Barriers and facilitating factors for COVID-19 vaccination in rural appalachia

Since the onset of the pandemic, COVID-19 mortality has disproportionately impacted populations impacted by health inequities. This study aimed to identify the barriers and facilitators to COVID-19 vaccination uptake in Appalachian Kentucky as a first step to developing vaccination interventions. Key informant interviews were conducted with 36 community leaders in 14 Appalachian Kentucky counties from January-June 2023. Interviews focused on leaders' perspectives about their community's COVID-19 experiences, community impacts of the pandemic, and vaccine facilitators and barriers in their communities. Iterative inductive-deductive coding was used to characterize responses. There were barriers and facilitators at multiple levels of the socioecological model. For example, individual barriers included distrust of federal government and diminished perceived risk, and interpersonal barriers included anti-vaccination norms. Community barriers included logistical challenges, as well anti-vaccination messages from healthcare providers. Perceived politicization of the vaccine and frequent changes to recommendations during the pandemic presented policy-level barriers. Facilitating factors included pro-vaccine messages from trusted community leaders, beliefs about reducing risk for others, and cues to action such as community events. The challenges to and opportunities for improving COVID-19 vaccination uptake identified here can inform vaccination education, distribution, and policy efforts in both Appalachian Kentucky and other communities with similar characteristics.