Campaign Approach to Reaching Rural Audiences

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  • Based on surveys fielded between March and May 2021, the Campaign developed a profile of rural adults to inform its approach to this audience.
    • Rural adults are older and less racially/ethnically diverse than the general population.
    • They are more likely to believe or be unsure about misinformation related to COVID and vaccines compared to those in urban areas, so providing fact-based information about vaccine safety and effectiveness is important.
    • Compared to urban adults, rural adults are less likely to trust public health officials—including HHS and CDC.
    • Rural adults are more likely than other adults to be in the Wait and See group. They are also more likely to be concerned about vaccine side effects and to want to build immunity via exposure compared to other adults.
  • CDC reported in March 2022 that the gap in COVID vaccination coverage between urban and rural areas had more than doubled since April 2021. Vaccine uptake of at least the first dose among rural residents ages 5 and older was 58.5% as of January 2022, and in urban counties, it was 75.4%.
    • Also, parents in rural communities said that their child will “definitely not” get a COVID vaccine about twice as often as parents in urban communities. About 76% of rural parents reported trusting their health care providers for information about the COVID vaccine, but nearly 40% of rural parents reported that their child’s doctor did not recommend that they get the vaccine, compared with only 8% of parents in urban communities.
  • In May 2021, the de Beaumont Foundation reported on results from its focus group research, which focused on why people changed their minds about getting the COVID vaccine. This research confirmed findings from Campaign creative testing focus groups in 2020 that highlighted the importance of acknowledging that it is normal for people to have questions about the vaccine.
  • Encouraging this audience to talk to a doctor or pharmacist to get answers to their questions and pointing out that the majority of doctors are choosing to get vaccinated themselves is an effective appeal for this audience.

Audience Market Research and Testing

A robust and continuous cycle of research drives all Campaign activities, including the approach to reaching rural audiences.

  • Primary research includes focus groups and interviews, creative testing surveys, and a weekly current events survey (a probability-based survey of 1,000 representative U.S. adults ages 18 and older), with findings provided by key demographic groups. Additional research includes audience segmentation and monitoring of news stories, social media, and secondary research. Findings are summarized for use across the Campaign.
  • Additional outcome surveys and analyses, along with social listening, enable performance tracking and real-time impact assessment to inform quick adjustments to messaging in a rapidly changing environment.

Key Messages for Audience

The Campaign’s approach is based on the premise that messaging must engage the rural audience culturally and emotionally. The messages consider traditions, hobbies, and family values while recognizing challenges and sacrifices. Additionally, for this audience, the Campaign uses a tailored call to action (CTA) that adds “Learn more” to the common CTA to “find vaccines or boosters near you.” This addition was based on recent research that indicates this audience’s preference is to get more information before deciding on vaccination.

Messaging guidance is based on qualitative and quantitative message testing insights, guidance from CDC, expert recommendations from audience-specific creative agencies, environmental scans, credible external research results, social listening, and iterative testing, among other inputs.

Current Campaign messaging centers on encouraging boosters among the highest-risk populations—older adults and those with chronic medical conditions that make poor COVID outcomes more likely. Specifically relevant messages for speaking about boosters to those who are 50 and older include:

  • During the peak of the Omicron surge, people 50 and older were hospitalized with COVID at twice the rate of younger adults and those 65 and older were hospitalized with COVID at 4 times the rate of younger adults.
  • Nine out of ten people who have died from COVID in the United States have been 50 or older and three out of four have been 65 or older.
  • Nearly eight out of 10 adults 55 and older have a medical condition like heart or lung disease, diabetes, or cancer that makes them more likely to suffer serious illness, including death, if they get COVID.

Campaign research has demonstrated that across all audiences, messages that indicate that vaccines and boosters together protect against the worst outcomes of COVID and that boosters extend protection to keep one safe from emerging variants were generally the most effective at driving intent to get a booster shot. For rural audiences, the following messages were shown to be the most effective:

  • COVID can cause severe disease, hospitalization, or death. Vaccines and boosters offer you the best protection from the worst outcomes of COVID.
  • Just because you had COVID doesn’t mean you can’t get it again. A COVID vaccine and booster are the best way to protect yourself against serious illness, hospitalization, and death.

Other Campaign messages continue to encourage parents to vaccinate their eligible children. Campaign research indicates that for most parent audiences, messages about the benefits of being vaccinated worked better than messages that focused on the risks of children having COVID, but for this audience, risk messages contributed strongly to driving intent to vaccinate children, with the following being the most effective:

  • Decades of research on dozens of vaccines have demonstrated that side effects usually show up within 6 weeks of vaccination. COVID vaccines have been studied and tested for almost 2 years in tens of thousands of adults and children, and serious side effects are very rare.
  • A vaccine gives your child's immune system the tools to fight COVID and prevents possible harmful effects from severe illness caused by COVID.
  • In January, hospitalizations among children with COVID reached record highs.
  • The COVID vaccine that your child is eligible for has been tailored for children under 12 years old and is given in a smaller dose appropriate for their age.
  • Our children rely on us from day one, and as they grow, we do everything we can to protect them. Protect your child from severe disease with a safe and effective COVID vaccine.

