Vaccination Messages Research Articles

Encouraging vaccination against COVID-19 has no compensatory spillover effects

Abstract Effective communication is essential for delivering public health messages and enabling behaviour change. Little is known about possible backfiring, or spillover effects, of COVID-19 vaccine messaging. In a study with n = 1,848 United Kingdom (UK) adults, we assess whether communication strategies that target vaccine hesitancy have any unintended, positive or negative, spillover effects on people's intention to engage in protective, compliance and prosocial behaviours. In June–July 2021, we conducted an online experiment to assess the potential spillover effects of three messages, emphasising (a) the medical benefits of COVID-19 vaccination, (b) the non-medical collective benefits of vaccination or (c) the non-medical individual benefits of holding a vaccination certificate. Exposure to different messages did not significantly affect people's intention to engage in protective, compliance, or prosocial behaviours. Instead, vaccination status (being vaccinated vs not) was positively associated with intentions to engage in protective, compliance and prosocial behaviours. Our results suggest that communication strategies that aim to increase vaccination uptake do not have any unintended effects on other health behaviours and vaccination campaigns can be tailored to specific populations to increase uptake and compliance.

Predicting COVID-19 Vaccination Uptake Using a Small and Interpretable Set of Judgment and Demographic Variables: Cross-Sectional Cognitive Science Study.

Despite COVID-19 vaccine mandates, many chose to forgo vaccination, raising questions about the psychology underlying how judgment affects these choices. Research shows that reward and aversion judgments are important for vaccination choice; however, no studies have integrated such cognitive science with machine learning to predict COVID-19 vaccine uptake. This study aims to determine the predictive power of a small but interpretable set of judgment variables using 3 machine learning algorithms to predict COVID-19 vaccine uptake and interpret what profile of judgment variables was important for prediction. We surveyed 3476 adults across the United States in December 2021. Participants answered demographic, COVID-19 vaccine uptake (ie, whether participants were fully vaccinated), and COVID-19 precaution questions. Participants also completed a picture-rating task using images from the International Affective Picture System. Images were rated on a Likert-type scale to calibrate the degree of liking and disliking. Ratings were computationally modeled using relative preference theory to produce a set of graphs for each participant (minimum R2>0.8). In total, 15 judgment features were extracted from these graphs, 2 being analogous to risk and loss aversion from behavioral economics. These judgment variables, along with demographics, were compared between those who were fully vaccinated and those who were not. In total, 3 machine learning approaches (random forest, balanced random forest [BRF], and logistic regression) were used to test how well judgment, demographic, and COVID-19 precaution variables predicted vaccine uptake. Mediation and moderation were implemented to assess statistical mechanisms underlying successful prediction. Age, income, marital status, employment status, ethnicity, educational level, and sex differed by vaccine uptake (Wilcoxon rank sum and chi-square P<.001). Most judgment variables also differed by vaccine uptake (Wilcoxon rank sum P<.05). A similar area under the receiver operating characteristic curve (AUROC) was achieved by the 3 machine learning frameworks, although random forest and logistic regression produced specificities between 30% and 38% (vs 74.2% for BRF), indicating a lower performance in predicting unvaccinated participants. BRF achieved high precision (87.8%) and AUROC (79%) with moderate to high accuracy (70.8%) and balanced recall (69.6%) and specificity (74.2%). It should be noted that, for BRF, the negative predictive value was <50% despite good specificity. For BRF and random forest, 63% to 75% of the feature importance came from the 15 judgment variables. Furthermore, age, income, and educational level mediated relationships between judgment variables and vaccine uptake. The findings demonstrate the underlying importance of judgment variables for vaccine choice and uptake, suggesting that vaccine education and messaging might target varying judgment profiles to improve uptake. These methods could also be used to aid vaccine rollouts and health care preparedness by providing location-specific details (eg, identifying areas that may experience low vaccination and high hospitalization).

