Understanding Vaccine Information Needs and Message Preferences for a Tailored mHealth Intervention

Vaccine hesitancy contributes to under-vaccination and recurring outbreaks of vaccine-preventable diseases in the United States. Rates are particularly low in rural areas. This qualitative study identified informational needs, trust in health information sources, and preferences for vaccine-related messaging to inform the design of a mobile application tailored to improve vaccine confidence and deliberative decision-making among rural caregivers.

Parents or caregivers of children aged newborn to 3 years from Montana and Nebraska were recruited based on their level of childhood vaccination hesitancy using the Parent Attitudes About Childhood Vaccines (PACV) scale. Overall, 32 caregivers (18 fromF Montana, 14 from Nebraska), grouped by low (31%), medium (19%), and high (44%) hesitancy, participated in focus groups and follow-up individual interviews. Consensus coding and thematic analysis using NVivo software was used to identify key themes and patterns.

Participants expressed key informational gaps, including questions about how vaccines work, safety testing, and the rigidity of immunization schedules. Gain-framed messages emphasizing benefits were consistently preferred over loss-framed messages, which were often perceived as judgmental or manipulative. Trust in local healthcare providers was a critical determinant of vaccine acceptance, surpassing trust in national health organizations. Participants advocated for non-judgmental, interactive, and personalized communication tools that mimic the relational trust found in provider interactions.

Findings support vaccination communication strategies that integrate trusted local messengers, transparent and empowering framing, and participatory engagement. Insights directly inform the design of a parent-facing mHealth application customized according to preferences elicited from our diverse participant stakeholders.