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Effective public health messaging has been necessary throughout the COVID-19 pandemic, but stakeholders have struggled to communicate critical information to the public, especially in different types of locations such as urban and rural areas.
This study aimed to identify opportunities to improve COVID-19 messages for community distribution in rural and urban settings and to summarize the findings to inform future messaging.
We purposively sampled by region (urban or rural) and participant type (general public or health care professional) to survey participants about their opinions on 4 COVID-19 health messages. We designed open-ended survey questions and analyzed the data using pragmatic health equity implementation science approaches. Following the qualitative analysis of the survey responses, we designed refined COVID-19 messages incorporating participant feedback and redistributed them via a short survey.
In total, 67 participants consented and enrolled: 31 (46%) community participants from the rural Southeast Missouri
We suggest convenient methods for community involvement in the creation of health messages by using a brief web-based survey. We identified areas of improvement for future health messaging, such as reaffirming the preventive practices advertised early in a crisis, framing messages such that they allow for personal choice of preventive behavior, highlighting well-known source information, using plain language, and crafting messages that are applicable to the readers’ circumstances.
Since the emergence of SARS-CoV-2 in 2019 and its resultant disease, COVID-19, public health communication has rapidly adapted to constantly changing information. Adding complexity to public health messaging, the arrival of variant strains, vaccinations [
In 2002, the US Centers for Disease Control and Prevention (CDC) published manuals such as the Crises and Emergency Risk Communication [
In addition, rural populations reported distinct beliefs about the COVID-19 pandemic [
To address missteps in health messaging early in the pandemic, researchers and public health professionals must examine the efficacy of health messages and identify best practices. Currently, there continues to be a need for efficient health messaging regarding COVID-19 risks, treatment, prevention, and vaccination [
Community participants were recruited from 2 regions of Missouri, Southeast Missouri (the
From July 2020 to September 2020, the research team reviewed the existing public health messages to be used in the surveys. Two research team members used a search engine (eg, Google [Google LLC]) and social media (eg, Facebook [Meta Platforms, Inc] and Instagram [Meta Platforms, Inc]) to identify local, state, national, and international COVID-19 public health messages. Following the full team review, we chose 2 messages in each of the following two types: (1) risk presentations and (2) infographics. A total of 4 messages were chosen because they varied in content, format, and imaging, and they were widely used in the media. Only 4 messages were selected to ensure adequate time in the web-based interview to fully explore how participants responded to the health information in 2 messages, along with their preferences associated with the overall content, format, and imaging in the selected messages. The selected messages were focused on prevention protocols and presented COVID-19 risk using various visual communication strategies. Their sources represented a range of experts (eg, the World Health Organization [WHO], the CDC, and Doctor of Medicine groups) and are described in detail in
Summary of the messages for each message seta.
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Message set 1 | Message set 2 | |||
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1A | 1B | 2A | 2B | |
Title | “Stop the Spread of Germs” |
“COVID-19 Risk Index” |
“Avoid the Three Cs. Be Aware of Different Levels of Risk in Different Settings” |
“Two Metres or One: What Is the Evidence for Physical Distancing in Covid-19?”b | |
Citation | [ |
[ |
[ |
[ |
|
Content and text | Depicts protocols for preventing the spread of COVID-19 and other respiratory viruses, including washing hands, wearing a face covering, and staying 6 ft away from others |
Divides common activities into columns based on risk level (ranging from “low” to “high” risk) Lists 4 factors that affect risk Tells viewers to wear a mask |
Describes the 3 Cs—3 factors that increase the likelihood of spread: “crowded places, close-contact settings, and confined and enclosed spaces” States what actions the viewer should take |
Depicts the risk of COVID-19 transmission based on multiple factors: whether people are silent, speaking, or shouting or singing; whether face coverings are worn; how long the contact lasts; the level of occupancy; and ventilation quality | |
Images | Simplified drawings of people performing the recommended protocols |
5 columns colored according to the risk level and filled with black icons representing different activities A black and white image of a mask |
3 circles depicting simplified drawings of the 3 Cs A Venn diagram of the 3 Cs Small black drawings of the recommended protocols |
Cells in tables filled with different colors depending on the risk level | |
Colors | Blue, green, and gold |
Shades of green, orange, yellow, and red |
Blue, yellow, and red |
Red, yellow, and green |
a1A, 1B, 2A, and 2B are the image abbreviations used.
