Predicting COVID-19 Vaccination Intentions to Inform Evidence-Based Messaging for Building Vaccine Confidence Among Rural Americans

Purpose: Examine possible message topics to promote rural vaccination using psychosocial antecedents of vaccination. Design: Cross-sectional survey administered by Research America, Inc. Setting: West Virginia (WV). Sample: 756 WV adults via convenience sample (n = 370; similar to 2% response rate from online panel of similar to 20 000 WV residents), and random digit dial of landlines (n = 174; similar to 1% response rate from 18 432 numbers) and cellphones (n = 212; similar to 1% response rate from 20 486 numbers). Measures: Outcome measures included self-reported vaccination intention and behavior. Predictor measures, rooted in theories of social and behavioral science that have been found to be predictive of vaccination outcomes (i.e., Reasoned Action Approach, Extended Parallel Process Model), included perceived severity and susceptibility, negative affect, instrumental and affective attitudes, social norms, self-efficacy, response efficacy, and perceived control. Analysis: Multivariate linear regression for intention and logistic regression for behavior. Results: Intention was positively predicted by affective attitude, beta = .30, P < .05, instrumental attitude, beta = .19, P < .05, response efficacy, beta = .19, P < .05, negative affect, beta = .16, P < .05, self-efficacy, beta = .13, P < .05, and subjective norm, beta = .13, P < .05, F(10, 267) = 30.12, Adj. R-2 = .53. Vaccination status was predicted by instrumental attitude, exp(B) = 2.09, and subjective norm, exp(B) = 2.00, Pseudo R-2 = .29, log likelihood = 125.11, chi(2)(10) = 38.34, P < .05. Promising message targets were instrumental attitude, M = 3.21, SD = 1.46, and subjective norms, M = 3.76, SD = 1.71. Conclusion: COVID-19 vaccine confidence messages should address (1) positive feelings and safety perceptions, (2) vaccination's effectiveness in preventing serious COVID-19, and (3) subjective vaccination norms.