Long before experimental psychology, religious writers, orators, and playwrights described examples of lie detection based on the verbal content of statements. Legal scholars collected evidence from individual cases and systematized them as “rules of evidence”. Some of these resemble content cues used in contemporary research, while others point to working hypotheses worth exploring. To examine their potential validity, we re-analyzed data from a quasi-experimental study of 95 perjury cases. The outcomes support the fruitfulness of this approach. Travelling back in time searching for testable ideas about content cues to truth and deception may be worthwhile. She lived in Babylon and was married to Joacim, a rich man. Every afternoon, she used to walk in her husband’s garden. One day, during her walk, Susanna sent her maids away and asked them to shut the garden’s doors because she wanted to bath. Unbeknownst to her, she was being spied by two lecherous old men who felt lust for her. The two elders approached her and blackmailed her to have sex with them. If she refused, they would declare they witnessed her committing adultery with a young man--which would explain why she sent her maids away. She refused and screamed, and the servants of the house rushed in after hearing her screams. The two elders accused Susanna of adultery, and the next day she was sentenced to death. But she prayed to God, and God illuminated young Daniel, who decided to question each elder separately. Daniel asked the first old man under which tree he had seen Susanna meeting her lover, and the old man replied: “Under a mastic tree.” Then Daniel asked the same question to the other old man, who replied: “Under a holm oak.” Since the two men had given different answers, it became apparent to the people that their accusation against Susanna was false. Susanna was exonerated, and the two wicked elders were put to death.Susanna and the elders. We encourage the reader to read the English translation of the more detailed version in the Apocrypha Book of Susanna (https://t.ly/dKUZ).This is a summary of the biblical tale of It is our tenet in this paper that century-old, or even Millenia-old writings like the tale of Susanna are good sources of inspiration for researchers seeking for deception cues. Ideas in such writings can be related to contemporary theories and transformed into formal hypotheses to be empirically tested with the methods of modern experimental psychology. Here we show how some cues examined by contemporary deception researchers resemble ideas expressed long ago by past writers, historians, and legal scholars, and we encourage researchers to scrutinize sources of these kinds in their search for promising “new” cues to deceit. We also offer examples of ideas that later turned out to be cul-de-sacs. At the end, we present a re-analysis of data of a legal doctoral thesis  that not2.2.1.Although we focus on detection of deception, in any given case errors of witnesses or suspects must also be considered as an alternative hypothesis to account for untrue statements e.g., . The dis2.2.In the 1st century AD, Roman orator and lawyerSender inconsistencies have been tested as a potential deception indicator in modern research. They do not seem to be strongly related to truthfulness, as results have been inconsistent across studies and are under the influence of several moderator variables consistency with the detector’s prior knowledge, which has been shown to be one of the cues that successfully reveal deception in real-life settings  or again in the mouth of someone whose interests are identical with ours (for he will not contradict)” (p. 32) and further recommended that “We must remember only to invent such things as cannot be checked by evidence” (p. 32). From contemporary research on 2.3.Hamlet (1603), Prince Hamlet suspects that his father, the king, was murdered by Claudius, Hamlet’s uncle, who immediately married Hamlet’s mother, queen Gertrude. To verify his suspicion, Hamlet asks actors to stage a play, The Murder of Gonzago. The play features a death similar to the death of Hamlet’s father. Hamlet pretends to observe Claudius’s reactions to the play to determine whether he murdered his father. While Hamlet, Claudius, Gertrude, and others are watching the play, the Player Queen enthusiastically declares that if her husband dies, she will never marry again. At this point, Hamlet asks her mother: “Madam, how like you this play?,” and she replies: “The lady doth protest too much, methinks” .In William Shakespeare’s play Hamlet, the possibility of remarriage in case of death of the husband).Note that in Shakespeare’s times, the main meaning of “protest” was “vow” or “declare solemnly” . To undeEmphasizing one’s truthfulness should make us suspicious to dig more deeply and ask related probing questions. Of course, this is only a hypothesis to be tested empirically. It does not imply that simple linguistic markers like “never” would be a valid means to differentiate lies from truth . This ex2.4.The liar, similar to La verdad sospechosa, the ever-increasing complexity of lie construction is beautifully described. Lelio, always eager to please young women and to gain financial advantages, from moment to moment continuously invents new lies for his benefits to ward off questions raised by his encounters. Toward the end, the web of lies has become so complex that it can no longer be upheld and collapses.In peu a peu, confronting them with this information to test for their veracity by examining whether they show contradictions.Some of these notions have been considered by current deception researchers. To uphold complex lies requires “a good memory” (Quintilianus), an ancient idea that reemerges in many writings e.g., . Lacking3.Ways to assess credibility were suggested not only by ancient religious writers, orators, and playwrights, but specifically also by legal scholars and judges, who summarized their experiences from extensive casework. Their contributions demonstrate that the content-oriented approach to veracity assessment has been used throughout history. In his doctoral dissertation, Hans-Udo Bender provided a detailed review of some of these early contributions, emphasizing in particular the legal procedural writings by Mittermaier’s recommendations were formulated in the bloomy legal language of his time, with some sentences over half a page long and difficult to understand, let alone translate. He distanced himself from prejudices toward certain religious groups, or toward women, whom he considered “capable to observe as reliably and accurately as men” (p. 345). More pertinent for us are Mittermaier’s recommendations regarding content aspects of statements. We first list a series of quotes and afterwards discuss their implications for contemporary theorizing and research using today’s terminology. Perhaps most importantly, smallest side details of an event, than a witness, who is unable to say anything about many circumstances, and hence demonstrates that his observation is incomplete and superficial.” .“... that we believe more a person who can provide the or in the afternoon, we should be suspicious. But if the witness erred whether he saw him alive at 7:00 h or 7:30 h am, this may simply be due to forgetting (p. 351).Mittermaier further addressed the question of certainty (confidence) regarding side details (pp. 351–352) and their importance for the evaluation of testimony. Certainty becomes particularly important if it concerns a “side detail that is later declared to be incorrect” (pp. 351–352). If a witness had stated this detail with “utmost certainty,” this becomes much more relevant than if the witness only “believed” the circumstance in question (p. 352).“... side details ... must among themselves be reasonably connected to each other...,” “... in line with her/his individuality,” “and with the circumstances at the time of observation” (p. 349).wahrscheinlich) and ... in accordance with common laws of nature” (p. 349).“The statement of a witness should be probable , Mittermaier also recommended judges.“... to inspect the scene of crime and/or to get help from experts” (p. 349).Handbook for investigating judges  Is certainty regarding central vs. peripheral details related to their respective accuracies? An eyewitness study about a filmed event indicated that both accuracy and confidence covaried with the centrality of the details as well as the question format . We enco3.4.From a modern perspective, knowledge about the personality of the witness (or suspect) has to be considered in two different ways. First, because it can influence the way the person communicates. Thus, today, court experts on Statement Validity Assessment emphasize that the development and personality of the witness  need to be considered to adequately assess the credibility of an individual statement . ExaminiSecond, knowledge about the interviewees’ personality can also provide information about their habits and preferences, and thus about what behaviors are plausible. Thus, in the context of assessing suspects’ honesty, researchers have suggested that a story that does not fit with the habits and preferences of the specific suspect should raise suspicion see .3.5.Taken together, some of the strategies Mittermaier described have in recent years been tested in We now turn to a study of court cases testing some of these ideas.4.Hans-Udo Bender’s (1987) study is a clear example of the approach we are defending here. Not only did he summarize Mittermaier’s ideas, but also other legal writings on the content of statements e.g., . But H.