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Razai MS, Mansour R, Ravindran P, Freeman S, Mason-Apps C, Morris J, Majeed A, Ussher M, Hargreaves S, Oakeshott P. Facilitators and barriers to vaccination uptake in pregnancy: A qualitative systematic review. PLoS One 2024; 19:e0298407. [PMID: 38640190 PMCID: PMC11029626 DOI: 10.1371/journal.pone.0298407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 01/25/2024] [Indexed: 04/21/2024] Open
Abstract
INTRODUCTION Vaccination during pregnancy protects both the mother and the foetus from vaccine-preventable diseases. However, uptake of the recommended vaccines (influenza, pertussis, COVID-19) by pregnant women remains low in Europe and the USA. Understanding the reasons for this is crucial to inform strategies to increase vaccination rates in pregnant women. This qualitative systematic review aimed to identify the barriers and facilitators to vaccination against influenza, pertussis/whooping cough and COVID-19 during pregnancy and identify possible strategies to increase vaccination rates. METHODS We conducted a comprehensive search of electronic databases, including Medline, PsycINFO, CINAHL, Web of Science, WHO database, Embase and grey literature to identify qualitative studies that explored barriers and facilitators to vaccine uptake among pregnant women (PROSPERO CRD42023399488). The search was limited to studies published between 2012 and 2022 conducted in high-income countries with established vaccination programmes during pregnancy. Studies were thematically analysed and underwent quality assessment using the Joanna Briggs Institute validated critical appraisal tool for qualitative research. RESULTS Out of 2681 articles screened, 28 studies (n = 1573 participants) were eligible for inclusion. Five overarching themes emerged relating to personal, provider and systemic factors. Barriers to vaccine uptake included concerns about vaccine safety and efficacy, lack of knowledge about vaccines' benefits and necessity, fear of adverse effects on the foetus or mother and low perception of disease severity. Facilitators included recommendations from trusted healthcare providers, easy access to vaccination, clear communication on the benefits and safety of vaccination, and positive social influences from family and friends. Strategies for increasing vaccination uptake included strong and proactive vaccine recommendations by trusted healthcare professionals, provision of vaccines during routine antenatal care, and clear and consistent communication about vaccines addressing pregnant women's concerns. CONCLUSION This review highlights the need for interventions that address the identified barriers to vaccine uptake among pregnant women. Recommendation from a healthcare provider can play a significant role in promoting vaccine uptake, as can clear risk/benefit communication and convenient access to vaccination. Addressing concerns about vaccine safety and providing accurate information about vaccines is also important.
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Affiliation(s)
- Mohammad S. Razai
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Rania Mansour
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | | | - Samuel Freeman
- University Hospitals Sussex NHS Foundation Trust, Sussex, United Kingdom
| | - Charlotte Mason-Apps
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Joan Morris
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Michael Ussher
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
- Institute for Social Marketing and Health, University of Stirling, Stirling, United Kingdom
| | - Sally Hargreaves
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
- The Migrant Health Research Group, Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
| | - Pippa Oakeshott
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
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Nouwens SPH, Veldwijk J, Pilli L, Swait JD, Coast J, de Bekker-Grob EW. A socially interdependent choice framework for social influences in healthcare decision-making: a study protocol. BMJ Open 2024; 14:e079768. [PMID: 38458790 DOI: 10.1136/bmjopen-2023-079768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVES Current choice models in healthcare (and beyond) can provide suboptimal predictions of healthcare users' decisions. One reason for such inaccuracy is that standard microeconomic theory assumes that decisions of healthcare users are made in a social vacuum. Healthcare choices, however, can in fact be (entirely) socially determined. To achieve more accurate choice predictions within healthcare and therefore better policy decisions, the social influences that affect healthcare user decision-making need to be identified and explicitly integrated into choice models. The purpose of this study is to develop a socially interdependent choice framework of healthcare user decision-making. DESIGN A mixed-methods approach will be used. A systematic literature review will be conducted that identifies the social influences on healthcare user decision-making. Based on the outcomes of a systematic literature review, an interview guide will be developed that assesses which, and how, social influences affect healthcare user decision-making in four different medical fields. This guide will be used during two exploratory focus groups to assess the engagement of participants and clarity of questions and probes. The refined interview guide will be used to conduct the semistructured interviews with healthcare professionals and users. These interviews will explore in detail which, and how, social influences affect healthcare user decision-making. Focus group and interview transcripts will be analysed iteratively using a constant comparative approach based on a mix of inductive and deductive coding. Based on the outcomes, a social influence independent choice framework for healthcare user decision-making will be drafted. Finally, the Delphi technique will be employed to achieve consensus about the final version of this choice framework. ETHICS AND DISSEMINATION This study was approved by the Erasmus School of Health Policy and Management Research Ethics Review Committee (ESHPM, Rotterdam, The Netherlands; reference ETH2122-0666).
