Background: In August 2021, only 47.6% of all eligible residents in South Carolina (SC) had received at least one dose of the COVID-19 vaccine, with only 41% having completed their vaccination series. Additionally, only 27% of all Hispanics in SC had completed their vaccination series compared to 34.1% of non-Hispanics. Vaccine hesitancy is a complex phenomenon that is context and vaccine-specific. Focusing on unvaccinated Hispanics living in rural areas of SC, this study aimed to identify barriers to vaccination and provide an educational intervention designed to address vaccine hesitancy.Methods: A complex mixed-methods evaluation design was used to conduct this study. First, in-person vaccine educational sessions were implemented, along with a pre-post-test survey, to assess changes in knowledge, attitudes, motivations, barriers, and intentions to receive COVID-19 vaccination. Second, in-person follow-up focus groups were held with the same participants to gather in-depth insight about participants’ knowledge and attitudes about the COVID-19 vaccination. Third, an online follow-up survey was conducted to assess the effect of the training and discussion session on COVID-19 vaccination. Study outcomes were assessed among the 17 individuals who participated in the educational sessions and focus group discussions.Results: Findings revealed that for unvaccinated Hispanics living in South Carolina; vaccine hesitancy was primarily driven by: 1) misinformation and information coming from unverified sources and 2) negative perceptions of the safety and effectiveness of the COVID-19 vaccines. Specifically, participants were fearful that the vaccine development was rushed and that the vaccines might contain questionable ingredients that could cause strong side effects or even death. Participants were also concerned that vaccination might cause them to get sick and be hospitalized, which would have financial implications since they could not afford healthcare or take time off work.Conclusions: Program implementation and mass communication campaigns should focus on COVID-19 vaccine safety and effectiveness, including side effects, what to expect after being vaccinated, and how to look for information from reputable sources. The educational session implemented proved to be effective and helped reduce vaccine hesitancy since most participants (80%) self-reported receiving a COVID-19 vaccine after program participation.

Background: Access to mental and physical healthcare in rural areas is challenging for Veterans and their families but essential for good health. Even though recent research has revealed some of the challenges rural Veterans face accessing healthcare, a complete understanding of the gap in access is still unclear. Methods: This qualitative study aimed to explore participants’ perceptions of healthcare access. Structured interviews were conducted with 124 Veterans and spouses of Veterans from rural qualifying counties in South Carolina and Florida. Results: The study’s results revealed five main dimensions of access: geographic proximity, transportation, communication, cultural competence, and resources. Distance to service needed can negatively impact access for Veterans and their families in general, especially for those whose health is declining or who cannot drive because of their age. Lack of transportation, problems with transportation services, and lack of public transportation can lead to delays in care. Additionally, the lack of communication with the Veterans Affairs (VA) Health System and with the healthcare team, as well as inefficient communication among the healthcare team, lack of coordination of care between the VA health system and community providers, and the lack of cultural competence of healthcare providers and contracted personnel made access to services even more challenging. Conclusions: Improving communication can help to develop a sense of trust between Veterans and the VA, and between Veterans and spouses with the healthcare team. It can also lead to increased patient satisfaction. Ensuring healthcare providers and contracted personnel are culturally competent to talk and treat Veterans can improve patient trust and adherence to treatment. Lastly, resource-related challenges included financial problems, lack of prompt access to appointments, lack of providers, limited access to local clinics and hospitals, limited local programs available, and reimbursement issues.

Background: Diabetes is a complex, prevalent condition. Effective diabetes self‐management requires knowledge, skills, and strategies to prevent or delay the onset of diabetes‐related complications. This study evaluated the effectiveness of delivery methods, online versus in‐person, for the 4‐month‐long Health Extension for Diabetes (HED) program, a self‐management support program. Methodology: A quasiexperimental comparative study design assessed whether online HED delivery was as effective as in‐person delivery and whether group differences affected health outcomes. Multivariate analysis of covariance (MANCOVA) was conducted to assess changes in participants’ weight, BMI, HbA1c, diabetes self‐efficacy, knowledge, and self‐management behaviors. This study included a total of 1018 participants ( o nline = 613; i n‐ p erson = 405). The online program was delivered synchronously via video or phone conferencing platforms, while in‐person sessions occurred at a community location. Survey and biometric data were collected at baseline and upon program completion to evaluate pre‐ to postprogram changes. Results: Online HED participants were mostly White non‐Hispanic, significantly younger, more educated, and had higher income than in‐person participants. Regardless of the delivery modality, positive changes pre‐ to postprogram were seen across all biometric and diabetes outcome measures. Significant differences between delivery modalities were observed for diabetes knowledge, with individuals in online groups demonstrating significantly higher knowledge scores at both assessment points. For weight and BMI, both modalities showed significant improvements. Conclusion: Online and in‐person HED modalities effectively improved diabetes self‐management, reaching two different demographic groups. Demographic differences between groups underscore the importance of offering multiple participation modalities to ensure accessibility and engagement across diverse populations. The HED program model, using a community‐clinical linkage through Cooperative Extension, is an effective model for improving health outcomes of participants enrolled in both online and in‐person DSMS programs. Future research should focus on how different participant characteristics influence engagement and long‐term diabetes outcomes across delivery modalities.

Online learning is one form of distance education mediated through information and communications technology. We used a descriptive research design to develop and validate a multidimensional instrument to assess readiness and motivations for online learning. We provided a theoretical framework to better understand the concept of readiness for online learning and motivations to learn online. We assessed the need for a professional online Master’s degree in [Major] from [University] and participants’ experience with online learning. Participants in this study included 531 Cooperative Extension agents, Natural Resource Conservation Agency, Farm Service Agency employees, and School-based agricultural educators from [State], [State], and [State]. Of those, 96 participants completed the open-ended question. The study findings revealed that the survey instrument is a valid and reliable tool. Most participants reported a tendency for self-directed learning as they indicated having higher learning expectations performances. Individuals who perceive themselves as capable of performing a specific task or behavior have high levels of self-efficacy. Participants expressed that distance from campus—no need to relocate, and flexibility were their primary motivators to enroll in online learning. Many prefer using asynchronous technologies since they provide a more convenient environment where they can work at their own pace and better balance their work and school responsibilities. Results may also suggest that participants who are motivated to pursue an online degree place a high value on being self-directed learners since they can plan, monitor, and evaluate their own learning process.