Aspects of the COVID-19 vaccination campaign differed from routine vaccines, including emergency use authorizations, the prioritization of access, and the politicization of messaging. Subsequently, many parents reported lower vaccine confidence relative to routine vaccines, and vaccination coverage stalled below targets. This study aimed to understand parental vaccine decision making and compare COVID-19 versus routine vaccine decision making. We conducted nine virtual focus groups between 25 February 2022-11 March 2022 with parents ( = 41) of the Children's Hospital of Philadelphia's patients, recruited via email and stratified by vaccine hesitancy status (non-hesitant vs. hesitant). Transcripts were analyzed using the vaccine hesitancy matrix domains. Of 41 total participants, 25 (61.0%) were non-hesitant, 16 (39.0%) were hesitant or their children were not up-to-date on adolescent vaccines, and most self-identified as female (95.1%) and White/Caucasian (61.0%). Most participants (87.5%) were fully vaccinated against COVID-19 and many of their first children ( = 26, 63.4%) were vaccinated against influenza. Several themes emerged regarding decision making: individual influences, group influences, vaccine and vaccine program influences, and contextual influences. While some influences were similar for routine and COVID-19 vaccine decision making (e.g., needing evidence-based information), other factors were vaccine- or situation-specific. Building trust requires a multi-faceted concerted effort that involves addressing the complex vaccine decision-making process.

<p><strong>PURPOSE: </strong>The aim of the study was to determine whether supplementing a bundled recommendation (recommendation for all 11- to 12-year-old platform vaccines) with tailored messaging that addressed one versus all parental concerns improved human papillomavirus (HPV) vaccination intent among mothers.</p>

<p><strong>METHODS: </strong>We conducted a Web-based randomized controlled trial, randomizing mothers who did not intend to vaccinate their 11- to 14-year-old child against HPV to (1) bundled recommendation video ("control"); (2) control&nbsp;+ video addressing the top HPV vaccine concern; or (3) control&nbsp;+ ≥1 videos addressing all concerns. Outcomes were HPV vaccination intent (1&nbsp;= extremely unlikely and 10&nbsp;= extremely likely) and strength of main concern (1&nbsp;= a little concerned and 10&nbsp;= very concerned). We assessed differences in intervention effects using generalized linear models for vaccine intent and mixed models for the strength of main concern.</p>

<p><strong>RESULTS: </strong>Of the 762 mothers, 51% had a female child, 82% of children were white, and 90% were non-Hispanic. The mean intent to vaccinate postintervention ranged from 3.5 (95% confidence interval [CI]&nbsp;= 3.1-3.8) in the control group to 4.2 (95% CI&nbsp;= 3.9-4.6) in the all-concerns group (p&nbsp;= .01). The mean strength of the concerns declined pre- to postintervention by .1 (95% CI&nbsp;=&nbsp;-.1 to .3) in the control group (p&nbsp;= .42), .6 (95% CI&nbsp;= .4-.9) in the top concern group (p &lt; .001), and .7 (95% CI&nbsp;= .5-1.0) in the all-concerns group (p &lt; .001). However, the mean strength of the main concerns postintervention remained high (≥7.0 for each group).</p>

<p><strong>CONCLUSIONS: </strong>Tailored messages addressing all concerns improved HPV vaccination intent and reduced the strength of the main concern more than bundled messages alone, but intent remained low and strength of the main concerns remained high in this vaccine-hesitant population.</p>