JMIR Publications

ABSTRACT

Background:

Despite documented efficacy, the public health impact of vaccinations is severely limited by misperceptions, hesitancy, and poor acceptance. Messaging from healthcare providers has not yet been optimized to overcome these barriers and has not been tailored to groups that face health disparities, such as rural Americans. Because vaccines have become controversial, as illustrated by the public response to the SARS-CoV-2 vaccines, traditional approaches that use persuasive education or advice to change perspectives are unlikely to have long-term effects and may even be counterproductive. Alternatively, motivational interviewing (MI) is a conversational approach to address modifiable behavior and its empathic nature can be useful when navigating challenging topics. Although MI has been found to be efficacious for improving vaccination rates among children and adolescents, it is unknown whether MI can reduce vaccine hesitancy and health disparities among underserved rural adults. Further, the ideal mode of delivery for MI is unknown, especially “dose,” “intensity,” and integration with mobile health (mHealth). Therefore, it is essential to investigate the efficacy of MI in promoting vaccine uptake in rural populations to reduce health disparities.

Objective:

Develop and evaluate the feasibility, acceptability, and preliminary efficacy of our mHealth-based motivational interviewing intervention to promote SARS-CoV-2 vaccination (MOTIVACC).

Methods:

Pilot mixed methods 2-phase study: convening a community advisory panel to understand barriers and facilitators to vaccination and mHealth uptake among adults (phase 1, n=16-20), and a pilot 3-group single-blind randomized controlled trial (RCT) for 8 weeks (phase 2, n=60). In the RCT, we recruit adults who have received no previous dose of the COVID-19 vaccine, and randomize them into one of three arms: Standard MI (SMI; n=20), Intensive MI (IMI; n=20), or mHealth-based MOTIVACC (n=20). The primary RCT outcomes are positive change in vaccine hesitancy and intention to obtain the vaccines, measured on Likert scales. The secondary RCT outcome is actual vaccine receipt.

Results:

Phase 1 of this study was approved by the ethics committees of both the University of Oklahoma and Oklahoma State University in July, 2022, and was completed June 2022. Phase 2 of this study was approved by the ethics committee at the University of Oklahoma in April, 2024.

Conclusions:

This randomized trial will evaluate the preliminary efficacy of MI for targeting SARS-CoV-2 vaccine hesitancy, as well as compare traditional MI versus mHealth-based MI. This will provide pivotal data on scalable strategies to assist in navigating vaccine hesitancy, including in rural populations. Clinical Trial: ClinicalTrials.gov NCT05977192