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University of Kentucky (UK) College of Public Health (CPH) researchers, in collaboration with investigators from the College of Medicine and the College of Communication and Information at UK, and the Kentucky Department for Public Health (KDPH), are leading a 5-year, $3.7 million project to study COVID-19 vaccination hesitancy in Eastern Kentucky. 

K-VAC Project

The project, called the Kentuckians Vaccinating Appalachian Communities (K-VAC), addresses the lower vaccination rates in Eastern Kentucky compared to other parts of the Commonwealth and the U.S. through a personalized, community-engaged approach.

Rural Appalachian Kentucky communities are particularly vulnerable to COVID-19 morbidity and mortality, and while more than half of U.S. residents have received at least one dose of the vaccine, many Kentucky counties report much lower uptake. 

Kathryn M. Cardarelli, Ph.D., Marc T. Kiviniemi, Ph.D., are co-principal investigators (PIs) and researchers in the Health, Behavior & Society department at CPH. They are spearheading the multilevel approach that addresses the individual, relational and structural variables potentially contributing to vaccine-hesitancy in this region of Kentucky. 

K-VAC’s co-investigators include Angela Carman, Anna Hoover, and Emily Slade (CPH), Kevin Pearce, Jamie Sturgill (College of Medicine), Frances Feltner (Center of Excellence in Rural Health), Diane Francis (College of Communication and Information), and Emily Messerli (Kentucky Department for Public Health’s Immunization Branch). 

“Structurally, this region is rural, with many communities geographically isolated and with challenges with access to health care,” said Kiviniemi. “In addition to low socioeconomic status, and elevated levels of chronic disease, this population is placed at significant risk of complications and mortality due to COVID-19 infection. K-VAC’s vaccination interventions must use individually tailored, strong community partnerships and strategies to build trust with this community.”

“We are studying ways of simultaneously addressing the willingness to be vaccinated and vaccine accessibility and seeing if addressing those problems increases the portion of the populate that has received a vaccine, what we call ‘vaccine uptake," said Cardarelli.

“We understand that there are different attitudes and feelings about vaccinations. This collaborative, community-based research aims to build better, trustworthy communications to help populations make more informed, actionable decisions while addressing the structural barriers such as physical location, transit time, community features, access to healthcare, among others," Cardarelli adds.

To ensure that the project’s approach is responsive to the communities’ cultural, social, historical and economic contexts, K-VAC will be guided by a Community Advisory Board that includes members of the Kentucky River Health Consortium (KRHC). KRHC members represent more than 50 organizations within K-VAC’s target population, including human services organizations, health coalitions, law enforcement agencies, and managed care organizations.

“Vaccination is a critical strategy for reducing the COVID-19 overall burden and health disparities, yet vaccine intentions and uptake are unacceptably low in our partner communities in Appalachian Kentucky,” said Cardarelli. “Nationally, individuals with lower education, lower household income, and those living in rural areas are more likely to express COVID-19 vaccine hesitancy. I am excited to be a part of this project, in collaboration with our project and community partners, to improve the lives of this population.”

The K-VAC project will make active use of facilities in the UK Center of Excellence in Rural Health (CERH). CERH collaborates with rural communities and other stakeholders to develop more effective approaches to rural health service delivery, engages in rural health policy research and provides medical services to residents of Appalachian Kentucky. 

At the UK College of Public Health, our vision is to be the catalyst of positive change for population health. Our mission is to develop health champions, conduct multidisciplinary and applied research, and collaborate with partners to improve health in Kentucky and beyond. Learn more about our people, programs and passion for public health at

Research reported in this publication was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number R01MD016864. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.