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Affiliation(s)
- Sven P H Nouwens
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
| | - Jorien Veldwijk
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
| | - Luis Pilli
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
| | - Joffre D Swait
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
| | - Joanna Coast
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Esther W de Bekker-Grob
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
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Boulet SL, Stanhope KK, DeSantis C, Goebel A, Dolak J, Eze O, Gathoo A, Braun C, Sutton M, Jamieson DJ. A Descriptive Study of Maternal Vaccination Uptake, Attitudes, and Beliefs in Pregnancy Among Persons Delivering at an Urban Safety Net Hospital. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:288-297. [PMID: 37363358 PMCID: PMC10285378 DOI: 10.1089/whr.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/28/2023]
Abstract
Objective To estimate uptake of influenza, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap), and COVID-19 vaccines during pregnancy and describe vaccine attitudes and beliefs among predominantly racial and ethnic minority individuals delivering at a publicly funded hospital. Methods We collected survey and electronic medical record data for English-speaking postpartum individuals who delivered a live-born infant from July 7, 2022, through August 21, 2022, and agreed to participate in our study. The 58-item survey included questions about general vaccine attitudes and beliefs as well as vaccine-specific questions. We calculated rates of influenza, Tdap, and COVID-19 vaccinations and compared distributions of survey responses by number (no vaccines, one vaccine, or two or three of the recommended vaccines) and type of vaccines received during pregnancy. Results Of the 231 eligible individuals, 125 (54.1%) agreed to participate. Rates of influenza, Tdap, and COVID-19 vaccination were 18.4%, 48.0%, and 5.6% respectively. A total of 61 (48.8%) did not receive any recommended vaccines during pregnancy, 40 (32.0%) received one vaccine, and 24 (19.0%) received two or three vaccines. Approximately 66.1% of the no vaccine group, 81.6% of the one vaccine group, and 87.5% of the two or three vaccine group strongly agreed or agreed that they trusted the vaccine information provided by their obstetrician or midwife. While most (>69.2%) agreed that the vaccine-preventable diseases were dangerous for pregnant women, only 24.0%, 29.3%, and 40.3% agreed that they were worried about getting influenza, whooping cough, or COVID-19, respectively, while pregnant. Discussion Vaccine uptake in our population was low and may be due, in part, to low perceived susceptibility to vaccine-preventable diseases. Obstetricians and midwives were trusted sources of vaccine information, suggesting that enhanced communication strategies could be critical for addressing maternal vaccine hesitancy, particularly in communities of color justifiably affected by medical mistrust.