bOn the basis of the figure presented in the study “Two Metres or One: What Is the Evidence for Physical Distancing in Covid-19?” [
All surveys and interview guides were approved by the Washington University Institutional Review Board (#202010069). All research procedures were approved by the Washington University School of Medicine Institutional Review Board.
Given the potential differences between urban and rural populations, we surveyed populations from 2 distinct regions, urban St Louis, Missouri, and the rural Southeast Missouri
We surveyed participants to elicit their opinions on COVID-19, including their preferences for preselected COVID-19 messages. The survey session lasted an average of 1 hour for each participant. Participants received a US $50 gift card for their time.
In the context of the COVID-19 pandemic, when in-person interviews were not considered appropriate or safe, the research team operationalized a web-based approach to capture participants’ opinions. To recruit participants, the research team members broadly distributed a web-based survey link via social media (eg, Facebook, Twitter [Twitter, Inc], and Craigslist [Craigslist, Inc]). This survey collected the participants’ contact information, including their email addresses, which were then kept within an Institutional Review Board–approved, password-protected database. After a participant completed the survey and was found eligible, the study team contacted them to schedule the full survey evaluating health messages. Public participants were eligible to participate if they were (1) self-reported English speakers, (2) aged 18 to 80 years, and (3) residing in either the Bootheel or St Louis. Our age cutoff for eligibility was 80 years owing to limitations in the feasibility of recruiting older adults remotely during COVID-19 surges, concerns over access to technology among this population, and potentially differing risk reduction recommendations for older adults. Participants were considered residents of the Southeast Missouri Bootheel if they lived in Dunklin, Stoddard, Mississippi, Pemiscot, or New Madrid County. Participants were considered St Louis residents if they lived in St Louis City or County. Health care professionals were eligible to participate if they (1) were self-reported English speakers, (2) resided in either the Bootheel or St Louis, and (3) self-identified as a health professional (eg, Registered Nurse, Licensed Practical Nurse, Doctor of Medicine, or Doctor of Osteopathic Medicine). Staff reached out directly via email or phone to eligible participants and scheduled a web-based appointment on a Health Insurance Portability and Accountability Act (HIPAA)–compliant Zoom (Zoom Video Communications, Inc) account for their participation in the study. Survey data were collected and managed using the REDCap (Research Electronic Data Capture; Vanderbilt University) system hosted at the Washington University [
To reduce participant burden and enhance the feasibility of survey completion, the messages were divided into 2 sets and randomly assigned to roughly equal numbers of participants by the research team before each survey. The purpose of random assignment was not to determine differences between message sets but to evaluate participants’ opinions on multiple types of health messages.
The research team conducted the surveys with participants between November 2020 and February 2021 (
Shorter, focused surveys were conducted with health care professionals using the same methods, but the questions were designed to capture the needs of their patient populations (
To analyze the qualitative data, the research team members used inductive thematic analysis [
We used various methods to ensure qualitative rigor [
In line with the goal of equity in the dissemination of study results to end users [
A total of 67 participants completed the study, with 31 (46%) community participants from the Bootheel, 27 (40%) community participants from the St Louis area, and 9 (13%) health care professionals from the St Louis area. Overall, 52% (35/67) of participants reviewed message set 1, and 48% (32/67) of the participants reviewed message set 2.
