The research team, led by Grace Taiwo Otitoju and colleagues at institutions including Texas Tech University Health Sciences Center El Paso, recruited participants through purposive, community-based sampling. Flyers with QR codes linking to an enrollment form were distributed across the University of Texas at El Paso campus and at community sites including food pantries, health fairs, and libraries. Of 55 people who registered online, 27 attended a session between July and September 2025. Eight sessions were held over Zoom, seven in English and one in Spanish, each lasting roughly 60 to 90 minutes. Sessions with three or more participants were treated as focus group discussions, while two-person sessions were analyzed as dyadic discussions within the same dataset. Participants kept their cameras off for anonymity and were identified only by pre-assigned numbers, with a virtual raise-hand feature used to manage turn-taking.

The demographic profile of the sample reflects the community it represents. Participants had a mean age of 22.5 years, and nearly 60 percent were female. A striking 81.5 percent identified as Hispanic or Latino, 80 percent were born in the United States, and participants had lived in the country for an average of nearly 20 years. Household incomes clustered in the $20,001 to $50,000 range for just over half the group, and nearly half had completed some college or a vocational degree. Self-rated health was generally positive, with more than 80 percent describing their health as good, very good, or excellent. The researchers transcribed each session, verified the transcripts against recordings, and analyzed them thematically, beginning with open coding and a codebook informed by the health belief model’s six constructs: perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy. Inductive coding allowed themes outside the model to surface.

The first major theme concerned general awareness and perception of vaccines, and here the picture was broadly favorable. Many participants framed vaccines as essential preventive tools that build immunity against serious illness, with some noting that rising disease levels made vaccination feel newly urgent. Yet perceptions were not formed in a vacuum. Participants repeatedly described vaccination as a social expectation embedded in childhood memory, school enrollment requirements, and family norms. One participant recalled that everyone had to be vaccinated to enroll in school, while another said her family always made sure the children received vaccines for everything. Institutional requirements, from high school health programs mandating tuberculosis and HPV shots to employers requiring full vaccination, functioned as powerful external drivers of uptake. At the same time, cultural conservatism within some families shaped attitudes toward specific vaccines, with one participant observing that some people believe the HPV vaccine encourages sexual activity, a concern documented in prior research on Latino communities.

The second theme mapped directly onto the health belief model’s barrier construct: cost, access, and scheduling. Participants described financial cost as a significant obstacle, and clinics that were far out of the way led some to cancel appointments altogether. Long work hours and competing responsibilities further limited attendance at both vaccination appointments and educational sessions. These structural barriers interacted with psychological ones. Concerns about side effects, particularly of COVID-19 vaccines, were prominent, with participants citing worries about long-term effects and the relative newness of the vaccines. Personal anecdotes carried considerable weight: one participant described a mother who became seriously ill after receiving the COVID-19 vaccine, an experience that fostered a cautious attitude. Such stories illustrate how individual risk perception, a core health belief model construct, is often shaped not by clinical data but by lived experience within families.

Motivations for vaccination, by contrast, were strongly communal. Participants emphasized protecting themselves and others, with several describing vaccination as a way to safeguard immunocompromised loved ones and the broader community. One participant stated a belief in protecting the community by protecting oneself, a framing that extends beyond individual benefit into social responsibility. Within the health belief model, these motivations align with perceived benefits, while school and workplace mandates operate as cues to action. But the researchers argue that community-oriented motivation suggests vaccine communication in this setting should attend to collective responsibility, not merely personal risk calculus. This finding is particularly relevant for a border community where family networks are dense and intergenerational influence is strong, and it hints at messaging strategies that emphasize protecting others rather than only oneself.