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Affiliation(s)
- Sheree L. Boulet
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Kaitlyn K. Stanhope
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Carol DeSantis
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Anna Goebel
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Julia Dolak
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Onyie Eze
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Asmita Gathoo
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Caroline Braun
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Madeline Sutton
- Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Denise J. Jamieson
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia, USA
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Pinkney JA, Bogart LM, Carroll KN, Bryan L, Witter G, Ashour D, Shebl FM, Hurtado RM, Goldfarb IT, Hyle EP, Psaros C, Ojikutu BO. Factors Associated With Coronavirus Disease 2019 Vaccine Uptake Among Pregnant Women and Nonpregnant Women of Reproductive Age in Jamaica. Open Forum Infect Dis 2023; 10:ofad201. [PMID: 37234512 PMCID: PMC10208745 DOI: 10.1093/ofid/ofad201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/10/2023] [Indexed: 05/28/2023] Open
Abstract
Background Despite high rates of coronavirus disease 2019 (COVID-19)-related maternal mortality, Jamaica currently has little data on COVID-19 vaccine uptake among pregnant women. Methods We conducted a cross-sectional, web-based survey of 192 reproductive-aged women in Jamaica from February 1 to 8, 2022. Participants were recruited from a convenience sample of patients, providers, and staff at a teaching hospital. We assessed self-reported COVID-19 vaccination status and COVID-19-related medical mistrust (operationalized as vaccine confidence, government mistrust, and race-based mistrust). We used multivariable modified Poisson regression to test the association between vaccine uptake and pregnancy. Results Of 192 respondents, 72 (38%) were pregnant. Most (93%) were Black. Vaccine uptake was 35% in pregnant women versus 75% in nonpregnant women. Pregnant women were more likely to cite healthcare providers versus the government as trustworthy sources of COVID-19 vaccine information (65% vs 28%). Pregnancy, low vaccine confidence, and government mistrust were associated with a lower likelihood of COVID-19 vaccination (adjusted prevalence ratio [aPR] = 0.68 [95% confidence interval {CI}, .49-.95], aPR = 0.61 [95% CI, .40-.95], and aPR = 0.68 [95% CI, .52-.89], respectively). Race-based mistrust was not associated with COVID-19 vaccination in the final model. Conclusions Pregnancy, low vaccine confidence, and government mistrust were associated with a lower likelihood of COVID-19 vaccination among reproductive-aged women in Jamaica. Future studies should evaluate the efficacy of strategies proven to improve maternal vaccination coverage, including standing "opt-out" vaccination orders and collaborative provider and patient-led educational videos tailored for pregnant individuals. Strategies that decouple vaccine messaging from government agencies also warrant evaluation.
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Affiliation(s)
- Jodian A Pinkney
- Correspondence: Jodian A. Pinkney, MD, Massachusetts General Hospital, 55 Fruit Street, Cox 5, Boston, MA 02114 (); Laura Bogart, PhD, RAND Corporation, 1776 Main Street, Santa Monica, CA ()
| | - Laura M Bogart
- Correspondence: Jodian A. Pinkney, MD, Massachusetts General Hospital, 55 Fruit Street, Cox 5, Boston, MA 02114 (); Laura Bogart, PhD, RAND Corporation, 1776 Main Street, Santa Monica, CA ()
| | | | - Lenroy Bryan
- University of the West Indies, Kingston, Jamaica
| | | | - Dina Ashour
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fatma M Shebl
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Rocio M Hurtado
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ilona T Goldfarb
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily P Hyle
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Christina Psaros
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Geoghegan S, Shuster S, Butler KM, Feemster KA. Understanding Barriers and Facilitators to Maternal Immunization: A Systematic Narrative Synthesis of the Published Literature. Matern Child Health J 2022; 26:2198-2209. [PMID: 36173503 PMCID: PMC9521012 DOI: 10.1007/s10995-022-03508-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/24/2022]
Abstract
Introduction Vaccines are being developed against Group B Streptococcus and respiratory syncytial virus. These vaccines are designed to be given to pregnant women to protect infants; thus, their success depends on uptake in this population. Maternal immunization programs have struggled to achieve target coverage rates. This systematic narrative synthesis aims to define the most important barriers and facilitators for maternal immunization and to identify priority areas for future research. Methods A search strategy was developed in Medline and adapted according to the requirements of additional search engines. Two reviewers independently reviewed the studies, using pre-specified inclusion and exclusion criteria. Results sections of included studies were coded, and thematic analysis was used to identify prominent themes. Results 321 studies were included in the final review. Most studies came from North America (37%), Europe (26%) or East Asia, Australia and New Zealand (22%). Low-and middle-income countries were under-represented. Five percent of studies came from Sub-Saharan Africa, and 2% came from South Asia. The prominent factors impacting maternal immunization were provider recommendation, perceived risks and benefits of maternal vaccines for the infant, race, birthplace, and access to healthcare. Few studies explored reasons behind racial and socioeconomic disparities in maternal immunization rates. Discussion A strong provider recommendation, equitable access to prenatal care and messaging that focuses on vaccine safety and infant benefits emerged as the key components for optimising vaccine uptake among pregnant women. Research among healthcare providers, minority groups and in low- and-middle-income countries was lacking. In anticipation of the expansion of maternal immunization programmes, focused research is needed to address these gaps and inform a successful public health strategy. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-022-03508-0.
