Graduation Date

Spring 5-4-2024

Document Type


Degree Name

Doctor of Philosophy (PhD)


Medical Sciences Interdepartmental Area

First Advisor

Russell McCulloh

MeSH Headings

COVID-19 Vaccine, HPV Vaccine, Mobile Application, Vaccination Hesitancy


Background. Mobile Health (mHealth) interventions, when meant to serve as decision support, require an in-depth investigation of current workflows and decisional needs to ensure future usability and acceptability. Rural groups were prioritized due to their limited healthcare access, and therefore, their increased need for interventions like mHealth apps that address health disparities.

Objective. To assess the decisional needs of parents/caregivers and/or Healthcare Providers (HCPs) in rural areas regarding emergencies with children with medical complexity (CMC, Project 1), COVID-19 vaccination (Project 2), and HPV and COVID-19 vaccination (Project 3).

Methods. Parents and HCPs were approached through various methods for participation, primarily by phone. Based on their background, they either participated in a focus group or key informant interview (KIIs). These interviews were de-identified, transcribed, analyzed for themes, and summarized into recommendations for future mHealth app changes.

Results. Our study of rural parents and emergency medical providers (Project 1) revealed that respondents found the Emergency Information Form (EIF) to be an easy way to engage parents and emergency personnel about the specifics of a CMC’s care before or during an emergency. They also identified areas for improvement regarding the organization, deployment, and optimal usage of the EIF in practice.

Our study of high-priority parents (Project 2) revealed that COVID-19 vaccine hesitancy encompasses multi-factorial concerns among parents/caregivers. These encompassed themes of vaccine newness, over-politicization, concerns about social pressure, and possible negative side effects.

Our study of rural parents and HCPs (Project 3) revealed that rural parents/caregivers and some HCPs were less familiar with the HPV vaccine, as compared to COVID-19 vaccines, and actively wanted more information on the vaccine. Parents/caregivers also reported that, beyond rapport with their HCP, they value external infographics, consistent vaccine discussions while they are not ready to vaccinate, and straightforward answers. From these results, a mHealth tool was constructed.

Conclusion. Phase 0 research to determine the information needs and workflows of parents/caregivers and healthcare providers can provide critical insights for mHealth intervention design and delivery, thus potentially increasing the effectiveness of these interventions in real-world settings.


2024 Copyright, the authors

Available for download on Friday, March 28, 2025