McKeirnan Kimberly C, Undeberg Megan R, Zelenko Skylar, Meratnia Ghazal
College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99202, USA.
Vaccines (Basel). 2024 Dec 21;12(12):1442. doi: 10.3390/vaccines12121442.
BACKGROUND/OBJECTIVES: Rural communities in the United States experience increased disparity of care for both general healthcare services and access to routine vaccines. Previous research has indicated a 40% lower vaccination rate in rural communities, as compared to urban counterparts. Having a better understanding regarding factors influencing lower vaccination rates in rural areas could help public health officials prepare for future vaccination efforts. This research sought to gather and evaluate the opinions of people who live and work in rural areas regarding barriers to COVID-19 vaccine uptake.
A semi-structured qualitative key informant interview design was utilized by researchers to gather opinions from university Extension staff in Washington State. Interview transcripts were analyzed using the Theory of Planned Behavior (ToPB) framework to evaluate COVID-19 vaccination-related intentions and motivational factors that the Extension staff observed among rural populations in their communities.
Twenty-one participants representing 34 out of the 40 Extension offices responded and were interviewed during fall 2023. Using the ToPB constructs, nine barriers were identified. Attitude-related barriers included the following: inherent social distancing in rural location negating vaccine necessity; lack of early vaccine availability in rural locales; concerns regarding ineffectiveness of the vaccine; and inadequate dissemination of vaccine information to non-English language speakers and those with limited access to technology. Subjective norm barriers included the following: perception of exclusion of rural populations' unique needs during design and implementation of vaccine mandates; exertion of social pressures on rural individuals' vaccine uptake decision; and highly visible breakdown in standard trust in core community institutions and leadership. Barriers related to loss of perceived behavioral control included vaccine mandates impacting self-perceived loss of autonomy and limitations in vaccine technology information impacting perception of vaccine safety.
By identifying barriers to vaccination in rural communities during the COVID-19 pandemic, future outreach efforts can be designed to improve intention and lead to stronger vaccination uptake.
背景/目标：美国农村社区在一般医疗服务和常规疫苗接种方面的医疗差距日益加大。先前的研究表明，与城市社区相比，农村社区的疫苗接种率要低40%。更好地了解影响农村地区疫苗接种率较低的因素，有助于公共卫生官员为未来的疫苗接种工作做好准备。本研究旨在收集和评估在农村地区生活和工作的人们对新冠疫苗接种障碍的看法。
研究人员采用半结构化定性关键知情人访谈设计，收集华盛顿州大学推广人员的意见。使用计划行为理论（ToPB）框架对访谈记录进行分析，以评估推广人员在其社区的农村人口中观察到的与新冠疫苗接种相关的意图和动机因素。
2023年秋季，来自40个推广办公室中的34个办公室的21名参与者做出回应并接受了访谈。利用ToPB结构，确定了九个障碍。与态度相关的障碍包括：农村地区固有的社交距离使疫苗接种变得不必要；农村地区早期疫苗供应不足；对疫苗有效性的担忧；以及疫苗信息没有充分传播给非英语使用者和技术获取受限的人群。主观规范障碍包括：在疫苗强制令的设计和实施过程中，认为农村人口的独特需求被忽视；社会压力对农村个人的疫苗接种决定产生影响；以及核心社区机构和领导层的标准信任出现明显崩溃。与感知行为控制丧失相关的障碍包括疫苗强制令影响自我感知的自主权丧失，以及疫苗技术信息的限制影响对疫苗安全性的认知。
通过识别新冠疫情期间农村社区的疫苗接种障碍，未来的宣传工作可以设计得更有针对性，以提高接种意愿并促进更高的疫苗接种率。