Field testing the transferability of behavioural science knowledge on promoting vaccinations

As behavioural science is increasingly adopted by organizations, there is a growing need to assess the robustness and transferability of empirical findings. Here, we investigate the transferability of insights from various sources of behavioural science knowledge to field settings. Across three pre-registered randomized controlled trials (RCTs, N = 314,824) involving a critical policy domain—COVID-19 booster uptake—we field tested text-based interventions that either increased vaccinations in prior field work (RCT1, NCT05586204), elevated vaccination intentions in an online study (RCT2, NCT05586178) or were favoured by scientists and non-experts (RCT3, NCT05586165). Despite repeated exposure to COVID-19 vaccination messaging in our population, reminders and psychological ownership language increased booster uptake, replicating prior findings. However, strategies deemed effective by prediction or intention surveys, such as encouraging the bundling of COVID-19 boosters and flu shots or addressing misconceptions, yielded no detectable benefits over simple reminders. These findings underscore the importance of testing interventions’ transferability to real-world settings.

An Experimental Study on how Messaging from CDC Affects Attitudes toward Mandatory MMR Vaccination for Schoolchildren.

During the COVID-19 pandemic, public health institutions, particularly the Centers for Disease Control and Prevention (CDC), were frequently attacked by politicians. Popular trust in these institutions declined, particularly among self-identified Republicans. Therefore, the effectiveness of public health institutions as vaccination messengers might have been weakened in the post-COVID-19 period. We conducted a survey experiment examining the effectiveness of messaging from the CDC in shaping people's attitudes toward mandatory MMR (measles-mumps-rubella) vaccination for schoolchildren. The experiment was embedded in a survey fielded in South Dakota, a "red state" with a population predisposed to distrust the CDC. Using registration-sampling, we received 747 responses. We used difference-in-means tests and multivariate regression to analyze the data. We found that participants who received a message from the CDC were more likely to support MMR vaccine mandate for schoolchildren than participants who received the same prompt from a state agency. Further analyses showed that messaging from the CDC was particularly effective among Republicans. Overall, our study showed that although the CDC was caught up in the political skirmishes during the COVID-19 pandemic, it remains an authoritative source of public health information. Public health officials at the local and state levels should not shy away from referring to the CDC in their vaccination messaging.

Impact of the COVID-19 pandemic on social media utilization, influences related to parental vaccine decision making, and opinions on trustworthy social media vaccination campaigns: A qualitative analysis

ABSTRACT There is a continued need for research to better understand the influence social media has on parental vaccination attitudes and behaviors, especially research capturing the effects of the COVID-19 pandemic. The goal of this study was to explore parents’ perspectives related to the impact the pandemic had on 1) social media engagement, 2) vaccine messaging on social media, and 3) factors to guide future intervention development. Between February and March 2022, 6 online, synchronous, text-based focus groups were conducted with parents of adolescents aged 11 to 17 years. Participants who all utilized social media were recruited from across the United States. Qualitative data were analyzed using content analysis. A total of 64 parents participated. Average age was 47 years, and participants were predominantly White (71.9%), female (84.3%), and engaged with social media multiple times per day (51.6%). Participants (95.3%) viewed obtaining all recommended vaccines as important or very important; however, overall vaccination rates for their adolescents were varied (50% ≥1 dose HPV; 59.4% MenACWY; 78.1% Tdap; 65.6% Flu; 81.3% COVID-19). Three themes emerged highlighting the pandemic’s impact on parent’s (1) general patterns of social media use, (2) engagement about vaccines on social media and off-line behaviors related to vaccination, and (3) perspectives for developing a credible and trustworthy social media intervention about vaccination. Participants reported fatigue from contentious vaccine-related content on social media and desired future messaging to be from recognizable health institutions/associations with links to reputable resources. Plus, providers should continue to provide strong vaccine recommendations in clinic.

Using Reddit Data to Refine Vaccine Messaging for a Plan-Do-Study-Act Communications Approach.

Language expressed in online forums can highlight which pro-vaccination messages intensify vaccine skepticism and which messages resonate with different populations. This study examined Reddit (an online discussion forum) to analyze what anonymous Canadians disclosed about their rationales for getting vaccinated against COVID-19 during the height of the pandemic. The investigation examined 266 Canadian subreddits (sub-forums on specific topics on Reddit) and evaluated 79 English-language phrases that people commonly use on Reddit to express the reason(s) why they (or someone close to them) chose to get vaccinated/boosted for COVID-19. The findings suggest that machine-learning techniques hold out the promise of a real-time approach toward public health messaging via an iterative Plan-Do-Study-Act cycle.

