Rural COVID-19 Vaccine Decision-Making: A Qualitative Meta-Synthesis

Area of Science:

• Public Health
• Sociology
• Health Communication

Background:

• COVID-19 vaccine decision-making is complex, particularly in rural U.S. populations.
• Understanding the multifaceted influences on these decisions is crucial for public health strategies.

Purpose of the Study:

• To develop a theoretical framework contextualizing COVID-19 vaccine decision-making among rural U.S. individuals.
• To describe the cognitive, social, and structural influences on these decisions.

Main Methods:

• Qualitative meta-synthesis using thematic synthesis and diagramming.
• Searches across major databases (PubMed, Scopus, CINAHL) and grey literature (Jan 2020-Sep 2024).
• Analysis of 21 selected qualitative and mixed-methods studies focusing on U.S. rural adults and COVID-19 vaccines.

Main Results:

• Seven interrelated themes emerged: Information, Beliefs, Trust, Feelings, Institutional, Community, and Culture.
• Key influences include communication quality, media, institutional trust, social relationships, and cultural values.
• Rural-specific barriers like limited health literacy, isolation, and misinformation significantly shaped decisions.

Conclusions:

• A nuanced, rural-contextualized theoretical framework emphasizes the interplay of information, trust, and social determinants in vaccine decisions.
• Vaccine decisions are dynamic, influenced by evolving trust and information landscapes within complex sociocultural contexts.
• The framework provides insights for tailored interventions to improve vaccine hesitancy and health equity in rural communities.