-As shown in Abmagerung], Inconstancy/Stereotypicality) or taken from viz. Exaggeration of Truthfulness and Freudian Slips.Importantly, H.-U. Bender also included “fantasy signals” whose presence were to be interpreted as lie criteria  in the form of a diagnosticity ratio. For reality criteria, diagnosticity equals the percentage of true accounts with the criterion present divided by the percentage of lies with the criterion present. For fantasy signals (lie criteria), diagnosticity equals the percentage of lies with the criterion present divided by the percentage of true accounts with the criterion present.This emphasizes the point that a specific criterion may well be diagnostic of truth status in a given case, but may nonetheless not be very useful in the majority of cases if it is only rarely encountered in this type of case. Furthermore, Bender suggested an index for the evidentiary value of his criteria .4.1.To test the validity of his criteria, H.-U. Bender conducted an archival analysis of courtroom cases of intentional perjury that were selected to avoid issues of circular validation often present in sexual abuse allegations.H.-U. Bender’s materials were from trials in which one or several witnesses had testified to help a defendant—a relative, friend, or work colleague—not to be convicted. When judges suspected intentional perjury had occurred, they charged these witnesses. This resulted in 95 purported perjury cases for analysis, with 53 witness statements judged to be truthful (no perjury) and 42 statements leading to convictions of perjury. More than half of the cases were validated by objective evidence (like a log book of car travel times), or in many occasions by later confessions of perjury. In a few cases, contradictory statements by other witnesses and other suspicious aspects of the case also led to a conviction of perjury by the trial judges.To demonstrate at least some effort to establish inter-coder reliability, 12 statements were each coded by three experienced practitioners and by H.-U. Bender himself. Singular reality criteria in transcripts of statements were coded by marking relevant passages as “clearly present.” Bipolar criteria  were coded separately as truth and lie criteria, respectively.Although no formal statistical values for inter-coder reliability were calculated, percentages of agreement were highly satisfactory for these cases , with prevalence rates between 0.40 and 0.74. All fantasy signals were significant, with medium to large effect sizes, but some had low prevalence rates . Conversely, Abstractness and Inhomogeneity were found in 2.0% of true and 45.0% of false statements, respectively . Both combinations had diagnosticities >20.0 and good practical utilities . The criteria combinations investigated by H.-U. Bender also showed significant discrimination  and high diagnosticity values but differed in practical utility. However, these findings may be specific to the perjury cases studied and should not be overinterpreted.It is impossible to summarize the complexity of H.-U. Bender’s analyses regarding the co-occurrences of two or three criteria in true and in false statements. Also, not enough statistical details were provided for a full re-analysis of the data, nor was the sample large enough to analyze for higher-order dependencies. Nonetheless, the best example of the potential fruitfulness of this approach is the demonstrated co-occurrence of Detailedness and Homogeneity. This combination was observed in 62.5% of true and only 2.5% of false statements .inconsistency. While this point may be trivial, it has implications for coding a narrative account. Consistency concerns the whole account and hence allows only a binary coding (0 vs. 1). Inconsistencies may refer to specific parts and aspects and hence allow more differentiated, and hence more sophisticated coding of reliability consistency:- error vs. deception,- consistency with laws of nature,- consistency between people,- internal  consistency within one single statement/interview,- consistency across different statements of the same person,- consistency of statements across different members of a group (who may or may not have communicated with each other), and- consistency regarding witnesses vs. suspects.We note that within the last two decades there has been a shift in emphasis from studying deceptive statements of witnesses to finding new methods of interviewing/interrogation of suspects. While government agencies have always financed research on the latter, the events of September 11th, 2001, and the subsequent U.S. Government reactions, appear to have instigated funding for new methods to deception detection (including detection of intent). In the United States, the U.S. High-value Detainee Interrogation Group (HIG) research program is an example see , but theAny of the (in)consistencies noted above may occur in combination with any of the others, giving rise to complex higher order interactions . Results may differ across such subgroups of studies and hence comparing studies across groups may not be meaningful. This may be particularly true for content-oriented approaches.A final point we want to address is:- consistency/inconsistency with known case facts or evidence.While studies address questions about these consistencies, we need to ask ourselves who are legally entitled to address these issues in real cases. In a democracy, these decisions are reserved to the judiciary, that is judges, magistrates, or juries. To what extent are forensic experts, or (poorly trained) police officers, allowed to have access to case facts and incorporate them in their decision? In some legal systems, experts are often denied permission to testify because their testimony may invade the province of the jury. Hence, to remain impartial, they should not have access to other case facts than the specific issue to be evaluated. For example, for expert evaluations of forensic evidence like fingerprints, 5.We encourage contemporary researchers to look back in history and consider writings from different disciplines from our cultural heritage, in particular legal writings, to search for solutions to the problem of deception detection. Throughout history, error and deception were always considered as threats to the validity of the content of statements. Our review of such sources is only cursory and eclectic, but we nonetheless offer the following conclusions:(1) Some of these writings offer interesting suggestions regarding cues to deception and interrogation strategies to discover them. These suggestions can be related to contemporary theories of deception detection and reformulated into testable research hypotheses, including potential moderator variables sometimes not considered in contemporary research.(2) Our cursory review demonstrates that many ideas in the current literature may not be as original as it may first seem, and hence we recommend that terms like “We are the first to investigate...” should simply be avoided.(3) While some of the cues described, in particular nonverbal ones, are often contradicted by empirical research, the content approach appears to have been the primary successful approach throughout history, not a 20th century or last decade invention.(4) Conclusions like “The statement contained more details” are too unspecific and need to be qualified by specific types of details that may be valid only in subareas of deception detection.(5) Noteworthy, certain types of details may only be found in descriptions of the main event, others in side events. The challenge will be to find precise definitions of main and side events.(6) Nonetheless, some limitations have to be noted. Looking around the globe ignores cultural, language-specific and country-specific legal differences that we have not addressed.(7) Some of the content cues mentioned may be idiosyncratic to certain types of legal contexts that may not apply to others: statements of witnesses vs. suspects, videotaped vs. oral vs. written statements, criminal vs. civil vs. other types of legal cases .cf.Finally, comparing writings from experts in certain fields with knowledge from experimental psychological laboratory research is not novel cf.. Blair eSLS conceived this paper and re-analyzed Programa V: Difusión de Resultados de Investigación.Article processing charges are covered by Universidad de Salamanca, The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Kennedy, Buenos Aires, Argentina”, they were incorrectly attributed to Francisco Capani, but do not belong to any author.In the published article, there was an error in original affiliations 3, 4. Affiliations “The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.


