative predictive value were used to compare self-reported perceived vaccine eligibility with correct (study-determined) vaccine eligibility (eTable in the Supplement). The association between guideline complexity and correct vaccine eligibility was determined with adjusted odds ratios (aORs), using logistic regression (SAS, version 9.4; SAS Institute) in which guideline complexity was assessed with states classified as either higher (word count >150, eligibility criteria >30) or lower (word count ≤150, eligibility criteria ≤30) complexity. Comparisons were 2-sided with significance set at α = .05. Emory University Institutional Review Board approved procedures and informed consent process. This study followed the STROBE reporting guideline.

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Article Information

Accepted for Publication: August 16, 2022.

Published: October 4, 2022. doi:10.1001/jamanetworkopen.2022.34579

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Schurr EH et al. JAMA Network Open.

Corresponding Author: Aaron J. Siegler, MHS, PhD, Department of Epidemiology, Emory University, 1518 Clifton Rd, Atlanta, GA 30322 (asiegle@emory.edu).

Author Contributions: Dr Siegler had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Schurr, Luisi, Sanchez, Lopman, Bradley, Siegler.

Acquisition, analysis, or interpretation of data: Schurr, Luisi, Sanchez, Lopman, Sullivan, Siegler.

Drafting of the manuscript: Schurr, Siegler.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Schurr, Lopman, Bradley.

Obtained funding: Lopman, Sullivan, Siegler.

Administrative, technical, or material support: Luisi, Sanchez, Sullivan, Siegler.

Supervision: Sanchez, Siegler.

Conflict of Interest Disclosures: Dr Lopman reported receiving personal fees from Epidemiological Research and Innovations LLC and Hillevax Inc outside the submitted work. Dr Sullivan reported receiving consulting fees from Gilead Sciences and the US Centers for Disease Control and Prevention, and grants from Merck outside the submitted work. Dr Siegler reported receiving grants from the National Institutes of Health and the Woodruff Foundation, paid to his institution, during the conduct of the study. No other disclosures were reported.

Funding/Support: Salesforce donated licenses and system development and the Kaiser Family Foundation provided design contributions. This study was supported by grant 3R01AI143875-02S1 from the National Institute of Allergy and Infectious Diseases (Dr Siegler).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We appreciate and acknowledge the contributions of our study participants. Mariah Valentine-Graves, MPH, Palmer Ramsay-Hipp, MPH, Radhika Prakash Asrani, MPH, and Ryan Zahn, MPH (all from Emory University), provided project management support, including participant management; they were not compensated beyond their normal salaries.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.