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Affiliation(s)
- Sarah Geoghegan
- Division of Infectious Diseases, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA. .,University College Dublin School of Medicine, Belfield, Dublin 4, Ireland.
| | - Sydney Shuster
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Karina M Butler
- University College Dublin School of Medicine, Belfield, Dublin 4, Ireland.,Children's Health Ireland at Crumlin, Dublin 12, Ireland
| | - Kristen A Feemster
- Division of Infectious Diseases, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd., Building 421, Philadelphia, PA, 19104, USA.,Global Medical and Scientific Affairs, Merck Research Laboratories, Merck & Co., Inc, 351 North Sumneytown Pike, Upper Gwynedd, PA, 19454, USA
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Flu and pertussis vaccination during pregnancy in Geneva during the COVID-19 pandemic: A multicentric, prospective, survey-based study. Vaccine 2022; 40:3455-3460. [PMID: 35534311 PMCID: PMC9076028 DOI: 10.1016/j.vaccine.2022.04.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/15/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022]
Abstract
Objective Methods Results Conclusions
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Development of effective messages to promote maternal immunization in Kenya. Vaccine 2022; 40:3761-3770. [DOI: 10.1016/j.vaccine.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 04/02/2022] [Accepted: 05/05/2022] [Indexed: 11/20/2022]
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Experiences of pregnant women and healthcare professionals of participating in a digital antenatal CMV education intervention. Midwifery 2022; 106:103249. [PMID: 35032932 PMCID: PMC8850414 DOI: 10.1016/j.midw.2022.103249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 01/04/2022] [Indexed: 11/24/2022]
Abstract
Objective The study aimed to explore the perspectives of participating pregnant women and Health Care Professionals (HCPs) towards receiving and providing cytomegalovirus (CMV) education so that barriers and facilitators towards incorporating CMV in routine antenatal care could be better understood. Design This process evaluation phase employed a qualitative design using individual, semi-structured, face-to-face interviews. Setting Recruitment and interviews took place within a large teaching hospital from an ethnically diverse area of South-west London Participants The study sample included 20 participants: 15 pregnant women, and five HCPs. All participants were involved in a single centre randomized controlled trial of a digital CMV educational intervention in pregnancy. Findings Pregnant participants expressed a strong desire to receive information about CMV as part of routine antenatal care. Although HCPs were accepting of the need for CMV education, it was evident that they felt unequipped to provide this; reasons included lack of time, uncertainty about clinical pathways and concern about the potential emotive impact of CMV education. Pregnant women suggested that expressing behaviour changes as risk reduction rather than prevention, made the behaviours feel more achievable and realistic. The support of partners was considered a key factor in the successful adoption of behavioural changes by pregnant women. Key conclusions and implications for practice There is an onus on HCPs to consider how CMV can be included as part of antenatal education, with messaging framed as risk reducing rather than prevention.