Migraine is one of the top ten causes of disability worldwide. However, migraine is still underrated in society, and the quality of care for this disease is scant. Qualitative research allows for giving voice to people and understanding the impact of their disease through their experience of it. This study aims at synthesising the state of the art of qualitative studies focused on how people with migraine experience their life and pathology.via PubMed, EMBASE, CINAHL, PsycINFO, and Cochrane Library were consulted up to November 2021 for qualitative studies. Studies to be eligible had to focus on adults (age > 18 years) with a diagnosis of primary episodic or chronic migraine following the International Classification of Headache. The quality of the study was analysed using the CASP  tool. The synthesis was done through a thematic analysis. CERQual  approach was used to assess the confidence in retrieved evidence.MEDLINE Ten studies were included, counting 262 people with migraine. Our synthesis produced four main themes. (1) “Negative impact of migraine symptoms on overall life” as migraine negatively impacts people's whole life. (2) “Impact of migraine on family, work and social relationship” as migraine reduces the possibility to focus at work and interact with people. (3) “Impact of migraine on emotional health” as people with migraine experience psychological distress. (4) “Coping strategies to deal with migraine” such as keep on living one's own life, no matter the symptoms.Migraine negatively impacts people's whole life, from private to social and work sphere. People with migraine feel stigmatised as others struggle with understanding their condition. Hence, it is necessary to improve awareness among society of this disabling condition, and the quality of care of these people, tackling this disease from a social and health-policy point of view. Migraine is a primary headache characterised by a throbbing pain on one side of the head, whose aetiology cannot be found in a specific structural alteration but in a combination of genetic and environmental factors  that adopted different approaches  and data collection methods . Instead, we excluded studies in languages other than English that adopted quantitative designs such as systematic reviews, case reports, case series, and randomised-controlled trials (RCTs).We considered eligible all the studies that included adults (age > 18 years) with a diagnosis of primary episodic or chronic migraine following the criteria of the International Classification of Headache Disorders (ICHD), with or without aura,In this meta-synthesis, the focus is on people's experience of migraine. Thus, we included qualitative studies that focused on people with migraine. Instead, we excluded studies that concentrated only on caregivers or physicians.via Pubmed, EMBASE, Cochrane Library, CINAHL, and PsycINFO. Since there is no consensus about which databases should be used for meta-synthesis, we adopted the recommendations from the “Cochrane Handbook for Systematic Reviews for Interventions”  selected the studies applying the inclusion and exclusion criteria to titles and abstracts. In case of disagreement, a third author was consulted (SB). The full texts were read, and the final selection was decided through discussion by two authors (AL and SB). In addition to the inclusion and exclusion criteria, researchers evaluated the sample characteristics to include or not a study. The final purpose of this synthesis is to collect the experiences of a wide range of people with migraine, so if two studies had the same sample and similar settings, only one was included.Two authors (AL and IC) independently extracted data from each study following the Cochrane indications  tool by two authors independently (AL and IC)  approach was used to assess the certainty of findings as either high, moderate, low or very low: it included the methodological limitations, relevance, coherence, and adequacy of data  according to ICHD criteria. The overall evaluations of CASP are collected in The synthesis produced four main themes, as shown in The first theme was present in most studies . Aura did not affect all people with migraine, but it was considered one of the most disabling symptoms.“Hearing that all day would kill me”, “A stereo that someone just keeps turning the volume up in my head”, “As echoing through my head”, “As fingernails on a chalkboard” Ramsey, .“And your eyes begin to close because your whole body hurts and you feel pain when there is any kind of noise, light, anything at all”  I'm gonna have to dive off (work), and I won't be able to fulfil duties” ” … the others, after a while, got tired of me” . Psychological distress was common among participants, who suffered a lot and often presented themselves as overwhelmed by this condition . From our synthesis, four main themes were brought to the forefront: “Negative impact of migraine symptoms on overall life”; “Impact of migraine on family, work and social relationships”; “Impact of migraine on emotional health”; and “Coping strategies to deal with migraine”. Our findings are in line with the ones from the meta-synthesis of Nichols et al. on chronic headaches . The authors would like to thank the librarians from Lund University for their assistance in creating the search string for this research.


