Utilizing the CFIR to Evaluate Rural COVID-19 Vaccine Uptake: Extension Personnel Perspectives.

Background/Objectives: Rural populations in the United States experienced consistently lower COVID-19 vaccination rates than urban populations during the pandemic. While barriers to vaccination have been well documented, less is known about facilitators of uptake in rural settings. This study aimed to identify facilitators of COVID-19 vaccination in rural communities from the perspectives of Washington State University (WSU) Extension personnel and to examine these factors using the Consolidated Framework for Implementation Research (CFIR) Outer Setting domain. Methods: A qualitative descriptive study was conducted using semi-structured key informant interviews with WSU Extension personnel. Twenty-one participants representing 34 of 40 Extension offices across Washington State were interviewed in Fall 2023. Interviews were transcribed, de-identified, and analyzed using deductive thematic analysis. Findings were organized into the seven CFIR Outer Setting constructs: critical incidents, local attitudes, local conditions, partnerships and connections, policies and laws, financing, and external pressures. Results: Perceived facilitators of COVID-19 vaccination were identified across all CFIR Outer Setting constructs. Trust emerged as a central theme, with participants reporting that vaccine acceptance was higher when information was delivered by trusted local sources, including Extension personnel, healthcare providers, community leaders, and informal networks. Participants described leveraging partnerships with public health agencies, schools, faith-based organizations, and community groups as enhancing outreach and information dissemination. Additional facilitators identified by participants included no-cost vaccine and personal protective equipment availability, accessible community-based vaccination sites, culturally appropriate educational materials, and coordinated communication systems. Conclusions: Rural vaccination efforts were supported by trust, strong community partnerships, and locally tailored strategies. These findings may inform future public health emergency responses in rural communities.