Abstract

Background: Black adults are frequently portrayed as uniformly vaccine-hesitant, obscuring heterogeneity in the attitudes, beliefs, and decision-making processes that shape vaccine decisions. Methods: Guided by the socioecological and 5C frameworks, a latent profile analysis was conducted to identify distinct and meaningful profiles of vaccine decision-making among Black adults in South Central Los Angeles, a historically disinvested and medically underserved community (N = 203). Results: Three profiles emerged: Empowered and Engaged Trusters (52.0%), Unempowered and Unengaged Noncommitters (32.2%), and Empowered and Engaged Skeptics (15.8%). Subsequent analyses identified healthcare utilization, age, and voting affiliation as predictors of profile membership. Additionally, profile membership was associated with five vaccination outcomes in expected directions, with Trusters reporting higher vaccination intentions and past uptake than both Noncommitters and Skeptics. Conclusions: Study findings underscore the heterogeneity in vaccine decision-making among Black adults and offer insight into the within-group diversity in vaccine acceptance beyond hesitancy. Findings have implications for tailored interventions that maintain confidence, overcome apathy, and reduce skepticism to better promote vaccine acceptance and uptake in Black disinvested communities.

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