Project Summary/Abstract Since the World Health Organization declared COVID-19 a pandemic, 31.6 million Americans have contracted the SARS-CoV-2 virus and 566,000 have died. Effective and safe COVID-19 vaccines have been developed, tested, and deployed in record time and 219 million vaccine doses have been administered in the US. Racial and ethnic disparities in vaccine uptake have been noted, but data are not yet available for some other disadvantaged groups. Sexual and Gender Minorities (SGMs) are potentially at risk for vaccine hesitancy due to social and historical factors affecting vaccination in general and healthcare access specifically. There is a critical need to understand vaccine attitudes and behaviors among SGMs. Our long-term goal is to reduce potential health disparities in COVID-19 among SGMs. The overall objective is to develop and deploy a decision aid that supports SGM COVID-19 vaccine decision making. Using survey and focus group methods, and following accepted international standards for decision aid development, we will develop a tailored decision aid to reduce vaccine decisional conflict and improve vaccine acceptance. The project’s specific aims are to: 1. Generate foundational knowledge of COVID-19 vaccine hesitancy among SGMs. We hypothesize that SGMs overall will be somewhat less accepting of the vaccine than the general population and, among SGMs, there will be subgroups with other vaccine hesitancy risk factors (e.g., race, gender minority identity, political affiliation) who have significantly higher rates of vaccine hesitancy. 2. Produce contextualized understanding of intentions to receive the COVID-19 vaccine. We hypothesize the reasons for vaccine acceptance or hesitancy will differ among SGM subgroups. Focus group discussions with diverse samples of SGMs who are vaccine-hesitant will identify knowledge gaps, misconceptions, perceived barriers, negative attitudes such as stigma and mistrust, and preferences for decision support. The primary outcome will be determining decision support needs for SGM subgroups. 3. Create decision aids to reduce decision conflict and improve acceptance of the COVID-19 vaccine. We will generate a decision aid, or multiple versions of a decision aid, to empower the SGM decision maker to compare options for protection against COVID-19, clarify values, and support efficacy for gathering more information, collaborating with a healthcare partner in the decision-making process, and/or obtaining the COVID-19 vaccine. We hypothesize the tailored decision aids will reduce decision conflict and improve vaccine acceptance.