COVID-19 vaccination uptake and receptivity among veterans enrolled in homelessness-tailored primary health care clinics: provider trust vs. misinformation

BackgroundCompared to the general population, individuals experiencing homelessness are at greater risk of excess morbidity and mortality from COVID-19 but have been vaccinated at lower rates. The U.S. Department of Veterans Affairs (VA)’s Homeless Patient Aligned Care Team (HPACT) program integrates health care and social services for Veterans experiencing homelessness to improve access to and utilization of care.MethodsThis study explores the vaccination uptake behavior and attitudes through a qualitative comparative case study of two HPACT clinics, one in California (CA) and one in North Dakota (ND). Semi-structured telephone interviews were conducted with Veterans enrolled in the two VA HPACT clinics from August to December 2021 with 20 Veterans (10 at each clinic).ResultsFour themes emerged from the interviews: (1) Vaccination uptake and timing— While half of the Veterans interviewed were vaccinated, ND Veterans were more likely to be vaccinated and got vaccinated earlier than CA Veterans; (2) Housing— Unsheltered or precariously housed Veterans were less likely to be vaccinated; (3) Health Care— Veterans reporting positive experiences with VA health care and those who trusted health providers were more likely to vaccinate than those with negative or nuanced satisfaction with health care; (4) Refusers’ Conspiracy Theories and Objectivity Claims— Veterans refusing the vaccine frequently mentioned belief in conspiracy theories while simultaneously asserting their search for objective information from unbiased sources.ConclusionsThese findings amplify the importance of improving access to population-tailored care for individuals experiencing homelessness by reducing patient loads, expanding housing program enrollment, and increasing the provider workforce to ensure personalized care. Health care providers, and housing providers, social workers, and peers, who offer information without discrediting or criticizing Veterans’ beliefs, are also key to effectively delivering vaccine messaging to this population.

Quality of Counselling, Exposure to Vaccination Messages, and Caregivers’ Knowledge on the Uptake of Pentavalent Vaccine in Six Northern Nigerian States

Quality of Counselling, Exposure to Vaccination Messages, and Caregivers’ Knowledge on the Uptake of Pentavalent Vaccine in Six Northern Nigerian States

Digital Volunteers as Trusted Public Health Communicators.

Social media influencers are increasingly being positioned by health campaigns as trusted messengers who can share public health information with their communities. There is also an opportunity for campaigns to work with unpaid, digital volunteers (DVs) who want to use their platforms for good, despite not being compensated. DVs are a cost-effective way of supplementing an influencer-driven messaging campaign. Our influencer and DV network, El Beacon, aims to spread pro-COVID-19 vaccination messages on social media to the Hispanic community. Since 2021, 3,001 DVs have been recruited. Process metrics related to DVs are tracked using a variety of software including Facebook ads manager, Sprout Social, and Hubspot. Metrics received include the number of volunteer sign-ups, cost per lead generated, ad performance, organic and paid impressions and engagement of ads and El Beacon social content, newsletter open rates, newsletter clickthrough rates, and newsletter engagement. Understanding best practices for recruiting and retaining DVs for a public health campaign can help other practitioners optimize their experience working with DVs. Some of these best practices include: identify a specific DV target audience that will be most receptive to your message and best reached by your recruitment efforts, be responsive to what resonates with your DVs, be flexible in how you define "network engagement," and use paid influencers to help build momentum.

COVID-19 Vaccine Communications on Instagram and Vaccine Uptake in Young Adults: A Content Assessment and Public Engagement Analysis

In Canada, during the pandemic, young adults (18–29 year-olds) represented one of the least-vaccinated age groups against COVID-19. These low vaccination rates, and high infection rates, left young people vulnerable to severe infections and created a risk for transmission to immunocompromised populations. Given young adults’ unique characteristics, to encourage vaccination among this demographic, public health and government officials must adopt an audience-centred approach to communication. We sought to understand if the vaccine messages from 8 Canadian federal government Instagram accounts met the needs of young adults based two frameworks: Guiding Principles for Crisis Communication (compassion and empathy, conversational tone, transparency, clarity, call to action and correction of misinformation), and the 5C Model for Vaccine Hesitancy (confidence, complacency, constraints, collective responsibility, and risk calculation). Across 159 posts that mentioned COVID-19 vaccines, there was limited incorporation of best practices, suggesting the government’s communication strategy did not meet the needs of young people.