In terms of COVID-19 exposure, more participants in the Bootheel knew someone close to them who tested positive for COVID-19 (19/31, 61% compared with 13/27, 48% in STL) or who was hospitalized for COVID-19 (25/31, 81% compared with 14/27, 52% in STL). More participants in the Bootheel responded that they could count on people in their neighborhood to help them (28/31, 90% compared with 16/27, 59% in STL) and go to the store for them if they were sick (25/31, 81% compared with 15/27, 56% in STL). Participants in the Bootheel rated the degree to which the pandemic created financial problems for themselves or their family higher than those in St Louis (
Baseline participant characteristics of the final sample (N=67)a.
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Region | ||||||
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Public (St Louis metro area; n=27) | Public (Southeast Missouri |
Health care professionals (St Louis metro area; n=9) | ||||
Age (years), mean (SD; range) | 38.0 (13.7; 24-67) | 30.3 (10.1; 19-68) | 34.9 (7.11; 25-47) | ||||
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Man | 12 (44) | 20 (65) | 2 (22) | |||
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Woman | 15 (56) | 10 (32) | 7 (78) | |||
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Nonbinary | 0 (0) | 1 (3) | 0 (0) | |||
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Black | 15 (56) | 13 (42) | 6 (67) | |||
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White | 11 (41) | 16 (52) | 3 (33) | |||
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Hispanic or Latino | 1 (4) | 0 (0) | 0 (0) | |||
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American Indian or Alaska Native | 0 (0) | 1 (3) | 0 (0) | |||
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Asian or Pacific Islander | 0 (0) | 0 (0) | 0 (0) | |||
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Other | 0 (0) | 1 (3) | 0 (0) | |||
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Less than bachelor’s degree | 8 (30) | 7 (23) | —b | |||
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Bachelor’s degree or higher | 19 (70) | 24 (77) | — | |||
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<15,000 | 2 (7) | 2 (6) | — | |||
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15,000-34,999 | 2 (7) | 0 (0) | — | |||
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35,000-54,999 | 6 (22) | 8 (26) | — | |||
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55,000-74,999 | 3 (11) | 15 (48) | — | |||
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≥$75,000 | 12 (44) | 6 (19) | — | |||
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Prefer not to say | 2 (7) | 0 (0) | — | |||
Health literacy, mean (SD; range) | 14.5 (2.3; 11.0-19.0) | 14.2 (2.4; 10.0-18.0) | — |
aTotals were calculated by column.
bWe did not collect education, income, health literacy, social, or economic data from health care professionals.
Social and economic impacts of COVID-19 for the public participants.
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Region | ||
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Public (St Louis metro area; n=27) | Public (Southeast Missouri |
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Yes | 8 (30) | 26 (84) |
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No | 18 (67) | 5 (16) |
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Not sure or do not know | 1 (4) | 0 (0) |
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Yes | 13 (48) | 19 (61) |
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No | 12 (44) | 11 (36) |
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Not sure or do not know | 2 (7) | 1 (3) |
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None | 5 (19) | 0 (0) |
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1 | 3 (11) | 4 (13) |
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2-5 | 13 (48) | 18 (58) |
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≥6 | 6 (22) | 9 (29) |
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|||
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Yes | 14 (52) | 25 (81) |
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No | 11 (41) | 5 (16) |
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Not sure or do not know | 2 (7) | 1 (3) |
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|||
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Yes | 9 (33) | 9 (29) |
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No | 18 (67) | 20 (65) |
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Not sure or do not know | 0 (0) | 2 (7) |
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|||
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Agree | 16 (59) | 28 (90) |
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Disagree | 11 (41) | 3 (10) |
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|||
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Agree | 15 (56) | 25 (81) |
|
Disagree | 12 (44) | 6 (19) |
How worried have you been about not being able to afford or access food because of the COVID-19 outbreak? (on a scale ranging from 1 [not worried at all] to 5 [somewhat worried] to 10 [extremely worried]), mean (SD; range) | 3.0 (2.6; 0-9) | 5.6 (2.8; 0-9) | |
How worried have you been about access to important resources such as transportation or housing due to the COVID-19 outbreak? (on a scale ranging from 1 [not worried at all] to 5 [somewhat worried] to 10 [extremely worried]), mean (SD; range) | 3.0 (3.3; 0-9) | 5.3 (3; 0-9) |
We did not identify any qualitative differences between the participants from the St Louis region and those from the Bootheel in how they responded to the messages or in their suggestions for improving the messages. Common themes for all groups included participants’ preference to see the main COVID-19 protocols in messages, desire for personal choice with regard to COVID-19 preventive behaviors, and suggestions for clear and easily accessible source information. Although health care professionals had responses similar to those of both public samples, they more often named health literacy as a factor that could compound the patient’s perceptions and made suggestions for their specific patient populations. Qualitative results are presented in the subsequent sections with italicized interviewer notes used to summarize participants’ responses to open-ended questions in the survey.
