Development of mHealth-based motivational interviewing intervention to address COVID-19 vaccine hesitancy in rural Oklahoma adults

Development of mHealth-based Motivational Interviewing Intervention to Address COVID-19 Vaccine Hesitancy in Rural Oklahoma Adults Purpose: The purpose of this study was to identify perceptions of the COVID-19 vaccine and mHealth platforms among key stakeholders and/or community members in rural Oklahoma counties for development of a Motivational Interviewing (MI) and Social Cognitive Theory (SCT)-based mHealth intervention to target vaccine hesitancy in rural adults. Methods: This qualitative study used the broad community model to recruit individuals from counties in Oklahoma with low rates of vaccination using snowball sampling via collaboration with Oklahoma State University Cooperative Extension and Center for Rural Health. Participants completed semi-structured interviews, which were transcribed verbatim and coded using deductive content analysis to classify perceptions into barriers and facilitators. Coding matrices were used to match perceptions with complementary SCT constructs and MI components. Results: Sixteen interviews were completed with representatives of 13 counties. The majority (87.5%) of respondents were women, ranging from 20-85 years of age (mean: 51.1 years). Salient barriers to vaccination included perceived COVID-19 severity/susceptibility, information inconsistency, desired autonomy, side effect concerns, and conspiratorial thinking (e.g., “…the community thinks that COVID’s been here for years and somebody just decided to release it on the people.”). Salient facilitators include protecting loved ones and general vaccine information (e.g., “…if people had access to information about vaccines and more in-depth opportunities to learn about it, that would have helped.”). Salient barriers to mHealth usage included internet access, community unfamiliar with technology, and age range (e.g. “They're just not changing with the generation, to be honest”). Salient facilitators included necessity, convenience, and quick/easy access (e.g. “If it was user friendly, I'm sure a lot of people would use it”). Intervention messages were developed utilizing SCT constructs and MI components in relation to barriers and facilitators for future implementation into a mHealth platform. Conclusion: This study documents barriers to and facilitators of obtaining that COVID-19 vaccine that provide critical information for development of an mHealth intervention targeting vaccine hesitancy. Perspectives shared are highly compatible with MI and SCT, thus these can serve as frameworks for intervention content and delivery.