Co-Designing Effective Pediatric Vaccine Promotion Strategies: Insights From Rural Wisconsin Parents

Rural distrust in science, intensified during the COVID-19 pandemic, has led to concern about the ongoing uptake of pediatric vaccination. It is also unclear how to most effectively promote health behaviors within rural communities. This study was designed to explore how rural parents interpret vaccine promotion message components, including text, images, and sponsorships, and design their own messages to provide insights for public health. Rural-living parents in Wisconsin (n = 27) were recruited to participate in virtual, 90-minute focus groups/co-design sessions regarding vaccine promotion in which they were asked to evaluate the effectiveness of researcher-provided textual messages, images, and sponsorship and create final public service announcements (PSAs) with elements they believed would resonate with other rural parents. As the conceptual model guiding this work was the theory of planned behavior, our focus was on the interpretations and attitudes that participants brought to the task of creating PSAs and their perceptions of social norms in their community. Braun and Clarke's 6-step thematic analysis was applied to qualitative data. Participants created PSAs that affirmed active parental roles in health care and emphasized local context and "relatability." Feelings were mixed about national-level organizations. While some reported negative connotations, others recognized knowledge and competence. Participants had negative assessments of message elements that referred to rural communities as stereotypical or homogeneous. Tailoring to include local, familiar, and relatable messages, images, and sponsors that emphasize parent roles in health decision-making and the knowledge of local providers is preferred among rural parents.