Online Communities as a Form of Organizing Narrative Content about SARS-CoV-2 Vaccination: Big Data Analysis

Distrust of vaccines is one of the key problems of modern healthcare both in Russia and abroad. Mass vaccination against SARS-CoV-2 provoked a large number of social media narratives. Online communities play an important role in the formation and dissemination of narratives. The complex system of numerous online platforms for discussing the topic of vaccination on a social network deserves a special description.&#x0D; The purpose of the study is to construct a typology of all significant communities of the popular Russian social network “VKontakte” that publish content on the topic of vaccination against COVID-19 (01/01/2020 – 03/01/2023) and describe it in terms of lobbied narratives. Big data collection and analysis methods were used, as well as narrative analysis. Of the 131,119 communities that published at least one vaccination message during the study period, 691 were selected based on self-positioning criteria (name, description) and/or the number of SARS‑CoV-2 vaccination messages above the established threshold. 14 thematic categories of communities have been identified, the self-positioning of which allows reconstructing narratives about forced vaccination and the right to choose; health care and debate about the benefits/effectiveness of vaccination; conspiracy theories; beneficiaries and trust in the authorities; pseudoscience, vaccination myths and scientific knowledge; childcare and parental rights; contrasting medical science with religious beliefs.&#x0D; Narratives formed by online communities signify a pronounced polarization of opinions in the digital society regarding SARS-CoV-2 vaccination. The “pro-waxer” and “anti-vaxxer” narratives are reconstructed. Quantitatively “anti-vaxxer” communities significantly predominate over “pro-waxer” ones.

Vaccine confidence mediates the association between a pro-social pay-it-forward intervention and improved influenza vaccine uptake in China: A mediation analysis

IntroductionA Chinese clinical trial has demonstrated that a prosocial pay-it-forward intervention that offered subsidized vaccination and postcard messages effectively increased influenza vaccine uptake and vaccine confidence. This secondary analysis explored the potential mediating role of vaccine confidence on the association between a pay-it-forward intervention and influenza vaccine uptake, and how this might vary by individual annual income levels. MethodsData from 300 participants (150 standard-of-care and 150 pay-it-forward participants) were included in the analysis. We conducted descriptive analysis of demographic and vaccine confidence variables. Multivariable regression and mediation analysis on interventions, vaccine confidence and vaccine uptake were conducted. A sub-group analysis was conducted to further understand whether associations between these variables vary by income levels (<=$1860 or >$1860). ResultsThe pay-it-forward intervention was significantly associated with greater levels of perceived influenza vaccine importance (adjusted odds ratio (aOR) = 3.60, 95 %CI: 1.77–7.32), effectiveness (aOR = 3.37, 95 %CI: 1.75–6.52) and safety (aOR = 2.20, 95 %CI: 1.17–4.15). Greater perceived influenza vaccine importance was associated with increased vaccine uptake (aOR = 8.51, 95 %CI: 3.04–23.86). The indirect effect of the pay-it-forward intervention on vaccination was significant through improved perceived influenza vaccine importance (indirect effect1 = 0.07, 95 %CI: 0.02–0.11). This study further revealed that, irrespective of the individual income level, the pay-it-forward intervention was associated with increased vaccine uptake when compared to the standard-of-care approach. ConclusionsPay-it-forward intervention may be a promising strategy to improve influenza vaccine uptake. Perceived confidence in vaccine importance appears to be a potential mediator of the association between pay-it-forward and vaccine uptake.

Feeling inspired and nostalgic: associations between media context-induced positive emotions and behavioral change among vaccine-hesitant individuals in the late stages of the COVID-19 pandemic

Purpose Campaigns to promote the COVID-19 vaccination messages to vaccine-hesitant consumers in the late stages of the pandemic are often met with resistance. This study aims to explore a way to leverage positive emotions induced from entertainment media consumption to promote vaccination messages to this audience group. Design/methodology/approach An online experiment was conducted with vaccine-hesitant consumers (N = 409). Participants viewed personally relevant entertainment music videos or mundane videos and vaccinated messages embedded in user-generated comments. Findings Data revealed that feelings of inspiration and nostalgia induced from entertainment media consumption increased vaccination intentions via increased risk perceptions and reduced anti-vaccination attitudes. Practical implications Social marketers should consider leveraging the combined effect of entertainment media-induced positive emotions and user-generated comments to motivate behavioral change among vaccine-hesitant individuals in the late stages of the COVID-19 pandemic. Originality/value The present study adds to social marketing literature by showing mechanisms that positive emotions induced from entertainment social media consumption might lead to health behavioral change.