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VISALLI GIUSEPPA, FACCIOLÀ ALESSIO, MAZZITELLI FRANCESCO, LAGANÀ PASQUALINA, DI PIETRO ANGELA. Health education intervention to improve vaccination knowledge and attitudes in a cohort of obstetrics students. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E110-E116. [PMID: 34322625 PMCID: PMC8283633 DOI: 10.15167/2421-4248/jpmh2021.62.1.1811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/19/2021] [Indexed: 11/30/2022]
Abstract
Introduction To improve the vaccination coverage in pregnant women it is important to increase their knowledge of vaccines and related preventable diseases. Midwifes can play an important role because they are often the first contact for woman during her pregnancy. This study aimed to explore the vaccination knowledge and attitudes in a cohort of Obstetrics students in Italy and improve their knowledge through an informative health education intervention. Methods The study consisted in the administration of a first questionnaire followed by a health education intervention concerning all aspects of vaccinations. Then, a second questionnaire to evaluate the efficacy of the educational program was administered. Results From the pre-intervention questionnaire resulted that almost the whole sample (97.1%) were favorable to vaccines in general. Moreover, 65.7% of the participants declared a sufficient level of vaccination knowledge but 62.9% found herself unprepared to answer questions and provide information about vaccinations. Concerning the answers about vaccination in pregnancy, the correct answers went from 17.1 to 68.6% respectively before and after educational intervention. The training intervention obtained a total consensus (100%). The most part of the students (85.7%) declared that the received information changed some of their beliefs and the entire sample (100%) stated that it improved their preparation. Conclusions Our results revealed some critical issues in the preparation of midwifes about vaccinations and confirm the necessity to carry out health intervention campaigns to these health professionals that, for the role they play, they must necessarily be well prepared.
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Affiliation(s)
- GIUSEPPA VISALLI
- Correspondence: Giuseppa Visalli, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, via C. Valeria, Gazzi 98100, Messina Italy - Tel.: +39 090 221 3349 - Fax: +39 090221 3351 - E-mail:
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Castillo E, Patey A, MacDonald N. Vaccination in pregnancy: Challenges and evidence-based solutions. Best Pract Res Clin Obstet Gynaecol 2021; 76:83-95. [PMID: 34090801 DOI: 10.1016/j.bpobgyn.2021.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/09/2021] [Indexed: 01/31/2023]
Abstract
Vaccination in pregnancy (VIP) is dually beneficial - it protects the mother and the baby from tetanus, influenza, and pertussis. VIP uptake is low in many countries. Vaccine hesitancy, defined by the World Health Organization (WHO) as a "delay in acceptance or refusal of vaccination despite the availability of vaccination services" is one of WHO's ten threats to global health per 2019. According to extensive research, mostly from high-income countries (HIC) and limited to tetanus, influenza and pertussis vaccines, lack of provider recommendations, safety concerns, and limitations in access are the main barriers to VIP. Health care provider recommendation is the leading facilitator for VIP across various socioeconomic status groups. Data on strategies to overcome patient, provider, and system barriers to VIP are inconsistent, contradictory, or lacking. Patient-focused research on evidence-based strategies to overcome provider and system barriers is needed. Furthermore, VIP programs require embedded continuous quality improvement to ensure sustainability.
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Affiliation(s)
- Eliana Castillo
- Department of Medicine, University of Calgary, Canada; Department of Obstetrics and Gynaecology University of Calgary, Canada.
| | - Andrea Patey
- Centre for Implementation Research, Ottawa Hospital Research Institute, Canada; Faculty of Health Sciences, Queen's University, Canada
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Maltz A, Sarid A. Attractive Flu Shot: A Behavioral Approach to Increasing Influenza Vaccination Uptake Rates. Med Decis Making 2020; 40:774-784. [PMID: 32772634 PMCID: PMC7457453 DOI: 10.1177/0272989x20944190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 06/11/2020] [Indexed: 11/17/2022]
Abstract
Background. We suggest and examine a behavioral approach to increasing seasonal influenza vaccine uptake. Our idea combines behavioral effects generated by a dominated option, together with more traditional tools, such as providing information and recommendations. Methods. Making use of the seasonal nature of the flu, our treatments present participants with 2 options to receive the shot: early in the season, which is recommended and hence "attractive," or later. Three additional layers are examined: 1) mentioning that the vaccine is more likely to run out of stock late in the season, 2) the early shot is free while the late one costs a fee, and 3) the early shot carries a monetary benefit. We compare vaccination intentions in these treatments to those of a control group who were invited to receive the shot regardless of timing. Results. Using a sample of the Israeli adult population (n = 3271), we found positive effects of all treatments on vaccination intentions, and these effects were significant for 3 of the 4 treatments. In addition, the vast majority of those who are willing to vaccinate intend to get the early shot. Conclusions. Introducing 2 options to get vaccinated against influenza (early or late) positively affects intentions to receive the flu shot. In addition, this approach nudges participants to take the shot in early winter, a timing that has been shown to be more cost-effective.
