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

This qualitative meta-synthesis (QMS) aimed to develop a theoretical framework to contextualise the COVID-19 vaccine decision-making processes among rural U.S. individuals, describing complex cognitive, social, and structural influences.

Qualitative meta-synthesis utilising thematic synthesis and diagramming methods.

Searches conducted across PubMed, Scopus, CINAHL, and grey literature databases between January 2020 and September 2024 identified relevant qualitative and mixed-methods studies.

Studies were screened against inclusion criteria: qualitative or mixed-methods design, U.S. rural adult populations, COVID-19 vaccine focus, and publication after January 2020. Twenty-one studies were selected, data extracted, coded, and analysed thematically to create a conceptual model. Quality appraisal was performed using the Critical Appraisal Skills Programme checklist.

Analysis yielded seven interrelated themes-Information, Beliefs, Trust, Feelings, Institutional, Community, and Culture-with 24 subthemes, highlighting dynamic interactions influencing vaccine decisions. Central factors included communication quality, media influence, institutional trust, social relationships, and cultural values. Decisions were temporal, iterative, and sensitive to evolving information and trust dynamics. Rural-specific barriers such as limited health literacy, systemic inequities, geographic isolation, and misinformation significantly shaped vaccine decisions.

This qualitative meta-synthesis provides a nuanced, rural-contextualised theoretical framework emphasising the interplay between information, trust, and social determinants in COVID-19 vaccine decision-making. Vaccine decisions among rural populations are embedded in complex sociocultural and structural contexts, evolving temporally with shifting trust and information landscapes.

The developed framework offers actionable insights to inform tailored public health interventions and policy strategies targeting vaccine hesitancy. Enhancing health literacy, leveraging trusted local communicators, ensuring transparency, and addressing structural inequities can effectively improve vaccine uptake and promote equitable health outcomes in rural communities.

The synthesis incorporates perspectives directly from rural community members, reflecting their lived experiences and contextual realities in vaccine decision-making processes.