Social media emerged as a double-edged sword, and perhaps the most consequential theme for future intervention design. Participants reported frequent encounters with vaccine misinformation and disinformation online, including false claims that vaccines cause autism or kill people, and they expressed frustration that celebrities with large platforms spread such content. Yet some participants described active verification habits, checking claims with their doctors or refusing to take online posts at face value, while acknowledging that many people accept what they see without scrutiny. Notably, the same platforms that carry misinformation, Instagram and TikTok, were identified as the preferred channels for reaching young adults, with engaging formats like memes and funny videos seen as attention-grabbing. The researchers are careful to distinguish preference from credibility: reach does not guarantee trust, and effective peer advocacy should not simply reproduce vaccine messages on popular platforms but must anchor them to credible information from healthcare professionals.

Peer influence itself proved mixed but meaningful. Participants described peer experiences as often the first point of contact for vaccine information, and said that a friend’s good experience with vaccination would encourage them to get vaccinated. Peers were seen as most persuasive when they were relatable or medically knowledgeable. This finding underpins the study’s central practical goal: informing a peer advocacy education curriculum that prepares teens and young adults to promote vaccine confidence in their own networks. Encouragingly, participants expressed substantial willingness to participate in peer-led advocacy, particularly when initiatives were accessible, incentivized, and supported by relatable peers and health professionals. They favored interactive formats such as campus events with food, free vaccine tables at health fairs, and one-on-one conversations that allow people to ask questions without embarrassment. One participant captured the underlying logic succinctly: people are more inclined to listen to those they have things in common with.

Interest in advocacy training was similarly strong, with clear preferences for format. Participants wanted short, hands-on, visually engaging sessions, suggesting time limits ranging from 30 minutes to an hour, and requesting practical tools such as charts of vaccine schedules by age, interactive activities, humor, and the presence of a health professional to answer questions. Scheduling flexibility was flagged as essential, since long work hours were a barrier to attendance, and participants recommended multiple sessions to accommodate different routines. These preferences will shape a proposed curriculum emphasizing 30-to-45-minute modules, visual and role-play activities, bilingual delivery in English and Spanish, digital information literacy training, strategies for responding to common vaccine myths, and culturally sensitive communication with family and peers. The researchers stress that these components remain proposals that must be evaluated in subsequent implementation research before any conclusions about effectiveness can be drawn.

The study’s limitations are acknowledged candidly. The sample was small and drawn from a single county, some sessions included only two participants because registered individuals failed to attend, and recruitment through QR-code flyers at university and community settings may have attracted a self-selected group already inclined toward health engagement. Most sessions were conducted in English despite the bilingual context of the border region. The researchers describe their findings as evidence of thematic adequacy rather than claiming full saturation within each focus group, and they caution that expressed willingness to advocate does not prove that young adults across the broader community would sustain participation. Still, the formative value is considerable. The study demonstrates that the health belief model remains a useful lens for interpreting perceived benefits, barriers, risk appraisal, and cues to action, but that family expectations, peer dynamics, and social media ecosystems must be built into any intervention from the start. In a community where vaccination generates billions of dollars in net economic benefit nationally yet hesitancy persists, equipping trusted young voices with accurate information, professional backup, and practical communication skills may be one of the most promising paths forward.

Subject of Research: Vaccine perceptions, barriers, and peer advocacy among young adults in an underserved US-Mexico border community

Article Title: Applying the health belief model to understand vaccine perceptions, barriers, and motivators and peer influence in an underserved community: A qualitative study

Article References: Otitoju, G. T., Hernandez, A., Sudanagunta, S., Sanchez, K., Dadha, P., & Molokwu, J. (2026). Applying the health belief model to understand vaccine perceptions, barriers, and motivators and peer influence in an underserved community: A qualitative study. Public Health in Practice, 12, Article 100864. https://doi.org/10.1016/j.puhip.2026.100864

Image Credits: AI Generated

DOI: 10.1016/j.puhip.2026.100864

Keywords: vaccine hesitancy, health belief model, peer advocacy, El Paso, young adults, qualitative research, Hispanic community, social media misinformation, HPV vaccine, COVID-19 vaccines, public health, US-Mexico border