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Affiliation(s)
| | - Adi Sarid
- Tel Aviv University and Sarid Research Services, Tel Aviv, IL, Israel
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Kilich E, Dada S, Francis MR, Tazare J, Chico RM, Paterson P, Larson HJ. Factors that influence vaccination decision-making among pregnant women: A systematic review and meta-analysis. PLoS One 2020; 15:e0234827. [PMID: 32645112 PMCID: PMC7347125 DOI: 10.1371/journal.pone.0234827] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/02/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The most important factor influencing maternal vaccination uptake is healthcare professional (HCP) recommendation. However, where data are available, one-third of pregnant women remain unvaccinated despite receiving a recommendation. Therefore, it is essential to understand the significance of other factors and distinguish between vaccines administered routinely and during outbreaks. This is the first systematic review and meta-analysis (PROSPERO: CRD 42019118299) to examine the strength of the relationships between identified factors and maternal vaccination uptake. METHODS We searched MEDLINE, Embase Classic & Embase, PsycINFO, CINAHL Plus, Web of Science, IBSS, LILACS, AfricaWideInfo, IMEMR, and Global Health databases for studies reporting factors that influence maternal vaccination. We used random-effects models to calculate pooled odds ratios (OR) of being vaccinated by vaccine type. FINDINGS We screened 17,236 articles and identified 120 studies from 30 countries for inclusion. Of these, 49 studies were eligible for meta-analysis. The odds of receiving a pertussis or influenza vaccination were ten to twelve-times higher among pregnant women who received a recommendation from HCPs. During the 2009 influenza pandemic an HCP recommendation increased the odds of antenatal H1N1 vaccine uptake six times (OR 6.76, 95% CI 3.12-14.64, I2 = 92.00%). Believing there was potential for vaccine-induced harm had a negative influence on seasonal (OR 0.22, 95% CI 0.11-0.44 I2 = 84.00%) and pandemic influenza vaccine uptake (OR 0.16, 95% CI 0.09-0.29, I2 = 89.48%), reducing the odds of being vaccinated five-fold. Combined with our qualitative analysis the relationship between the belief in substantial disease risk and maternal seasonal and pandemic influenza vaccination uptake was limited. CONCLUSIONS The effect of an HCP recommendation during an outbreak, whilst still powerful, may be muted by other factors. This requires further research, particularly when vaccines are novel. Public health campaigns which centre on the protectiveness and safety of a maternal vaccine rather than disease threat alone may prove beneficial.
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Affiliation(s)
- Eliz Kilich
- Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Topical Medicine, London, United Kingdom
| | - Sara Dada
- Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Topical Medicine, London, United Kingdom
| | - Mark R. Francis
- Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Topical Medicine, London, United Kingdom
| | - John Tazare
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Topical Medicine, London, United Kingdom
| | - R. Matthew Chico
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Topical Medicine, London, United Kingdom
| | - Pauline Paterson
- Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Topical Medicine, London, United Kingdom
| | - Heidi J. Larson
- Department of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Topical Medicine, London, United Kingdom
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
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Ames HMR, Glenton C, Lewin S, Tamrat T, Akama E, Leon N. Clients' perceptions and experiences of targeted digital communication accessible via mobile devices for reproductive, maternal, newborn, child, and adolescent health: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019; 10:CD013447. [PMID: 31608981 PMCID: PMC6791116 DOI: 10.1002/14651858.cd013447] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Governments and health systems are increasingly using mobile devices to communicate with patients and the public. Targeted digital client communication is when the health system transmits information to particular individuals or groups of people, based on their health or demographic status. Common types of targeted client communication are text messages that remind people to go to appointments or take their medicines. Other types include phone calls, interactive voice response, or multimedia messages