Many participants recognized the main COVID-19 protocols as behaviors such as hand washing, maintaining 6 ft of social distancing, and wearing a mask [
Yes something is missing, they should include good ways in wearing a mask, information there that shows where a person wear a mask, not leave nose uncovered, chances of transmit[ing] the virus
Another participant said the following:
What about washing hands, other preventive messages...should be part of every message
The presentation of risks across various activities appeared to resonate with participants’ interest in personal choice or the freedom to make their own choices regarding their health and safety. One of the participants said the following:
I believe people have the right to make their own choices. This isn’t telling people what to do; it just...tells them about the risk. So if you do everything they recommend, your risk is low, but it allows me to make the decision for myself.
Similarly, another participant said the following:
I don’t feel like they’re telling you what to do, they’re just giving you guidance on how to avoid certain situations and getting COVID.
A health care professional commented the following:
I like the spectrum rather than do this and don’t do this; more realistic [because] nothing is zero risk
Another participant said that they liked that the message “doesn’t feel too preachy” (Interviewer notes of the response of P30 from STL about message 2A).
Most participants described “good” source information as being apparently authentic because of the presence a large logo, coming from a trusted source, and including resources for follow-up. Follow-up could mean obtaining more information about the message or COVID-19 or receiving contact information on whom to call in case one experiences COVID-19 symptoms. One of the participants said the following:
[It’s missing] maybe the CDC website or something...I don’t know who this is coming from. I should trust this, I guess...it’s missing the CDC or something.
Another participant said that the message should provide “a piece of contact information, such as a number to call...There should be information on who to contact if I suspect someone has COVID-19, is exhibiting symptoms” (Interviewer notes of the response of P192 from the Bootheel about message 1A). A participant also remarked that the message “had no source, web link...[I am] not likely [to follow-up]. I don’t know [the] journal and don’t see [the source] as a link” (Interviewer notes of the response of P200 from the Bootheel about message 2B).
After we asked them which sources in a provided list they used before, they then identified which source they used the most as a free-response answer. The most preferred sources among the participants in St Louis were local news; social media, such as Twitter and Facebook; the WHO; and the CDC, whereas the most preferred sources in the Bootheel were social media, the WHO, and newspapers. For health care professionals, the most preferred sources were the CDC, newspapers, and local news stations.
Health care professionals contextualized their suggestions within the applicability of the messages to their patients. They assessed whether the actions outlined in the messages were applicable to their patient populations with limited health literacy or who were older, had low income, or spoke English as a second language. One of the health care professionals said the following:
I think [telling people to stay home when they’re sick] triggers people. A lot of people...can’t do that because of their financial situation, lack of sick leave, or other things.
One of the providers gave the following answer:
A lot of it [would be confusing] for my patients, most of my patients speak Spanish.
Another provider said the following:
For some, not everything in here might...be practical. For example, staying 6 feet apart might not be practical for people...[like for those] sharing an apartment or a house with multiple people.