Qualitative data were collected using individual interviews to inhabitants and health professionals to describe how dog population management measures were perceived, and to identify barriers and opportunities related to their implementation (n = 37). Descriptive and inferential analysis (quantitative data) and thematic analysis  were performed. Results show that the two main measures implemented at the time of the study – dog culling and short-duration veterinary clinics – were not perceived as fully acceptable and sustainable. Reinforcing access to veterinary services and other dog-related services, such as shelters and training programs on dogs, was identified as a need to improve dog bites prevention and dog population management in remote Indigenous communities. The implementation of animal health measures should be decided by concerned Indigenous communities to follow decolonial practices. It includes ensuring informed consent of dog owners, improving communication before, during and after interventions, separating veterinary services from rehoming and, most importantly giving back to Indigenous communities the complete leadership over animal health in their communities.Globally, people living in northern Indigenous communities are at higher risk of dog bites than the rest of the population living in North America, with annual incidence ranging from 0.61 to 59.6/10,000 inhabitants. Considering that rabies is endemic in wild canid populations in certain regions of the Arctic, the prevention of dog bites and the management of dog populations are of crucial importance for public health in these contexts. Most northern communities lack access to veterinary services, mainly due to their remote geographical location and to limited financial resources. Currently, northern Indigenous communities are using different approaches and strategies to prevent dog bites and manage dog populations, but the effectiveness of these approaches sometimes lacks evidence, and their low acceptability may affect their implementation. This study aims to describe (1) the current access and uses of veterinary services, and (2) the perceived barriers and opportunities related to dog population management practices currently implemented, or that could be implemented, in a Naskapi community and an Innu community located in northern Quebec (Canada). Quantitative data were collected through a survey to inhabitants on veterinary services ( The sevDog bite incidence varies greatly depending on the local context , 9. The Dog populations in northern Indigenous communities can be challenging to define, since dogs can be kept by individual owners, or they can be considered as community dogs , feral dogs (no owners), free-roaming owned dogs or owned dogs kept home. Currently, northern Indigenous communities are using different approaches and strategies to prevent dog bites and manage dog populations, including dog population management programs , the implementation of laws and regulations to reduce the number of free roaming dogs, dog culling , as well as training programs to reduce risky behaviors –17. HoweOne major barrier to dog management is that most northern communities lack access to veterinary services, mainly due to their remote geographical location and to limited financial resources –18. WhenSometimes, communities receive short-duration animal health services from different organizations. These services can be administered by veterinary schools , 17, by This study investigates factors influencing the implementation of dog bite prevention and dog population management measures in the context of two northern Indigenous communities located in Quebec, Canada, namely Kawawachikamach (KWW) and Matimekush-Lac John (MLJ). The objectives are (1) to describe the current access and uses of veterinary services, and (2) to identify the perceived barriers and opportunities related to dog population management practices currently implemented or that could be implemented in the future.2.2.1.Six authors are non-Indigenous people living in southern regions of the province of Quebec. Four of them are veterinarians and researchers, one is a veterinarian-clinician, and one is an anthropologist researcher, all familiar with the context of dogs in northern Indigenous communities. One author is from the Naskapi community living in Kawawachikamach.2.2.Balancing Illness and Wellness at the Human-Dog Interface in Northern Canada.The study was conducted in two northern Indigenous communities located in Quebec, Canada, namely Kawawachikamach (KWW) and Matimekush-Lac John (MLJ), and one municipality, Schefferville (SCH). KWW is a Naskapi community and MLJ is an Innu community, which are separated by a 15-km road. MLJ is surrounded by the territory of SCH. They are located above the 54th parallel and can only be reached by train or plane. The research team received the approval and support of the Naskapi community of KWW, the community of MLJ and the town of SCH, as part of the larger project into which this study fits called According to the last census in 2021, the population is 641 inhabitants in KWW , 682 in 2.3.Qualitative and quantitative methods were used for this study. Quantitative data were collected through the administration of a questionnaire to assess the access to and use of veterinary services by community members. Qualitative data were collected through individual interviews to describe how the current dog population management measures were perceived, and to identify barriers and opportunities related to the implementation of future potential measures. Naskapi and Innu local coordinators from KWW and MLJ participated in the recruitment of participants and translation of questions when needed. Data were collected between May 27th and June 12th, 2019. The detailed methodology can be found in Daigle et al. , which a2.4.2.4.1.p < 0.05, with either Pearson’s Chi squared test or Fisher Exact test when the theoretical size of any cell was lower than 5. Only significant results are reported. Missing data were excluded to calculate proportions for individual variables.A questionnaire was developed and adapted from tools previously developed by the project team . The fir2.4.2.Semi-structured interviews were conducted with participants representing three categories of community members, in each locality. The three categories include adult  (1) residents who have had a dog bite (or parents of children who have had a dog bite), (2) residents who owned a dog that has bitten a person and (3) health care professionals involved in dog bite management. To recruit community members with these three profiles, we invited participants who completed the questionnaire for the first two categories, and health care professionals were invited to participate in-person when visiting the local health centers in the communities. An interview grid was developed specifically for this project in collaboration with the local coordinators of the involved communities see ], and th2.5.The interview grid and survey questionnaire were reviewed by one representative of the targeted communities and approved by band councils. Consent forms for both parts were completed or consent was given orally (in English or French) beforehand. Oral consent is an accepted alternative way to obtaining consent in a way to respect the traditional oral information transmission . Financi3.n = 38) reported having only one dog. Amongst dog owners, 30% were from KWW and 46% were from MLJ-SCH. In total, 37 inhabitants completed the interview , of which 66% self-identified as Indigenous.In total, 122 people completed the survey , of which 47 (39%) reported owning at least one dog. Most dog owners (3.1.3.1.1.Services used by dog owners are described in Veterinary services offered in the community were considered insufficient by most respondents (86%) see . Access I think if the community was willing to help with the vet fees, then maybe people would take care of them better, because it would be more of an incentive, right, they would not have to pay out of their hands, they would not have to pay out of their pockets too much money.” (ID017 – KWW).Some interviewees perceived that people would be willing to pay for veterinary services. A few interviewees mentioned that the Band council  should pay or should provide help with dog services: “3.1.2.charity] here to preserve anonymity), many interviewees spontaneously shared their perceptions on their services. Reported perceptions of these services were heterogeneous, including positive and negative experiences  This reduction was perceived as a relief: “When they came, [charity], they removed 140 strays. […] It was stressful all the time with these dogs, all the time in surveillance mode, in attack mode. Because there were males in heat everywhere. Even the children were afraid to play outside. It was dreadful. There, the children are playing outside now.”  