that offer healthcare information, advice, monitoring, and support. OBJECTIVES To explore clients' perceptions and experiences of targeted digital communication via mobile devices on topics related to reproductive, maternal, newborn, child, or adolescent health (RMNCAH). SEARCH METHODS We searched MEDLINE (OvidSP), MEDLINE In-Process & Other Non-Indexed Citations (OvidSP), Embase (Ovid), World Health Organization Global Health Library, and POPLINE databases for eligible studies from inception to 3-6 July 2017 dependant on the database (See appendix 2). SELECTION CRITERIA We included studies that used qualitative methods for data collection and analysis; that explored clinets' perceptions and experiences of targeted digital communication via mobile device in the areas of RMNCAH; and were from any setting globally. DATA COLLECTION AND ANALYSIS We used maximum variation purposive sampling for data synthesis, employing a three-step sampling frame. We conducted a framework thematic analysis using the Supporting the Use of Research Evidence (SURE) framework as our starting point. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. We used a matrix approach to explore whether potential implementation barriers identified in our synthesis had been addressed in the trials included in the related Cochrane Reviews of effectiveness. MAIN RESULTS We included 35 studies, from a wide range of countries on six continents. Nineteen studies were conducted in low- and middle-income settings and sixteen in high-income settings. Some of the studies explored the views of people who had experienced the interventions, whereas others were hypothetical in nature, asking what people felt they would like from a digital health intervention. The studies covered a range of digital targeted client communication, for example medication or appointment reminders, prenatal health information, support for smoking cessation while pregnant, or general sexual health information.Our synthesis showed that clients' experiences of these types of programmes were mixed. Some felt that these programmes provided them with feelings of support and connectedness, as they felt that someone was taking the time to send them messages (moderate confidence in the evidence). They also described sharing the messages with their friends and family (moderate confidence).However, clients also pointed to problems when using these programmes. Some clients had poor access to cell networks and to the internet (high confidence). Others had no phone, had lost or broken their phone, could not afford airtime, or had changed their phone number (moderate confidence). Some clients, particularly women and teenagers, had their access to phones controlled by others (moderate confidence). The cost of messages could also be a problem, and many thought that messages should be free of charge (high confidence). Language issues as well as skills in reading, writing, and using mobile phones could also be a problem (moderate confidence).Clients dealing with stigmatised or personal health conditions such as HIV, family planning, or abortion care were also concerned about privacy and confidentiality (high confidence). Some clients suggested strategies to deal with these issues, such as using neutral language and tailoring the content, timing, and frequency of messages (high confidence).Clients wanted messages at a time and frequency that was convenient for them (moderate confidence). They had preferences for different delivery channels (e.g. short message service (SMS) or interactive voice response) (moderate confidence). They also had preferences about message content, including new knowledge, reminders, solutions, and suggestions about health issues (moderate confidence). Clients' views about who sent the digital health communication could influence their views of the programme (moderate confidence).For an overview of the findings and our confidence in the evidence, please see the 'Summary of qualitative findings' tables.Our matrix shows that many of the trials assessing these types of programmes did not try to address the problems we identified, although this may have been a reporting issue. AUTHORS' CONCLUSIONS Our synthesis identified several factors that can influence the successful implementation of targeted client communication programmes using mobile devices. These include barriers to use that have equity implications. Programme planners should take these factors into account when designing and implementing programmes. Future trial authors also need to actively address these factors and to report their efforts in their trial publications.
