Redefining the Vulnerable Population in Public Health Research: Incorporating Ideological Determinants of Anti-vaccination Attitudes

Abstract

Purpose

The disparities of COVID-19 vaccination rates between the rural and urban areas have become apparent during this pandemic. There is a need to understand the root causes of vaccine hesitancy demonstrated by the rural population to increase coverage and to contain the disease spread throughout the United States. This study aimed to explore other factors influencing vaccine hesitancy among rural dwellers besides the geography-related barriers such as poor health care access and individuals having no or suboptimal insurance coverage.

Methodology/Approach

By reviewing existing data and literature about vaccination, health literacy, and behaviors, and prevailing ideologies, we discuss the potential causes of vaccine hesitancy in rural areas that could create barriers for successful public health efforts related to vaccine coverage and provide suggestions to ameliorate the situation.

Findings

Geography-related barriers, health literacy, and preconceived notions are key determinants of adopting healthy behaviors and complying with public health authorities' recommendations among rural individuals during a public-health crisis. We argue that ideology, which is much deeper than preconception or misconception on vaccination, should be incorporated as a key factor to redefine the term “vulnerable populations” in public health research.

Research Limitations/Implications

The limitation of our study is that we have not found an effective way to encourage the populations who hold conservative religious and political ideologies to join the efforts for public health. Even though geography-related barriers may strongly impact the rural dwellers in achieving optimal health, the various forms of ideologies they have toward certain health behaviors cannot be discounted to understand and address vaccine-related disparities in rural areas. There is a need to redefine the term “vulnerable population” particularly as it relates to rural areas in the United States. During large-scale public health disasters, scholars and public health authorities should consider the ideologies of individuals, in addition to other factors such as race/ethnicity, area of residence (rural vs. urban), and socioeconomic factors influencing the existing vulnerabilities and health disparities.

Citation

Kawakami, A., Gandhi, S., Lehman, D. and Kronenfeld, J.J. (2023), "Redefining the Vulnerable Population in Public Health Research: Incorporating Ideological Determinants of Anti-vaccination Attitudes", Kronenfeld, J.J. (Ed.) Social Factors, Health Care Inequities and Vaccination (Research in the Sociology of Health Care, Vol. 40), Emerald Publishing Limited, Leeds, pp. 65-79. https://doi.org/10.1108/S0275-495920230000040004