Sterilization was perceived as a solution to improve dog behaviors, by one interviewee: “After the dogs were fixed, the females fixed and the males neutered, there were great results. […] And since, after [the operation of my dog], he is really calm, gentle, barks less, such a good change for the good. Like the other dogs around that I have seen.” .Positive aspects reported by the interviewees included a perceived reduction of the dog population size, with positive outcomes for the inhabitants: “I’m disturbed of the situation going on now after the operations and the vaccinations that they had, I find that it is worst that it was before. […] Yeah, like their attitude, their aggressiveness is worse than it was before. I mean, we are having more bite issues now than we had before.” (ID015 – KWW). Another participant mentioned in the interviews that they lost their dog during the visit of the organization: “[…] they never brought my dog back. […] they were only supposed to take dogs that did not have collars and the skinny ones. But they took all the dogs.” (ID028 – KWW). This interviewee reported that this intervention was conducted without their consent: “When [charity] came here, they took my dog […] I did not want them to. She was pregnant and they took her away. They said they would bring her back and they never brought her back and they said they were going to do… I do not know if they did [the surgery], they never brought my dog back.” (ID028 – KWW). Other interviewees were against the concept of taking dogs from northern communities for adoption in “the south.” One health care professional mentioned: “[…] organizations that pick-up dogs in the North to bring them back to the South, I am completely against that. I find that our animal shelters in the South are already overcrowded. We euthanize all the time, then we take the dogs from the North and bring them back to the South and they are not happier, because they are dogs that are genetically made to be in wide-open spaces.” . One nurse reported being concerned about the possibility of relocating rabid dogs from northern communities to southern locations: “A few years ago, there was a dog that was sent by [charity] or something that had rabies.” .However, concerns were reported by interviewees regarding the interventions of the charity. One inhabitant perceived negative impacts on dog behaviors after the clinic: “3.2.3.2.1.there are too many dogs and there is no service here about controlling the dogs or the dog’s population or whatever. That’s why [the local authority] shoot them around here.” (ID021 – KWW). The lack of acceptability of this practice was shared amongst different types of community members. As one interviewee mentioned: “But, we do, once a year, bring down the dog population and we get harsh criticism from the [dispensary] and from the outside: “What are you guys doing?” But what are you going to do if you got a child that is mauled to death […].” (ID016 – KWW) One interviewee from the community also perceived this option as unsustainable: “They do the purge and they think that’s going to fix it, but then, six months later, the same problem comes up.” (ID017 – KWW).Although interviewees often recognized that dog culling was the only option available, the lack of acceptability of this practice to control the dog population was frequently reported. Reasons supporting the use of this approach included too many free-roaming dogs or a previous dog bite event: “[…] 3.2.2.Dogs who are just roaming around all the time could be taken so […] if the owner loses the dog, they would have to go to the rescue shelter and say: “OK, that’s my dog.” And maybe, there, they can be informed.” (ID025 – KWW) Sixty percent (60%) of the survey respondents were also in favor of a dog shelter . Finally, another person suggested that dog care services during the day would help to manage dogs in the community: “[…] or it could have […] like a little dog school, a doggie day care, you know. So, if you do not have time because I work from nine to five, and sometimes, by the time I get home, I’m kind of tired.” (ID031 – KWW).Four interviewees mentioned that it would be interesting to have a system to register or identify dogs (without asking this question directly): “3.2.3.I think the more people know, the more they’ll work to be safe, make the dogs safer for the children. […] Maybe if the Nation provides training, like how to train your dogs, just to show them what basic needs they need and if there is a financial issue that they’d be willing to help pay, I guess, for a bit of dog food, just maybe a bit of the vaccines because the vaccines and neutering the dogs, it can get pricey for a family.” (ID017 – KWW).Most survey respondents from both localities were also in favor to have dog obedience training for dog owners (58%) and a training program on dog behaviors and care for children or others (60%). The importance of improving access to information and training about dogs and dog management practices was raised by many interviewees: “used Facebook a lot. Why not. Community radio. People listen to the radio a lot. Facebook and community radio […]. Because people, Indigenous people, they are very, very visual.” . However, some interviewees raised concerns about barriers that could be present with training programs. A few people perceived that inhabitants may not prioritize such training: “[people around are not well informed about the risks], not at all. I do not think they would really care if there was a presentation on that as well […]. You see, I was kind of busy, I wasn’t trying to avoid you.” (ID031 – KWW).Many interviewees reported that it would be useful to have prevention promoted in the community either through radio or social media: “[Charity] Because the kids, mostly will interact with other dogs. They’re the ones outside most of the time.” (ID025 – KWW) Targeting kids was also considered an interesting option to transfer knowledge to parents: “And then, kids get home and sometimes even like the kids bring home something from school and tell me something I did not know.” (ID025 – KWW) Health care professionals from both localities agreed unanimously that children should be taught on dog interactions and how not to trigger aggressive behaviors in dogs. A collaboration between departments of both communities would be interesting, as one nurse mentioned: “Here, in the schools, it would be very interesting to start working on [training programs], in collaboration with the Band Council, the dispensary, the city, the police, to have a good knowledge. People are not well informed about dogs, if there are bites. They know it’s dangerous, but no more than that.” . One interviewee mentioned that the consideration and symbolism of the dog could be taught through the elder’s knowledge transmission: “I think children should be taught about it. Because before, the elders said that dogs had to be respected, but this teaching seems to be going away. But it should be brought back.” .Making training available in schools for kids was suggested as part of the solution: “4.This study describes perceived barriers and opportunities to improve dog bite prevention and dog population management practices in a Naskapi, an Innu, and a settler community located in northern Quebec, Canada. Results show a lack of acceptability of current practices and a need to strengthen access to veterinary and dog-related services. Raising awareness on existing services is also necessary, given that vaccination against rabies was considered unavailable by most dog owners despite the fact that there is a vaccination program offered annually by the government , 21.The two main measures available at the time of the study – dog culling and short-duration veterinary clinics – were not perceived as fully acceptable or sustainable, which is coherent to findings from previous studies conducted in other northern Indigenous communities. In a study conducted in an Inuit village in Nunavik  in 2015, 43% of Inuit participants were against culling biting dogs . In anotRegarding short-duration veterinary services, they were perceived differently amongst participants in this study. Since permanent veterinary services are not always available in northern communities, it is frequent that remote communities only have access to occasional services , 16. OccLeishmania spp., rabies, Brucella spp., Echinococcus spp., or Leptospira spp.  . The admmeeting with mushers, dog obedience training classes, outside activities with dogs”  beforehand. Oral consent is an accepted alternative way to obtaining consent in a way to respect the traditional oral information transmission  and thisLD: study design, data collection, analysis and interpretation of data and redaction. AR and CA: study design, contribution to the data analysis and interpretation and revision of the manuscript. FL, KNM, YR, and AS: contribution to result interpretation and final revision of the manuscript. All authors contributed to the article and approved the submitted version.