Why or How? the impact of Construal-Level Theory on vaccine message receptivity

We propose that Construal Level Theory (CLT) can be applied to incrementally improve vaccine message receptivity because it impacts a variety of health decisions and complements the constructs of the Health Belief Model. Across three studies, we explore CLT related specifically to the COVID-19 vaccine. First, we analyze Twitter sentiment and find evidence that the vaccine was a high-level construal. Then, we use prospective hindsight to show that higher-level construal dominates the explanations people provide for if they were to get vaccinated in the future. Finally leveraging construal level message congruence, we find a higher-level message is more effective than a lower-level one in increasing willingness to get vaccinated. Taken together, these studies show that a virus vaccine was perceived as a higher-level construal and suggests that future messaging should include both the higher-level ‘Why’ as well as the lower-level ‘How’ to get vaccinated.

Elevating Home Health Aide Input in Co-Creation of COVID-19 Vaccine Messaging.

Home health aides (HHAs) care for patients highly vulnerable to COVID-19 and are disproportionately women from minority communities that have been adversely impacted by COVID-19. Yet, direct care workers are less likely to be vaccinated against COVID-19 compared to others. As the pandemic evolves, interest in vaccination may decrease suggesting the need for relevant vaccine messaging to HHAs. Objectives: (1) to describe HHAs and administrators' perspectives related to COVID-19 vaccination messaging, and (2) to co-design a Communication Toolkit to create COVID-19 vaccine messages. Methods: HHAs and administrators from 4 geographically diverse Palliative Care Research Cooperative (PCRC) hospice agencies were recruited for a multi-method process involving qualitative interviews (17 HHAs and 5 administrators), community engagement (CE) studios, and development of a Communication Toolkit. Interviews were guided by the PEN-3 conceptual framework to explore barriers and facilitators to vaccination. Data were analyzed using qualitative content analysis. Results: Despite power differences, HHAs and administrators share a commitment to protecting patients affected by serious illness. HHAs desire vaccine messaging that includes personal narratives, good news about the vaccine, and facts about benefits and risks of the vaccine. Preferred message formats include the agency intranet, daily briefings, or "little seeds" (ie, short, high-impact information). Through the studios, HHAs provided input on a Toolkit prototype with messages tailored to the context of home care. Conclusions: Grounded in the commitment of HHAs and administrators to protecting vulnerable patients, we co-created an adaptable Communication Toolkit to address COVID-19 vaccination misinformation and mistrust among direct care workers.

COVID-19 Vaccination Messengers, Communication Channels, and Messages Trusted Among Black Communities in the USA: a Review.

Black and African American adults exhibited higher levels of mistrust and vaccine hesitancy and lower levels of vaccination throughout the COVID-19 pandemic. Vaccination and booster uptake remains disproportionately low among Black adults. We conducted a systematic review of empirical research published between February 2021 and July 2022 from five electronic databases and the grey literature. We screened studies that assessed COVID-19 vaccination information needs and preferences as well as communication strategies among Black adults in the USA. We extracted data, then analyzed and synthesized results narratively. Twenty-two articles were included: 2 interventions, 3 experimental surveys, 7 observational surveys, 8 qualitative inquiries, and 2 mixed methods studies. Studies reported credible and preferred COVID-19 vaccination information sources/messengers, channels, and content. Commonly trusted messengers included personal health care providers, social network connections, and church/faith leaders. Electronic outreach (e.g., email, text messages), community events (e.g., forums, canvassing), and social media were popular. Black communities wanted hopeful, fact-based messages that address racism and mistrust; persuasive messages using collective appeals about protecting others may be more influential in changing behavior. Future communication strategies aiming to increase vaccine confidence and encourage COVID-19 booster vaccination among Black communities should be developed in partnership with community leaders and local health care providers to disseminate trauma-informed messages with transparent facts and collective action appeals across multiple in-person and electronic channels.

Strategies to Promote COVID-19 Vaccinations in the United States. A Content Analysis of the „We Can Do This” Campaign Videos

In response to COVID-19 vaccine resistance, U.S. states implemented numerous incentives to increase vaccination rates. In addition to financial and non-cash prizes, COVID-19 vaccinations were also promoted through education campaigns. The aim of this article is to analyse the persuasive strategies used in the “We Can Do This” campaign videos to encourage vaccination uptake and examine whether these techniques were effective considering the research on COVID-19 vaccine messaging. The paper analysed 70 campaign videos from 2021 using quantitative and qualitative content analysis. The study found that the videos employed a range of effective persuasion strategies to promote COVID-19 vaccines. Differences and similarities between the most and least viewed spots were also explored.

