Determinants of Influenza Vaccine Uptake Among Rural Populations in a Southeastern U.S. State

Influenza is a significant global healthcare problem. Despite the availability of influenza vaccines, vaccination rates remain low, particularly among rural populations. This study aims to investigate the impact of trust and demographic factors on influenza vaccination status among rural populations.

Cross-sectional data were collected as a subgroup analysis of rural populations within a parent study assessing Coronavirus Disease 2019 (COVID-19) vaccination uptake among residents in the state of Alabama, U.S.A. Participants were at least 18 years old and recruited from a Qualtrics panel. Rurality (non-metro) was determined using the United States Rural-urban Commuting Area (RUCA) Codes of 4-10. Data were analyzed using a weighted sample to adjust for differences in sex and race distributions.

A little over one-third (37.8%) of the participants reported having received influenza vaccine in the 2023-2024 flu season. Less than half (48.4%) reported they previously received COVID-19 vaccines, and a greater percentage (54.5%) of them had a high understanding of health information. The multivariable logistic regression analysis indicated that prior COVID-19 vaccination, political affiliation, household income and trust in doctors' communication competency were significantly associated (p < 0.05) with greater influenza vaccine uptake.

Improving influenza vaccine uptake in underserved rural communities requires strengthening trust in healthcare providers, addressing access barriers and enhancing communication strategies that reflect sociopolitical influences on vaccination behavior.