Partnerships and Outreach

Key Activities and Metrics to Date

  • Communication Toolkit: Created and shared a Rural Community toolkit to provide public education messaging on COVID prevention and to build vaccine confidence.
  • National Partnerships: Working with partners, such as the American Library Association and the National Parent Teacher Association, to reach rural communities through member organizations with in-person events and Campaign messaging materials.
    • Healthy Trucking Association of America (HTA) is helping reach commercial drivers through engaging messages and partnerships with fleets nationwide. Multiple pop-up COVID vaccine clinics are being coordinated with fleets.
      • A vaccine clinic held in connection with the HTA Jamboree at the I-80 Truckstop near Davenport, IA, resulted in 37 vaccines and boosters. An HTA booth also provided informational materials about COVID vaccines throughout the 3-day event that drew nearly 50,000 visitors.
    • The National Rural Education Association is helping reach parents and teachers in rural America with testimonials and education through a multifaceted approach, including conferences, articles, and videos.
  • Regional Partnerships:
    • The Campaign is partnering (non-paid) with the Appalachian Regional Commission (ARC) to reach their core constituents in Appalachia. The charge of ARC is economic development, and the organization works with small businesses and nonprofits in the Appalachian region. Tactics include:
      • Toolkit: Developed a communications toolkit that focuses on content directed at employers in the Appalachian region. Content includes fact sheets, posters and flyers (for the workplace), social media (to be shared within employer channels), and videos that can be played at the workplace.
      • Testimonials: Developing a testimonial with a business leader on how COVID has presented for the rural communities to share with members of the ARC.
    • United Methodist Health Ministry Fund in Kansas helped reach parents and adults with reliable information from trusted messengers in Kansas, including testimonials and informational videos.

Key Activities

  • Comprehensive paid advertising is directed to rural, non-Hispanic White audiences via national media and in specifically selected local markets around the country. Custom creative for rural audiences is developed for local radio, digital, print, and social media in regional markets.
    • Digital/Social/Digital Out of Home (OOH): Geotargeting digital and social ads to designated market areas (DMA) and ZIP code levels on thousands of sites and platforms, with national placements on sites such as The American Legion, Smart News, and Nextdoor.
    • Television: Placing ads on networks that over-indexed with rural audiences, such as The Weather Channel, Fox Sports, and Small Town Big Deal.
    • Radio: Geotargeting radio ads to DMA and state level on stations selected by genre/format.
    • Print: Geotargeting print ads to DMA and state level.


  • Early in the Campaign, Slow the Spread reinforced basic prevention measures, with ads for radio, newspaper, digital, and social media.
  • Building Vaccine Confidence, the Campaign’s advertising push, included TV, radio, newspaper, digital and social media, and digital OOH, initially focusing on seniors as the first eligible population for vaccinations, then targeting health navigators—the health care decision-makers in families, young adults, and now parents of children who are eligible for vaccination. Tailored ads to encourage boosters for the vaccinated are also part of the Campaign.

Earned Media

Key Activities and Metrics to Date

  • The Campaign has specifically targeted rural communities through monthly audio news releases with the National Association of Farm Broadcasting, resulting thus far in 194 syndicated airings of 21 original releases for a reach of 355,300 impressions.
  • Since May 2021, the Campaign has conducted monthly outreach to targeted states based on rates of COVID and vaccine hesitancy. In December 2021, we also added states with a large percentage of the booster-eligible population and states with high numbers of vaccinated parents willing to consider vaccination for their children. Broadcast media tours, proactive pitching, and ready-to-run articles in this local outreach effort and iHeart radio programming have resulted in an estimated reach of 808 million impressions in markets with the largest percentage of rural populations.
  • Coverage of the HTA activities during the Truckers Jamboree in July 2022 resulted in a radio interview with HTA CEO Jon Slaughter and a television interview on a local news/talk show with the Scott County Public Health vaccine clinic director. Both provided messages on how to learn more and find vaccines for rural audiences and together garnered approximately 350K impressions.

Trusted Messengers

  • As hunting and fishing are hobbies for many rural adults, the Campaign collaborated with Outdoor America, a content delivery authority for people who are passionate about outdoor sports and recreation. Outdoor America produced nine video vignettes, including a localized series with popular Outdoor America host Mike Auten. The goal of each vignette was to relate to the audience through outdoor content, strengthen confidence in the COVID vaccine, and encourage vaccination.
    • The initial video spots ran on both Outdoor America’s platform and in additional paid digital and social media and delivered more than 13 million total impressions.
  • The team collaborated with rural partner HTA to work with rural messengers and radio personalities:
    • Captain Jack Nash on the ground at the Mid-America Trucking Show, where he served as an interviewer for their Healthy Trucking Facebook Lives at the HTA booth.
    • Shane Owens, a country music singer whose wife videotaped his COVID vaccination as part of a testimonial video.
    • Three commercial trucking personnel shared their vaccination stories through their trucking networks with one of the stories being featured in a digital article in Military Families.
    • Sirius Road Dog Trucking included COVID education in multiple conversations with Nicole Dreiske, host of Highway to Health.
    • Greg Thompson, Executive Producer of The PodWheels Network, interviewed two regional directors of The U.S. Department of Health and Human Services for the podcast Healthy Trucking.
  • The team collaborated with the United Methodist Health Ministry Fund in Kansas and the National Rural Education Association to interview trusted messengers of rural parents such as pediatricians, teachers, community health workers, and student testimonials. Both partners disseminated the interviews through means such as paid video advertising, member networks, and op-eds in newspapers.
  • Additional opportunities to leverage rural trusted messengers are in development with media partners involved in outdoor recreation, country music, sports, and military arenas.

Creative Samples

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