A health care professional who worked in a health home answered that the advice regarding avoiding close contact would be hard because “some patients like that physical contact...Some people are also hard of hearing, so you would have to get close to them so they can hear you” (Interviewer notes of the response of health care professional P276 about message 2A).
Community participants’ suggestions for message improvement aligned with the best practices for health literacy [
Although the health care professionals’ suggestions also aligned with the principles of health literacy, they were more likely to specifically reference the terms “literacy” or “health literacy” when gauging the potential impact of the message. For example, one of the health care professionals commented that “some of the visual language is less clear, people with low literacy would be [confused]” (Interviewer notes of the response of health care professional P156 about message 1A)
I think it’s highly detailed if you have the time and literacy...but as a general service announcement, I don’t think it’s that effective.
Yet another health care provider said the following:
I think it’s really good but there’s a lot of blocks, which I think someone educated with good eyesight that’s fine, but for someone who is older or low literacy that is too much going on.
For more suggestions and quotes on this topic, see
Public participants’ suggestions for improving the messages with health literacy principles.
Participants’ suggestions | Examples and quotes |
Use clear language that is easy to understand; vague terms without definitions are confusing. |
Examples of phrases that were confusing: “Reopen intelligently” Vague use of “duration” “When near people, wear a mask” “Forceful exhalation” “Face covering” “High or low occupancy” “Opening intelligently” |
Ensure that the “most important” images and messages stand out by making them larger and placing them along the top or top left. |
“The mask is a message that needs to be reinforced. If people are going to look at anything, they’ll look at the top row. The middle is busier, so people won’t glance at that, they’ll glance at the top” (Interviewer notes of the response of health care professional P85 about message 1A). |
Remove any information that is not strictly necessary to prevent overwhelming viewers. |
“What’s really good about this piece is that it puts so much information in one space there is no unnecessary information and it is clear even for people that may not fully understand English” (Interviewer notes of the response of P224 from the Bootheel about message 2A). “I think this one is not as good as the other one. I feel like people are not as likely to really decipher through all the color coding and different info. I feel like the other was more straight forward, direct, easy. This one you have to spend a little more time with it and dig into it” (Interviewer notes of the response of P131 from STL about message 2B). |
Ensure that the image is not busy, cluttered, or cramped, and sufficiently space out text and images. |
“I feel like it’s too much. They could make it simpler. I can’t even read it, the print is too small. I would need glasses. For example, if this was hung up in a restaurant, I wouldn’t stop to look at it cause it’s just too much, and the print is too small” (Interviewer notes of the response of P269 from the Bootheel about message 1B). “Too info dense; too much wording...given the format it’s cluttered and crowded with too much text” (Interviewer notes of the response of P156, from STL about message 1B). |
Colors chosen for the image should enhance the attractiveness and understandability of the message. |
“It is a lot more clear because of the colors; [I] suggest a lot more colors and brighter colors so it is more eye-catching” (Interviewer notes of the response of P268 from the Bootheel about message 1B). “It is beautiful for the color which makes it easier to understand” (Interviewer notes of the response of P219 from the Bootheel about message 2B). “It catches your attention, the bright colors draw you in” (Interviewer notes of the response of P15 from STL about message 2A). |
People in the images should be diverse (eg, gender, race, and ethnicity) but more realistic looking. |
“Better images—use real individuals to be more legible, not every person can like cartoons, real people be better” (Interviewer notes of the response of P146 from STL about message 1A). “I think I’d prefer eyes, nose, and mouth on people. It does look a little funny. I like the diversity of it” (Interviewer notes of the response of P23 from STL about message 1A). |
Messages should have emotional appeal to be effective. |
“Message like this could appeal more to people’s human nature, something to suggest this is dangerous, people are dying and this is very important, this is informative but doesn’t touch people’s emotions” (Interviewer notes of the response of P05 from STL about message 1A). |
