Table 4.

Vaccine concern, key message attributes, types of visuals, and type of cultural targeting strategy.

Vaccine concerna			Key message attributes		Types of visuals		Cultural targeting strategy
Vaccine development
	Human protections in research	Acknowledge historical research abuses (eg, U.S. Public Health Service Syphilis Study, Henrietta Lacks). Provide examples of protections provided in research. Discuss how the community can be involved in the research process (eg, co–primary investigator, community advisory board, consultant).		Not applicable		Sociocultural, evidential
	Who is at the table?	Discuss researchers (ie, current job, expertise) across all backgrounds and their role in the development process. List their current jobs.		Researchers of diverse backgrounds (visual) Researcher describing role in vaccine development (video)		Sociocultural, evidential, peripheral
	Too new and too quick	Define mRNAb and its role in the body. Discuss the mRNA vaccine history and how it works in the body. Define what mRNA does not do (change DNA). Compare mRNA vaccine development to existing vaccine development processes. Define the EUAc. Discuss the number of vaccines given to date, adverse events, and how to identify those events. Confirm that being unvaccinated places one at higher risk of death compared to those who received the vaccine.		Timeline of COVID-19 vaccine development (visual and video)		Evidential, peripheral
	How research works	Define research. Define clinical trials and their phases. Define types of researchers. Define sites of research and who can participate. Discuss what happens after research.		Demonstration of phases in the clinical process and steps within each phase (visual)		Evidential, peripheral
Vaccine safety
	mRNA and DNA	State years of mRNA existence and mRNA’s role in the body. Explain the process of mRNA technology. Identify vaccines that use mRNA technology. Emphasize benefits of vaccination over natural immunity.		Demonstration of the mRNA technology process (visual and video)		Evidential, peripheral, linguistic
	Infertility	Demonstrate how the proteins needed for pregnancy and needed to make the spike protein are not the same. Emphasize that women are able to conceive, have a healthy pregnancy and baby, and breastfeed after vaccination. State that babies receive antibodies from vaccinated mothers. Highlight that COVID-19 may impact fertility in men. Highlight cons of nonvaccination in pregnant women (eg, increased risk of stillbirth, newborn deaths, hospitalization).		Explanation of pregnant women getting the vaccine or women conceiving getting vaccinated (video)		Evidential, linguistic
	Underlying medical conditions	State the reason to vaccinate with an underlying condition. State that the vaccine will not give an individual COVID-19. Discuss the vaccine schedule for those immunocompromised. Discuss the severity in COVID-19 if not vaccinated. State to consult with a doctor in getting the vaccine.		Explanation of why those with underlying medical conditions need the vaccine (video)		Evidential, linguistic
	Your heart	Define myocarditis and pericarditis. Compare the rate of heart problems in those who get vaccinated compared to those who get COVID-19. Demonstrate the symptoms and treatment of heart disorders. Emphasize the recommendation by infectious disease experts and the American Academy of Pediatrics for children.		Explanation of myocarditis and vaccination (video)		Evidential, linguistic
	GBSd (adult only)	Define GBS. Discuss the signs of GBS. Discuss the number of cases to date after vaccination. Emphasize that it is rare.		Not applicable		Evidential, linguistic
	Blood clots (adult only)	Identify the number of cases with the Johnson & Johnson vaccine. Discuss why the Food and Drug Administration (FDA) halted the clinical trial to determine whether risks of blood clots outweigh the benefits of the vaccine. State recommendation of Moderna and Pfizer vaccines over the Johnson & Johnson vaccine. Discuss the symptoms of blood clots. State the blood clot risk for those vaccinated and unvaccinated.		Symptoms of blood clots vs symptoms of COVID-19 (visual)		Peripheral, evidential, linguistic
	Side effects	Emphasize the number of years for COVID-19 research. Discuss the number of lives and hospitalizations prevented with vaccines. Identify the risk of allergic reactions and short-term side effects. Discuss that side effects are short-lived and everyone reacts differently. State that routine vaccinations show no long-term side effects.		Side effects of vaccination compared to natural infection through SARS-CoV-2 (visual and video)		Peripheral, evidential, linguistic
	Too young (parent only)	Emphasize the impact of COVID-19 on children. Provide recommendations for COVID-19 vaccination by age. Emphasize that vaccination protects them and others. State that the long-term effects of COVID-19 in children are unknown, but long COVID is seen in many.		Statistics of current COVID-19 cases in children and increases in COVID-19 cases, hospitalizations, and deaths in children overtime (visual)		Evidential, peripheral, linguistic
Vaccine effectiveness
	Unsure if it works	Define effectiveness and how to obtain it (ie, fully vaccinated). Demonstrate risks if not vaccinated.		Comparison of risk of hospitalization and death of those vaccinated vs not vaccinated (visual)		Peripheral, evidential, linguistic
	Variants	Define “breakthrough case.” Discuss mutations and how new variants are created. Discuss the impact of emerging variants on vaccines and health. Emphasize the impact of virus on short- and long-term health.		Not applicable		Evidential, linguistic
	Natural immunity	Define natural immunity versus vaccine-induced immunity. Emphasize vaccine-induced immunity being much safer than natural immunity. Discuss the “gamble” in natural immunity over vaccine-induced immunity. Discuss the benefits of vaccination despite having COVID-19.		Comparison of the health risks of those with natural immunity and those vaccinated (visual and video)		Peripheral, evidential, linguistic
	Too many vaccines	Discuss the lack of danger of multiple vaccines at a time. Remind people of receiving many vaccines at once as a baby and preteen. Compare the number of proteins in the vaccine to the number of proteins if exposed to SARS-CoV-2.		Not applicable		Evidential, linguistic
	Boosters. Why?	Define boosters and why they are needed. Discuss booster recommendations. Emphasize discussing getting a booster with a provider.		Stating the vaccine dose and booster schedule of each vaccine (image) Defining a booster and why we need it (video)		Evidential, peripheral, linguistic
	Is it even needed?	Discuss transmission routes and rates by variant. Compare COVID-19 hospitalization, long COVID, and death rates among those vaccinated and unvaccinated. Discuss the susceptibility and severity of COVID-19 and the importance of vaccination.		Tracker of COVID-19 rates and deaths (United States and Tennessee)		Evidential, peripheral, linguistic

^aAll vaccine concerns were vetted by community leaders and members (ie, constituent-involving strategy) and edited to be comprehendible (ie, linguistics).

^bmRNA: messenger RNA.

^cEAU: emergency use authorization.

^dGBS: Guillain-Barré syndrome.