Fun with Frustration? TikTok Influencers’ Emotional Expression Predicts User Engagement with COVID-19 Vaccination Messages

ABSTRACT This study examined what kinds of TikTok video and message features are associated with user engagement in the context of COVID-19 vaccination. Content analysis was applied to study a sample of 223 COVID-19 vaccination-related videos from creators with at least 10,000 followers. The content analysis involved coding themes, video formats, the valence of attitude toward vaccination, and emotional expressions from the influencers. A majority of videos showcased personal vaccination experiences, followed by fictitious dramas and instructional information. More fictitious dramas expressed unclear attitudes, neither explicitly supporting nor opposing the COVID-19 vaccine, compared to personal vaccination stories and instructional videos. Some imaginative and dramatic scenes, such as zombie transformation or dramatic spasms after taking the vaccines, were widely imitated across influencers, perhaps humorously, and raised concerns about diminishing positive images of vaccine uptake. Videos with simultaneous expression of humor and frustration significantly predicted engagement when the video content opposed or was uncertain about taking the vaccine, implying the effectiveness of mixed emotional attributes within a message. This study provides insight into how social context and message choices by creators interact to influence audience engagement.

Evaluation of online videos to engage viewers and support decision-making for COVID-19 vaccination: how narratives and race/ethnicity enhance viewer experiences.

Vaccine hesitancy has hampered the control of COVID-19 and other vaccine-preventable diseases. We conducted a national internet-based, quasi-experimental study to evaluate COVID-19 vaccine informational videos. Participants received an informational animated video paired with the randomized assignment of (1) a credible source (differing race/ethnicity) and (2) sequencing of a personal narrative before or after the video addressing their primary vaccine concern. We examined viewing time and asked video evaluation questions to those who viewed the full video. Among 14,235 participants, 2,422 (17.0%) viewed the full video. Those who viewed a personal story first (concern video second) were 10 times more likely to view the full video (p < 0.01). Respondent-provider race/ethnicity congruence was associated with increased odds of viewing the full video (aOR: 1.89, p < 0.01). Most viewers rated the informational video(s) to be helpful, easy to understand, trustworthy, and likely to impact others' vaccine decisions, with differences by demographics and also vaccine intentions and concerns. Using peer-delivered, personal narrative, and/or racially congruent credible sources to introduce and deliver vaccine safety information may improve the openness of vaccine message recipients to messages and engagement.

Understanding Clinic and Community Member Experiences with Implementation of Evidence-Based Strategies for HPV Vaccination in Safety-Net Primary Care Settings

HPV vaccination rates remain below target levels among adolescents in the United States, which is particularly concerning in safety-net populations with persistent disparities in HPV-associated cancer burden. Perspectives on evidence-based strategies (EBS) for HPV vaccination among key implementation participants, internal and external to clinics, can provide a better understanding of why these disparities persist. We conducted virtual interviews and focus groups, guided by the Practice Change Model, with clinic members (providers, clinic leaders, and clinic staff) and community members (advocates, parents, policy-level, and payers) in Los Angeles and New Jersey to understand common and divergent perspectives on and experiences with HPV vaccination in safety-net primary care settings. Fifty-eight interviews and seven focus groups were conducted (n = 65 total). Clinic members (clinic leaders n = 7, providers n = 12, and clinic staff n = 6) revealed conflicting HPV vaccine messaging, lack of shared motivation to reduce missed opportunities and improve workflows, and non-operability between clinic electronic health records and state immunization registries created barriers for implementing effective strategies. Community members (advocates n = 8, policy n = 11, payers n = 8, and parents n = 13) described lack of HPV vaccine prioritization among payers, a reliance on advocates to lead national agenda setting and facilitate local implementation, and opportunities to support and engage schools in HPV vaccine messaging and adolescents in HPV vaccine decision-making. Participants indicated the COVID-19 pandemic complicated prioritization of HPV vaccination but also created opportunities for change. These findings highlight design and selection criteria for identifying and implementing EBS (changing the intervention itself, or practice-level resources versus external motivators) that bring internal and external clinic partners together for targeted approaches that account for local needs in improving HPV vaccine uptake within safety-net settings.