Vaccine hesitancy exists on a continuum ranging between complete adherence and complete refusal due to doubts or concerns within a heterogeneous group of individuals. Despite widespread acknowledgement of the contextual factors influencing attitudes and beliefs shaping COVID-19 vaccine hesitancy, qualitative research with equity-deserving groups, accounting for unique lived experiences, remains a gap in the literature. We aim to identify and begin to understand and document the unique contextual factors shaping hesitancy by equity-deserving groups as it relates to relationships with government and health authorities.Participants were recruited and interviewed between Aug-Dec 2021. Semi-structured interviews using a convergent interviewing technique were conducted with individuals from the general population, as well as individuals who identify as First Nations, Métis, or Inuit, members of the LGBT2SQ + community, low-income Canadians, Black Canadians, and newcomers. Interviews were audio recorded and transcribed by a team of researchers. Memos were written following interviews and used to complement the thematic analysis of the interview data. Themes are presented in the results section.The rationale for hesitancy among equity-deserving groups is consistent with literature documenting hesitancy in the general population. Contextual factors surrounding equity-deserving groups’ attitudes and beliefs, however, are unique and relate to a history of oppression, discrimination, and genocide. We identified factors unique to subgroups; for example, religious or fatalistic beliefs among participant who identify as FNMI, fear associated with lack of testing and speed of vaccines’ production among participants who identify as FNMI, Black, and LGBT2SQ + , distrust of the healthcare system for LGBT2SQ + and Black Canadians, and distrust of the government and opposition to vaccine mandates for participating who identify as LGBT2SQ + , low-income, FNMI, or Black Canadian. Newcomers stood out as very trusting of the government and accepting of COVID-19 vaccination.While our data on vaccine hesitancy largely mirror concerns reported in the vast body of literature citing rationale for COVID-19 hesitancy in high-income countries, the contextual factors identified in our work point to the need for wider systemic change. Our results may be used to support efforts, beyond tailored promotion campaigns, to support the confident acceptance of vaccines for COVID-19 and the acceptance of novel vaccines as future infectious diseases emerge. Canada’s first COVID-19 case was confirmed on January 23, 2020, in Toronto, Ontario . Within COVID-19 VH in high-income countries is well documented and has been associated with a number of factors, including the absence of a recent history of influenza vaccination, lower perceived risk of contracting COVID-19, reduced fear of COVID-19 disease, lower perceived COVID-19 disease severity, absence of a chronic medical condition, belief that vaccines are not safe/effective, concerns with the speed in which COVID-19 vaccines were developed, exposure to misinformation about COVID-19, and public concerns over the safety of vaccines –12. AlteOver the last few years, the research community has generated a vast body of literature regarding COVID-19 VH as it relates to equity-deserving groups. Equity-deserving has been defined as “a group of people who, because of systemic discrimination, face barriers that prevent them from having the same access to the resources and opportunities that are available to other members of society, and that are necessary for them to attain just outcomes” . Within Despite progress made in understanding contextual factors influencing attitudes and beliefs shaping COVID-19 vaccine VH in equity-deserving groups , researcGiven that attitudes and beliefs can influence behavior, government and public health have worked to tailor public health messaging to promote vaccine uptake in diverse communities. However, as we will discuss, the unique contextual factors, as they relate to equity-deserving populations’ relationships with government and health authorities in the past, will require interventions that go beyond tailored vaccine promotion efforts. Indeed, typical promotional materials have been criticized as not addressing specific anxieties elicited by the novel vaccines , no lessThe data presented herein are part of a larger research project investigating the acceptance of COVID-19 countermeasures in Canada. Here, we specifically focus on data collected from participants who self-identified as belonging to an equity-deserving group regarding their perspectives on COVID-19 vaccination.n = 56) were conducted with individuals aged 18 + between August and December 2021. In addition to the general population (n = 19), we specifically sampled subpopulations of equity-deserving populations, including First Nations, Métis, or Inuit (n = 7), LGBT2SQ + (n = 5), low-income Canadians , Black Canadians (n = 7), and newcomers . We acknowledge that each of the subgroups is unique from one another due to differences in shared experiences, cultural beliefs, and practices, which is important given that VH is specific to groups and communities. This, however, does not mean there are no similarities across subgroups. Additionally, we acknowledge that within each of the subgroups, there is diversity across participants, and as such, we do not intend to use our findings for generalization. Participants were recruited through Leger, Canada’s largest and most representative research marketing firm, to gain representation from harder-to-reach populations. Leger recruited potential participants and provided contact information to the research team to obtain consent to participate and schedule the interviews. Participants for our sample size were collected until we reached saturation of themes  with. That's important to me.” – 25-34, Woman, FNMI7A lack of understanding of how vaccines work, which may have resulted in a perception of severe vaccine side effects, is evident by the following quote:Perceived political agendas behind vaccination campaigns were seen as shaping individuals’ by undermining the level of trust in the vaccines. Relatedly, trust in the government was seen as an influencing factor of VH, with lower trust in the government seemingly increasing VH and higher trust in the government seemingly decreasing VH. For instance, despite receiving both vaccine doses, a participant  disclosed with us the process of “(…) going back and forth because [they] don't really trust the government in a lot of things”. Their delay in receiving a vaccine demonstrates their hesitancy.Lack of autonomy;Government control, andViolation of citizens’ rights and freedoms.While most participants were vaccinated, VH was still present, with vaccine hesitant participants only getting vaccinated either because it was mandated of them or because they felt pressured by their families to do so. Among those who were against vaccine mandates, we identified the following key themes:For instance, a participant  describes the consequences of not following the mandate  as a form of “punishment”. For this participant “(…) to punish somebody for not taking something that they know is a risk to them with a hundred percent certainty that there's that possibility, it's morally and ethically wrong”. This quote illustrates the perspective that vaccine mandates run counter to freedom of choice and autonomy.“I can remember when I went to school, and the big emphasis was on positioning like a scale of rights on one side and responsibilities on the other. If you had the right, you had a responsibility. If you had a responsibility, then you should have an equal weight. But now people seem to be so focused on the right, they forget about responsibility.” – 75+, Woman, LI4In contrast, some participants acknowledged that mandates are important and necessary in some contexts, such as grocery stores, medical offices/hospitals, and the military. Responsibility for others within the community  versus personal freedoms  was also discussed in relation to vaccine mandates.Fatalistic beliefs in divine will and predeterminism;Rapid development and production of COVID-19 vaccines;Experiences with the healthcare system;Distrust of the government;Personal liberty and vaccine mandates, andSupport for government.In the section that follows, we present contextual factors surrounding equity-deserving groups’ attitudes and beliefs that are more unique to these groups, beyond those experienced across the general population. Equity-deserving groups described VH in terms of the following key themes:Fatalistic beliefs in divine will and predeterminismUnique to our participants who identified as FNMI were discussions of fatalistic beliefs in divine will/predeterminism driving hesitancy. For example, a participant  discussed COVID-19 infections as “mother nature's way of cleansing things”. For this subgroup, contextual factors such as religious beliefs or fate were identified as playing an important role in how individuals perceived the need for vaccines or how they perceived the risk of COVID-19. For example, another participant highlighted the process of actively taking action to protect oneself with vaccines, and how perhaps one should just accept one’s fate.