On the basis of the survey feedback on our first message sets, we designed new messages to reflect participants’ perspectives. Specifically, we used a list of clear questions rather than directives so that messages could be more readily received and allow readers to make various choices regarding preventive behaviors. We also depicted a diverse (eg, race and ethnicity and age) range of people and activities (eg, eating and outdoor activities) and provided a section on masks that reinforced the main COVID-19 protocols and a link for learning more to establish greater trust with the source. Using the same principles, we also created a message set dedicated to clarifying the postvaccination status. We aimed to reiterate the main COVID-19 protocols [
Of the original 65 participants we were able to reach via email (2 participants did not provide an email or gave invalid email addresses), 54 completed the survey, leading to an 83% completion rate. Most participants had an overwhelmingly positive response to the new messages and agreed that the new messages incorporated their feedback from the surveys. Overall, the participants liked the content, bright colors, and simple wording. Common themes expressed by most participants were that they appreciated the simple, precise wording and liked the bright, distinct colors that caught readers’ attention and positive emotional appeal. A participant in St Louis (P23) said that the reminders of what people could do after vaccination “shines” (Interviewer notes of the response of P23 from STL). One of the participants commented the following:
I’m quite impressed by how simple and illustrative the messages are and by just a quick glance I’m able to understand what message the sender wants to portray.
Another participant said the following:
Yes, [they included my feedback], most certainly so. They made the words larger so everyone can see and also they used more graphic pictures that can be interpreted easily.
Despite the anticipated differences between the urban and rural populations’ responses to COVID-19 health messages, both groups responded similarly. Both wanted health messages that were consistent, were attractive, were accessible, and emphasized choice in behavioral responses to the pandemic. Furthermore, although our public sample in the Bootheel may have experienced higher COVID-19 exposure and worse social and economic impacts of the pandemic, as indicated by their response to our survey questions on COVID-19, and thus could have had more particular desires for messages owing to personal contexts, the messaging preferences were largely the same between the Bootheel and St Louis samples. This result differs from studies that have found differences between urban and rural populations’ responses to COVID-19 messages [
The participants described their preference for COVID-19 protocols to be succinctly presented in each message they saw. They were especially drawn to messaging that called for the use of face masks, social distancing, and other preventive measures. These findings are supported by similar studies conducted in different locations and suggest potentially complex relationships between people and the preventive health behaviors that public health officials, governments, and researchers encourage during health crises. Such actors inconsistently promoted the use of nonpharmaceutical interventions such as masking, and this inconsistency persisted and left members of the public confused on whether masks were advised or which type of mask to wear [
The participants also preferred that personal choice be reflected in COVID-19 messages. That is, they wanted COVID-19 messaging to present the possible repercussions of nonadherence to protocols to inform individuals’ decisions. The importance of personal choice may reflect American beliefs surrounding individual liberties, and messages that appear to infringe on personal freedoms can lead to a decreased likelihood of enacting preventive behaviors [
The trustworthiness and accessibility of the source of information generated concern among the participants. They wanted to see credible sources and suggested including larger logos for trusted sources, such as the WHO or CDC. They also wanted to see contact information for sources, such as phone numbers or websites. Participants across our samples listed local sources such as friends, family members, local news, physicians, or other health care professionals as their most used sources of information on COVID-19. This finding is consistent with studies that found that facilitating relationships with local stakeholders and health care providers is essential for building trust in COVID-19, especially in rural communities [
The health care professionals in our study emphasized the need for applicability in COVID-19 messages. They expressed that health messages should be created with the patient populations’ literacy levels and ability to adequately follow the advised protocol in mind. Other studies have suggested the importance of explaining viral spread according to the reader’s level of understanding [
Participants’ preferences for COVID-19 health messages reflected the best practices for health literacy, emphasizing the importance of these concepts for successful COVID-19 and other health messages. Aspects such as clear communication, prioritization, conciseness, legibility, attractiveness, realism, and emotional appeal were highlighted as essential components for any COVID-19 message [
