Understanding the Drivers of Vaccine Hesitancy During COVID-19 in Mississippi, United States

This dissertation examines vaccine hesitancy in Mississippi, a state with low vaccination rates and healthcare disparities. Using a quantitative approach with secondary data, guided by the Health Belief Model and Social Ecological Model, this study explores vaccine acceptance through three interconnected papers. The first two analyze data from the “Mississippi State Department of Health Vaccine Confidence Survey”, while the third uses the “Mississippi Medical Professional Vaccine Confidence Survey”. In the first study, I explored how physician-participant demographic concordance affects vaccine intentions. Race-concordant physician trust consistently associated with lower vaccine intentions, potentially reflecting deep-rooted historical (mis)trust. Gender- and age-concordant trust initially showed negative associations but shifted after adjusting for demographic and socioeconomic factors. Subgroup analyses revealed that race-concordant trust increased intentions among both White and Black participants, while gender-concordance was linked to lower intentions for both men and women. Age-concordance negatively influenced older adults’ intentions. Education, income, and widowhood increased vaccine confidence; however, private/no insurance and Republican affiliation lowered it. Physician diversity is likely to improve trust; however, Mississippi’s provider shortage necessitates practical strategies to increase representation where feasible.In the second study, I examined demographic predictors of two domains of vaccine concerns: health risk and trust, and efficacy and timing. Older age and higher education correlated with reduced health risk and trust concerns, while Black participants reported more skepticism. Education also corresponded with slightly greater concerns about efficacy and timing, particularly among women. Higher income decreased overall concerns, whereas Republican affiliation was linked to lower perceived safety and effectiveness. In my third paper, I examined how demographic and decision-making factors influence HCWs' vaccine advocacy. Conspiracy-related concerns reduced vaccine promotion, while risk and safety concerns were not predictive. Political affiliation was non-significant, though Independents trended toward greater encouragement than Republicans. Gender had no significant effect. Interaction analysis revealed no moderating effects of gender or political affiliation, reinforcing that attitudinal rather than demographic factors drive hesitancy. Given the small sample and exclusion of pediatric providers, results should be interpreted cautiously. Findings highlight the need for HCW training, peer influence, and (mis)information correction to strengthen vaccine promotion in MS.