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NRHA survey seeks to understand rural COVID-19 vaccine hesitancy

It has been nearly three years since COVID-19 first upended life and health care as we know it. Since then, many rural health care providers and stakeholders – including the National Rural Health Association – have strongly encouraged vaccination as the best way to prevent serious illness, hospitalization, and death from the virus – but in rural communities, vaccine confidence and demand remain serious and deadly concerns. Data from Centers for Disease Control and Prevention (CDC) show that unvaccinated adults are significantly more likely to be hospitalized for COVID-19, and cases in vaccinated individuals are typically less severe.

In February and August of 2022, NRHA’s program services team partnered with global research company Morning Consult to better understand beliefs about COVID-19 vaccines in rural communities. Developed with support from CDC and in collaboration with the Federal Office of Rural Health Policy as a component of the Rural COVID-19 Vaccine Education and Communications Campaign, each survey asked approximately 1,900 rural adults, parents, and teenagers about their views on the COVID-19 vaccine and barriers to vaccine or booster uptake. The results offer important insight into rural attitudes about vaccination, as well as how rural residents receive health care information and their most trusted sources. Some topline takeaways have been published here:

View full initial survey results (published March 2022)

View full follow-up survey results (published Sept. 2022)
  • In many people’s minds, COVID-19 is becoming a constant presence much like the common cold or flu. Seventy-eight percent of vaccinated rural adults think COVID-19 is here to stay, along with 58 percent of unvaccinated rural adults.
  • Despite the acknowledgment that the virus is here to stay, vaccination rates have remained stable since February, with 63 percent of rural adults reporting at least partial vaccination for COVID-19. 
  • Most rural adults have had some type of personal experience with COVID-19. Three out of four rural adults know someone who has had COVID-19 (76 percent), and two out of five have had COVID-19 themselves (38 percent) – the latter representing a 15-percentage point increase from February. A majority experienced only mild symptoms and say their experience did not impact their intent to get vaccinated.
  • Concern about serious adverse effects from the COVID-19 vaccine remains a major factor in rural vaccine demand, with 83 percent of persuadable unvaccinated adults citing this as a barrier – though 66 percent report they do not actually know someone who has suffered adverse effects. In this survey, unvaccinated respondents were considered “persuadable” if they indicated that they may be open to vaccination in the future.
  • Similar to February, a child’s reported vaccination status typically aligns with a parent’s reported vaccination status: Three-quarters of vaccinated rural parents say they have vaccinated their eligible child(ren) at least partially (51 percent), compared to 7 percent of unvaccinated rural parents who say the same. Sixty percent of unvaccinated parents say they have no plans to have their child(ren) vaccinated in the future.
  • Compared to February, unvaccinated rural parents are less trusting of various information sources and less confident in the COVID-19 vaccine and health agencies. Unvaccinated rural teens also have less confidence in health agencies compared to February.
  • Thirty-six percent of persuadable unvaccinated adults are overwhelmed by the amount information and misinformation available – but the most trusted source for health care information remains health care providers. Seventy-seven percent of rural adults, 64 percent of rural parents, and 68 percent of rural teens cited their personal health care providers as trusted sources for COVID-19 vaccine facts.

To help rural health care providers, community leaders, and other stakeholders communicate COVID-19 vaccine safety and efficacy in their own words at the local level, NRHA has partnered with Legato Healthcare Marketing to develop the Rural Vaccine Confidence Initiative. With magazine ads, posters, fliers, videos, social media posts, and many other customizable print and digital materials, this robust toolkit helps rural residents steer clear of confusing misinformation and gain the real COVID-19 vaccine facts from their most trusted source: their health care provider. Learn more at RuralHealth.US/vaccine.

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