Corresponding Author

Florence M. Weierbach, PhD, MSN, MPH, RN

E-mail: Weierbach@etsu.edu

Author Affiliations

1. Florence M. Weierbach, PhD, MSN, MPH, RN: Professor, College of Nursing, East Tennessee State University (ETSU) (Johnson City TN); E-mail: weierbach@etsu.edu

2. Rebecca Adkins Fletcher, PhD: Associate Professor, Center for Appalachian Studies, ETSU

3. Ingrid E. Luffman, PhD: Associate Professor, Department of Geosciences, ETSU

4. Cynthia Meyer: Nursing PhD Candidate, College of Nursing, ETSU

5. Janet M. Keener: Research Computing Consultant, ETSU

6. Manik Ahuja, PhD, MA: Assistant Professor, Department of Health Services Management and Policy, ETSU College of Public Health

7. Hadii M. Mamudu, PhD, MPA: Professor, Department of Health Services Management and Policy, ETSU College of Public Health

Author Area of Expertise

Florence Weierbach: Public Health Nursing, Rural/Appalachian Communities, Social Determinants of Health

Rebecca Adkins Fletcher: Medical and Cultural Anthropolgy

Ingrid E. Luffman: Spatial Analysis

Cynthia Meyer: Social Justice, vulnerable populations

Janet Keener: Redcap Administrator

Manik Ahuja: Substance abuse, quantitative methods

Hadii M. Mamudu: Health Policy, cardiovascular risk research


Introduction: The newly emergent COVID-19 virus reached pandemic levels in March 2020. By the middle of August 2020, there were over 1 million deaths attributed to COVID-19 in the U.S., with those in rural areas outpacing urban counterparts. Prior to emergency approval of the Pfizer, Moderna and Johnson & Johnson vaccine formulations, mitigation efforts addressing individual behavior were challenging. However, even with the entrance of these three new vaccines, herd immunity was not achieved in rural areas, as vaccine uptake remained low there. Although there has since been an abundance of COVID-19-related research addressing health literacy, vaccine hesitancy and overall medical mistrust, few of these studies focus on Appalachia.

Purpose: This study identifies barriers and facilitators to adherence with COVID-19 mitigation, focusing specifically on vaccine hesitancy in South Central Appalachia.

Methods: A secondary data study was conducted with a subset of Appalachian residents from the COVID-19 Public Health survey. Participants were grouped by county using ARC economic county designations for analysis. The dependent variable, vaccine hesitancy, was explored in relation to five categories of independent variable: (1) demographics (with four conceptual areas); (2) belief; (3) action; (4) medical mistrust; and (5) health literacy.

Results: Findings indicate vaccine hesitancy attributes include beliefs addressing COVID-19 threat, overstatement of severity of illness, risk of vaccines, vaccine safety information not present from manufacturer, and independent decision to vaccinate. Findings from this study are comparable to HPV vaccine studies in Appalachia.

Implications: As interventions are developed for Appalachia, it is paramount to focus vaccine administration at the individual and population level.



Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Weierbach FM, Adkins Fletcher R, Luffman IE, Meyer C, Keener JM, Ahuja M, Mamudu HM. Factors associated with COVID-19 vaccine hesitancy in South Central Appalachia. J Appalach Health 2023;5(3):71–84. https://doi.org/10.13023/jah.0503.06