Following our initial analysis, the results of which indicated similarities in messaging preferences, we created a short web-based survey for original participants to comment on new messages created based on their original surveys, continuing participants’ engagement in the research process. Our high completion rate for the survey on message redistribution and participants’ appreciation for the incorporation of their feedback from the initial surveys indicate the importance of continued contact with research participants. Disseminating results back to participants and engaging them throughout the message development process can improve the trust in researchers and strengthen the ties between research organizations and various communities. Other studies have found that creative methods of recontacting participants and disseminating results in the form of community listening sessions or research forums can improve the willingness to participate in research [
Informed by our findings, we created refined health messaging that incorporated the themes participants discussed during their surveys to disseminate examples of health messaging that both incorporated participants’ varied preferences and aligned with health communication best practices. These messages were action oriented and uniquely addressed personal choice in health prevention, common health protocols, and accessible source information. We used a list of questions to prompt readers to consider their risk when planning activities to present less overwhelming visual content and align with participants’ preferences for personal choice. When communicating complex topics, such as personal risk and probabilities, researchers and public health officials often use visual depictions, such as icon arrays and figures, to help enhance the understanding of numerical estimates [
This study has multiple limitations and strengths that indicate potential avenues for future research on people’s opinions related to health messaging. First, we used self-selection methods for recruitment, which may have attracted individuals who were highly motivated to participate in a study related to COVID-19. These methods may have also resulted in samples of people with higher incomes, educational attainment, and health literacy scores than the general public in both St Louis and the Bootheel. At the time of data collection, which was during the early phases of the COVID-19 pandemic, remote recruitment based on self-selection was our only recruitment option, which likely limited the populations we were able to reach for our study. These methods may also have resulted in samples of people with higher health literacy scores, incomes, and educational attainment than the general public in both St Louis and the Bootheel. Such selection bias may suggest that participants were more predisposed to respond positively to COVID-19 mitigation efforts and express preferences for messaging that suggested behavioral interventions for COVID-19 spread. Difficulties in recruiting health care professionals in the Bootheel likely arose because of the overall lack of providers in the area and the strained schedules of providers during the time of the study. Future research can use different recruitment methods to gather a more representative sample of urban and rural regions to adequately examine the nuances in regional responses to health messaging.
Potentially owing to our sampling methods, our results differ from other findings of rural populations’ hesitance and distrust toward behavioral recommendations related to COVID-19 [
In addition, although our data represent participant perspectives from a relatively early point in the pandemic, the message redistribution method may continue to prove useful when examining other health literacy issues in the context of urban and rural health disparities. These disparities continue to be observed in cancer prevalence [
This analysis of participants’ responses indicates areas of improvement for future health messaging, such as reaffirming common COVID-19 protocols, framing content such that it allows for personal choice, and advertising easily accessible source information. Messages communicated by health care professionals should align with the needs of specific patient populations, and all messages must include plain language, effective wording, emotional appeal, and an attractive design. Participants’ engagement in message creation can aid in health equity implementation. These findings are critical for stakeholders developing public health messages for the COVID-19 pandemic and other public health crises.
The survey given to the members of the public samples during this study.
The survey used for the providers in our study.
The messages we created in response to participant feedback as well as the brief survey we used to collect participants’ opinions on the newly created messages.
Centers for Disease Control and Prevention
Health Insurance Portability and Accountability Act
Research Electronic Data Capture
St Louis metropolitan region
World Health Organization
MP was a consultant for UCB biopharma in 2022 on a topic unrelated to this manuscript.
Research reported in this publication was supported, in part, by the Washington University Institute of Clinical and Translational Sciences grant UL1TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.
Data are available upon reasonable request to the corresponding author. Data are not publicly available to protect the confidentiality of the study participants.