Structural Barriers or Attitudinal Barriers? Finding From the First Dose Coronavirus Disease 2019 (COVID-19) Vaccine Outreach Program in Sik District of Kedah of Northern Peninsular Malaysia

Abstract Introduction Outreach program is one of the strategies to reach the underserved population besides investigating the barriers to the first dose of the COVID-19 vaccine. There is scarce information on the outcome of the COVID-19 outreach program and the reasons for missing the first dose COVID-19 vaccine among adult residents stayed in the rural Sik district. The study aimed to describe the Sik District outreach program's outcome in terms of the proportion of residents being successfully vaccinated and the reasons for missing the first dose COVID-19 vaccine at the public vaccination center. This study also determined the factor associated with structural barriers among residents who missed the first dose of the COVID-19 vaccine in the Sik District. Material and Methods This was a retrospective study on the secondary data and the data analysis was conducted between June to August 2022. The Sik District outreach program was held between October 2021 to January 2022 after a line listing of residents who missed the first dose COVID-19 vaccine was compiled. Descriptive, bivariate and logistic regression were utilized in analyzing the data. Ethical approval was obtained from the relevant authorities before conducting the study. Results A total of 486 out of 553 residents were vaccinated through this outreach program, yielding 87.6% of success rate. Most of the residents were noted to have transportation problems (52.6%), followed by vaccine hesitancy (19.8%), vaccine refusal (13.2%), and afraid of needles (8.5%). Only ten residents were successfully vaccinated out of the total 73 residents who were categorized as vaccine refusal following on-site counseling. The proportion of attitude-related barriers was 45.4%, while structural-related was 54.6%. The associated factors for structural barriers in this outreach program were being bed-bound residents, being non-citizen residents, staying away from the health care facilities, and being older age. Conclusion This outreach program increases the vaccination coverage rate despite the barriers to the underserved population. The outreach team may have no problem handling the residents with structural barriers, however, dedicated and trained staff are needed for the residents with attitudinal barriers.