“I've just about had it. It's like, I had to take one for pneumonia. I had to take one for the flu, had to take it because of my lungs. And I thought I just had it. Maybe my time is my time” – 55-64, Woman, FNMI6Rapid development and production of COVID-19 vaccinesRelating to risk, the lack of testing and speed of production of the vaccines was associated with doubts about their safety and efficacy across FNMI, Black Canadians and LGBT2SQ + participants.“I was a little hesitant, just because of the mRNA. I mean, they say it's been around forever. But, at the same time, I mean, I think we all should've been able to sign an informed consent that this was experimental, because, I mean, even the guy who made the mRNA said, ‘Until you've done 10 years of human trials, it's still experimental.’ I was a little worried because of that. I didn't want my son to take it.” – 35-44, Woman, FNMI4“To me, it's basically just like pharmaceutical and medical marketing, trying to push a product because they feel it's going to be effective. They don't know if it's going to be effective. They're just going off of numbers and statistics and research, and their own research.” – 35-44, Man, BC3This was identified as a prominent factor impacting the VH of equity-deserving groups. For instance, the following two quotes illustrate that individuals were worried about how fast COVID-19 vaccines were developed, leading them to question the safety of the vaccine and risk to their health and well-being:Experiences with the healthcare systemAs a consequence, one participant  shared not wanting to be “(…) the first to get a vaccine (…)”. To this same participant, “[the vaccine] was just very much in a trial phase and from [their] experience working with trials, [they] felt very uncomfortable participating in something that [they were] being tested on.”“When you identify as part of the queer the community, I think that the first thing is that there's always a little part of your brain when you're encountering a health care provider, especially someone that you're not familiar with, that they might have personal biases or they might be personally uncomfortable, for whatever reason (...) I think that's a negative because it's like an extra step or an extra barrier or an extra condition to how we access or receive by health care settings.” – 25-34, Man, LGBT2SQ+ 4The previous quotes on hesitancy due to the rapid development and production of COVID-19 vaccines also relate to the subgroups’ experiences with the healthcare system. Members of the LGBT2SQ + community, as well as Black Canadians, expressed their distrust of the healthcare system as being a key factor impacting their decision-making regarding COVID-19 vaccines. For instance, a member of the LGBT2SQ + community explained how members of their community worried they would be treated differently by the medical community.Distrust of the governmentRelatedly, a participant from the Black community  explained how “everybody's genetic makeup is different. Someone may get the vaccine and be fine. Someone may get the vaccine and be very ill from it. It's not a guarantee”. However, this participant also explained that despite this, “(…) healthcare officials would portray [COVID-19 vaccines] as a beneficial thing to do for yourself, your household, your colleagues, your society, your community”. They further explained that this stance by the healthcare officials is not adequate since “they're not you”, and thus “they can't really say what's in your best interest”. This shared perspective highlights a lack of trust in the ability of healthcare professionals to understand and advocate for the unique needs of their patients.“I have little to no trust in my government. I feel that the government is the powers that be, or, for example, Trudeau, are simply symbols of many other moving parts and many of these moving parts are self-serving. (…) And I don't believe that many of the promises and agreements that it makes and dealings that it does, are not always in the best interest of the community.” – 25-34, Woman, LGBT2SQ+ 5Distrust of the government, as it relates to COVID-19 VH, was expressed across several groups. For instance, below, an LGBT2SQ + participant discusses their perception of the government as self-serving, as opposed to serving the population and at-risk communities such as the LGBT2SQ + community.This aligns with experiences from low-income participants, where they discussed feeling misunderstood and unvalued by the government. They further expressed how the definition of being low-income alone is problematic and not representative of the diversity within this subgroup. For instance, one participant  stated that they believed that “(…) [the government] should redefine what they mean by low income”. The same participant explained that “things have changed, things have increased, prices have changed”, suggesting that perhaps the definition is fluid and must be revisited to ensure the needs of the population are being met. A greater understanding of the experiences of low-income Canadians was seen as beneficial to helping the government better serve individuals within this community and help them feel heard and valued.“I think it's just defiance. I've had it with the whole health care telling us what we have to do now. And I'm so offended. (…) When did somebody think that because they had an outbreak of something, it's okay to take away people's rights or have them forced to give some of your medical information? I don't understand why that is so acceptable now. I get it. We're in a panic. I get we are going through something bad. But we've had bad things happen before.” – 55-64, Woman, FNMI6Personal liberty and vaccine mandatesParticipants also talked about feelings of defiance. For example, a following participant , discussed their feelings towards government in relation to COVID-19 vaccine mandates:Another prominent factor associated with VH was objection to COVID-19 vaccine mandates. Black Canadians perceived this as a violation of their ability to advocate for themselves and as a barrier to Black Canadians’ own decisions. For example, one participant  shared their lack of choice in their vaccination status, sharing that they were forced to get it “so that's why [they are] going to eventually do it, but [they] would prefer not to”. They then followed this statement by stating that “it doesn't seem like [they] have much to say about it at this point”, which seems to be an expression of lack of choice.“(…) When it comes to the point that you're firing... essentially firing. They call it leave without pay, but they're basically off the job, 290 healthcare workers, healthcare workers who last year were being heroes for treating people with this and risking their lives at a guaranteed risk to combat this virus, and then a year later just to get rid of them and say, yeah, we don't value you anymore because you're not going along with our narrative, it's not good.” – 18-24, Man, LI7Vaccine mandates were also described by this subgroup as not beneficial to the general population and as a violation of the government’s responsibility to protect the population. Some low-income participants who reported being hesitant about the COVID-19 vaccine felt they had no choice in whether they received the vaccine since the alternative would be unemployment, which may suggest a form of resentful acceptance or rather, adherence without acceptance. For instance, a participant  talked about having to take “a second job to help with [their] financial situation”, however, that job “falls under that new umbrella that Doug [premier of Ontario] put out this week”, and as consequence they now “have to get vaccinated, or [they] don't work”. They went on to state their lack of choice in accepting the vaccine, “if [they] don't work, then [they] don't pay my bills”. Another participant shared their discontent with vaccine mandates, challenging the government decision to dismiss healthcare workers refusing the vaccine by stating:“So, [not receiving] the booster would be out of defiance. It's up to me. It's not up to you whether I get it. It's I don't want to put it on a piece of paper and hand it to border security going across the border. It's not right. It's not my border. (…) That's the Canadian border. It's not my border. So, I have different views on some things.” – 55-64, Woman, FNMI6Support for governmentAdditionally, and in line with earlier data regarding personal liberty as a factor driving the rejection of vaccination, the following quote shows the opinion of a participant who identified as FNMI arguing that by being in unceded territory, they are not within Canadian jurisdiction and, as such, should not have to abide by rules put in place by the government.Contrary to previous groups, newcomers stood out by being generally very trusting of the government and accepting of COVID-19 vaccination. For instance, a participant  stated “any person coming to Canada will follow everything they need to follow to come here because  want to be here. If [newcomers] had to get a vaccine, they will get it. If [newcomers] had to quarantine, they will quarantine. [Newcomers] will respect the rules.” Another participant , provided greater insight into this phenomenon, by explaining that newcomers “(…) don't want a situation where they have to get deported to their country just because of a pandemic, kind of a thing”, and how newcomers “don't want their dream of a better life to be thrown away”.