A four-phase framework for culturally responsive vaccine messaging

Abstract Background Efficacious messaging campaigns are essential for increasing vaccine uptake, particularly in communities with low coverage and heightened hesitancy. A major barrier to equitable vaccination is the lack of culturally responsive messaging that reflects the values and experiences of underserved minoritized populations. Despite growing recognition of cultural responsiveness, few studies offer systematic, theory-informed approaches to message design, implementation, and validation. To address this gap, we propose a four-phase framework that explicitly centers culture and behavioral theory into vaccine messages, with the goal of improving relevance, resonance, and effectiveness among marginalized groups. Methods Grounded in a design science approach, the framework comprises four integrated phases across seven sequential steps. Phase 1 involves formative research comprising an environmental scan of public health messaging (Step 1) and a systematic review of message efficacy studies (Step 2), as well as focus groups assessing the cultural responsiveness of existing messages (Step 3). Phase 2 includes belief elicitation through open-ended surveys to identify key factors influencing vaccine decisions (Step 4). Phase 3 uses quantitative methods to examine belief-based correlates of vaccination hesitancy and intentions (Step 5). Phase 4 applies findings from earlier phases to develop culturally informed message prototypes, assessed for appropriateness through focus groups (Step 6) and evaluated in a feasibility trial using a pre-post design (Step 7). Conclusion This four-phase framework offers a rigorous, replicable approach for developing theory-driven, culturally tailored health messages. It is intended for future vaccine communication initiatives and can be adaptable to other health behavior contexts and diverse minoritized populations.