Informing Effective Messaging: Rural School Personnel’s Attitudes, Beliefs, & Influences Related to COVID-19 Vaccination

Abstract

High vaccination rates are imperative for safer in-person operations in schools. Rooted in Theory of Planned Behavior, and with an aim of better understanding factors associated with vaccination status, this study examined the attitudes, behavioral beliefs, and subjective norms related to COVID-19 vaccinations among vaccinated and unvaccinated school personnel. Insight into these factors is vital towards informing effective messaging.

Using a quasi-experimental, cross-sectional, mixed-methods design, a convenience sample of PreK-12 school personnel working in rural central Illinois completed a one-time, online survey. Multiple survey items were compiled to develop four composite variables: COVID-19 vaccine confidence; vaccine conspiracy beliefs; vaccine hesitancy; and COVID-19 mitigation behaviors. Binary logistic regression was employed to determine if these variables were associated with subject’s COVID-19 vaccination status. A qualitative content analysis was performed using responses to six open-ended questions, with intercoder reliability facilitated using two researchers independently coding responses.

At the time of the study, of 411 study participants, 286 received at least one COVID-19 vaccine dose and 125 were unvaccinated. The COVID-19 vaccine confidence composite variable was found to be significantly associated with subjects’ COVID-19 vaccination status (β = 9.55; 95% CI, 5.595-16.293; p ≤ .001); however, other composite scores were not statistically significantly. Odds ratio suggests that for every increase of 1 in a participant’s confidence in the COVID-19 vaccine composite score increased the likelihood of having received one dose of the vaccine by 9.55%. Qualitative content analysis revealed themes shared among both groups: 1) concerns about limited research regarding COVID-19 vaccine safety and efficacy; 2) personal and social benefits of vaccination, including helping those most vulnerable; and 3) the importance of school-based vaccination clinics in reducing vaccination barriers in rural areas.

Messaging, delivered by local, trustworthy persons, aimed at building confidence in the benefits of COVID-19 vaccinations is essential. School-based vaccination clinics should be prioritized for increasing vaccination rates.