“We are arriving at a new country, so in my case, I want to learn about the country, and I want to follow all the rules. So I don't know if all newcomers are the same, but if they think like I think, they are easy because they want to make the thing correctly in this new country.” – 35-44, Woman, N7Being new to Canada and being offered the opportunity to immigrate and start a new life in a new country seem to be associated with vaccine acceptance, seemingly arising from feelings of both gratitude and fear of deportation, as demonstrated in the quote below:This study aimed to investigate contextual factors contributing to COVID-19 VH across equity-deserving populations in Canada. Our findings speak to the nature of COVID-19 hesitancy, as observed during pre-pandemic vaccine campaigns and during the early stages of vaccine availability. In many ways data are consistent with the existing literature on COVID-19 vaccine hesitancy , 37–40. Participants identifying as FNMI discussed topics relating to themes of fatalistic beliefs in divine will/predeterminism as reasons not to accept the COVID-19 vaccine. Without expertise in this area, we suggest further research that engages FNMI communities to better understand and work to support vaccine acceptance in a manner that respects and accounts for these beliefs as a next step forward. Data also points to the importance of taking action to acknowledge and respond to feelings of defiance toward government mandates in association with VH. Historical experiences of oppression and cultural genocide across generations of FNMI communities may be exacerbated by the Government of Canada still failing to meet the needs of Indigenous People, as they experience barriers to adequate health care, healthy food, clean water supply, and experience issues such as overcrowded housing, homelessness, and high levels of incarceration . RelatedContextual factors for the LGBT2SQ + community: themes of perceptions relating to experimental vaccines and vaccine safety, as history of medical harm and distrust of the healthcare system Participants that identified as LGBT2SQ + also expressed concerns regarding the lack of testing of COVID-19 vaccines and low trust in government. As with FMNI, these are commonly cited concerns regarding the COVID-19 vaccine, but the rationale for these concerns may be rooted in experiences of systemic oppression leading to a lack of trust and VH . For exaBlack participants in our research cited concerns regarding COVID-19 that largely reflect those of the general population, namely, distrusting healthcare providers/the healthcare system, rejection of vaccine mandates, and concerns about vaccine safety. However, the contextual factors discussed provide novel insight. In relation to vaccine mandates, participants described the denial of their rights and feeling that decisions were being made for members of the Black community and hesitancy related to medical distrust. These findings have been reported elsewhere in the Canadian context  and suppLow-income individuals in this study discussed feeling misunderstood by the government, which impacted their acceptance of the COVID-19 vaccines. Participants justified these feelings by sharing how they believe that those in power, namely, political leaders, have not experienced some of what the low-income community has experienced, creating a sense of disconnect between the two. Some of the distrust in authority and concerns of conflict of interest in this subgroup may arise from failures in a formal representative democracy of low-income individuals, which leads to situations where wealthy peoples’ opinions carry more weight than the opinions of the poor . RepreseLow-income participants also cited concerns regarding the lack of prioritization of employment over vaccination status. The threat of unemployment is more salient for low-income individuals, since low-income individuals often do not have a safety net and experience barriers in access to quality food, hosing care, and safety, as well as experience financial stress and poor mental health and more often engage in risky behaviors . In the Newcomer participants were found to be generally accepting of the COVID-19 vaccine, a finding that is inconsistent with research suggesting that the odds of VH among immigrants in Canada are approximately two times greater than their Canadian‐born counterparts . It is pUnderlying our themes and impacting the level of acceptance of novel vaccines across groups, appears to be an issue of eroding trust, particularly trust towards the government and public health. Previous research has found trust to be a critical factor impacting vaccine decision making, and thus VH , 56. HowOur findings suggest that governments must work with equity-deserving groups to address vaccine-related anxieties and worries by acknowledging and responding to their needs. This approach may take different forms and will vary depending on the target population. While we did not co-develop our work with affected communities and acknowledge this as a limitation, our findings provide a foundation upon which to engage with communities and develop human-centered design strategies, such as co-creation, co-design, and co-production efforts, focused on VH across equity-deserving groups . For exaWhen collecting demographic data for participants involved in the study, level of education was not considered, despite being a key influencing factor of VH. While some sources interchangeably use education or level of income as a good indicator of SES, it is possible that data on low levels of education could have provided further insight into some of the themes presented. Political affiliation as a participant characteristic has also been suggested to be a strong influencing factor related to VH and should be a consideration in research investigating the acceptance of novel vaccines in the future. Our recruitment via Leger precluded us from obtaining perspectives of equity-deserving groups marginalized based on language (non-English or French speaking), those with the inability to be recruited or participate due to literacy or access to technology or from indigenous peoples living on reserve. Lastly, we were not able to ensure congruence between interviewer and interviewee for all subgroups of focus. We acknowledge this is the limitation in both the collection, analysis, and interpretation of data. Our team will prioritize representation of marginalised populations, who understand the unique contexts of these communities in Canada, in future research.before we can expect attitudes and behaviours to change. Government and health officials might act on these findings by working with communities to co-design/co-produce efforts to address VH; going beyond simply tailoring promotional campaigns. As we “exit” the COVID-19 pandemic and see the emergence of novel infectious diseases and related vaccines, hesitancy in equity-deserving groups should continue to be a priority for public health across Canada. We focus here on historical and political factors that are and should continue to be redressed to promote the confident acceptance of health promotion efforts now and moving forward.VH is complex and multifaceted. This study highlights demographic and contextual factors associated with COVID-19 VH that are unique to equity-deserving groups within Canada. While the data regarding hesitancy largely mirror concerns reported in the vast body of literature citing rationale for COVID-19 hesitancy in high-income countries, the contextual factors related to historic and ongoing oppression point to the need for wider systemic change, over or in conjunction with tailored promotional materials. Herein, we identified novel themes – e.g., fatalistic beliefs in divine will/predeterminism – that demonstrate a need for greater engagement with the community to better understand and support promotion efforts that do not run counter to belief systems. Our data provide government agencies and policymakers with an overview of the contextual factors influencing VH among equity-deserving groups that relate to unmet needs that should be addressed