The influence of COVID-19 messaging on immunization and other outcomes

PURPOSE: The CDC reported COVID-19 disparities in outcomes between rural and urban areas. These may be related to differences in perceived severity of disease subsequent to discrepant public messaging. This study assessed the impact of different COVID-19 messaging in Georgia rural and urban counties on immunization, cases, and death rates. METHODS: The research design was longitudinal retrospective using mixed methods with secondary data from Georgia public databases (January 2020–July 2022) and COVID-19 messaging information from public agencies’ websites. The sample included 120 urban and 39 rural counties. Outcome variables included COVID-19 cases, mortality, and vaccination rates, and predictor variables included type of information related to COVID-19 and geographical location (rural/urban). Quantitative data were analyzed with IBM SPSS27 and qualitative data with NVivo 12 Plus. RESULTS: Preliminary findings indicate no significant rural/urban differences in cases (M(rural) = 24,152.9, SD = 6080.2, and M(urban) = 25,137.1, SD = 2885.5 per 100,000), however significantly higher rural deaths (mean difference = 177.9, SE = 30.6, 95% CI [117.4–238.3], P < .001). Urban vaccination rates were significantly higher (mean difference = 5.18, SE = 1.54, CI [2.15, 8.22], P < .001). Preliminary qualitative analysis found fewer rural sources of information about severity of disease, testing options, and vaccination compared to urban areas. CONCLUSIONS: Rural/urban disparities in COVID-19 outcomes and vaccination were statistically significant in death rates and vaccination rates, despite similar number of cases recorded over the study period. Limited access to information about COVID-19 in rural counties explain some of the variability.