Trust in Vaccine Information Sources, Perceived Message Credibility, Healthcare Provider Recommendations, and Influenza Vaccine Hesitancy and Uptake Among Rural Adults in Indiana

To examine associations between trust in influenza vaccine information sources, perceived message credibility, healthcare provider (HCP) influenza vaccine recommendations, and influenza vaccine hesitancy and uptake among adults living in rural Indiana. We surveyed adults from two rural northern Indiana clinics between May 2024 and March 2025. Influenza vaccine hesitancy was measured using a validated nine-item scale, and vaccine uptake was assessed by self-reported influenza vaccination within the past year. Multivariable linear and logistic regression analyses with multiple imputations examined associated factors. Among 213 participants, 78.9% trusted HCPs and 54.0% trusted professional organizations as influenza vaccine information sources. Trust in influenza vaccine information from HCPs (B = -1.09, 95% CI: -1.42, -0.76), professional organizations (B = -0.30, 95% CI: -0.58, -0.03), and receiving HCP vaccine recommendations (B = -0.79, 95% CI: -1.05, -0.52) were associated with lower influenza vaccine hesitancy. Greater perceived bias in vaccine information from mass media was associated with higher hesitancy (B = 0.13, 95% CI: 0.03, 0.22), while greater perceived bias in social media was associated with lower hesitancy (B = -0.10, 95% CI: -0.19, 0.00). Receiving HCP vaccine recommendations was strongly associated with vaccine uptake (aOR = 12.69, 95% CI: 4.04, 39.83), whereas trusted influenza vaccine information from family members (aOR = 0.22, 95% CI: 0.05, 0.93) and higher hesitancy (aOR = 0.16, 95% CI: 0.07, 0.35) were associated with lower uptake. Rural HCPs remain a trusted vaccine information source in this rural population. Strengthening vaccine-specific clinical communication strategies and addressing broader determinants of hesitancy may improve influenza vaccination uptake in rural populations.