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Affiliation(s)
- Heather MR Ames
- Norwegian Institute of Public HealthPostboks 222 SkøyenOsloNorway0213
| | - Claire Glenton
- Norwegian Institute of Public HealthPostboks 222 SkøyenOsloNorway0213
| | - Simon Lewin
- Norwegian Institute of Public HealthPostboks 222 SkøyenOsloNorway0213
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070Cape TownSouth Africa7505
| | - Tigest Tamrat
- World Health OrganizationDepartment of Reproductive Health and Research20 Avenue AppiaGenevaSwitzerlandCH‐1211
| | - Eliud Akama
- University of WashingtonSeattleWashingtonUSA
| | - Natalie Leon
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070Cape TownSouth Africa7505
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Attitudes of Pregnant Women and Healthcare Professionals Toward Clinical Trials and Routine Implementation of Antenatal Vaccination Against Respiratory Syncytial Virus: A Multicenter Questionnaire Study. Pediatr Infect Dis J 2019; 38:944-951. [PMID: 31261362 DOI: 10.1097/inf.0000000000002384] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is a common cause of infant hospitalization and mortality. With multiple vaccines in development, we aimed to determine: (1) the awareness of RSV among pregnant women and healthcare professionals (HCPs), and (2) attitudes toward clinical trials and routine implementation of antenatal RSV vaccination. METHODS Separate questionnaires for pregnant women and HCPs were distributed within 4 hospitals in South England (July 2017-January 2018). RESULTS Responses from 314 pregnant women and 204 HCPs (18% obstetricians, 75% midwives, 7% unknown) were analyzed. Most pregnant women (88%) and midwives (66%) had no/very little awareness of RSV, unlike obstetricians (14%). Among pregnant women, 29% and 75% would likely accept RSV vaccination as part of a trial, or if routinely recommended, respectively. Younger women (16-24 years), those of 21-30 weeks' gestation, and with experience of RSV were significantly more likely to participate in trials [odds ratio (OR): 1.42 (1.72-9.86); OR: 2.29 (1.22-4.31); OR: 9.07 (1.62-50.86), respectively]. White-British women and those of 21-30 weeks' gestation were more likely to accept routinely recommended vaccination [OR: 2.16 (1.07-4.13); OR: 2.10 (1.07-4.13)]. Obstetricians were more likely than midwives to support clinical trials [92% vs. 68%, OR: 2.50 (1.01-6.16)] and routine RSV vaccination [89% vs. 79%, OR: 4.08 (1.53-9.81)], as were those with prior knowledge of RSV, and who deemed it serious. CONCLUSIONS RSV awareness is low among pregnant women and midwives. Education will be required to support successful implementation of routine antenatal vaccination. Research is needed to understand reasons for vaccine hesitancy among pregnant women and HCPs, particularly midwives.
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Chamberlain AT, Limaye RJ, O'Leary ST, Frew PM, Brewer SE, Spina CI, Ellingson MK, Dudley MZ, Orenstein WA, Donnelly MA, Riley LE, Ault KA, Salmon DA, Omer SB. Development and acceptability of a video-based vaccine promotion tutorial for obstetric care providers. Vaccine 2019; 37:2532-2536. [PMID: 30962093 PMCID: PMC6472923 DOI: 10.1016/j.vaccine.2019.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 12/17/2022]
Abstract
A prenatal care provider's recommendation for maternal vaccines is one of the strongest predictors of vaccine acceptance during pregnancy. Aside from basic talking points, few resources exist to help obstetric care providers effectively navigate conversations with vaccine hesitant patients. This paper describes the development and acceptability of "VaxChat," an hour-long, evidence-based video tutorial aimed at improving obstetric care providers' ability to promote maternal vaccines. Between June and November 2017, 62 obstetric care providers registered to receive continuing medical education credit for viewing VaxChat. Of the post-tutorial responses received, over 90% said VaxChat increased their knowledge of what to say to vaccine hesitant patients, increased their confidence in addressing vaccinations with their pregnant patients, and will help them improve their practice culture regarding maternal vaccine promotion. Eighty percent intend to change how they approach vaccine conversations. These data suggest VaxChat may be a welcome complement to existing provider-to-patient talking points.
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Affiliation(s)
- A T Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322, United States.
| | - R J Limaye
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - S T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital, 13199 E Montview Blvd, Suite 300, Aurora, CO 80045, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO 80045, United States
| | - P M Frew
- School of Community Health Sciences, University of Nevada, Las Vegas, 4505 S Maryland Pkwy, Las Vegas, NV 89154, United States
| | - S E Brewer
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital, 13199 E Montview Blvd, Suite 300, Aurora, CO 80045, United States
| | - C I Spina
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital, 13199 E Montview Blvd, Suite 300, Aurora, CO 80045, United States
| | - M K Ellingson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322, United States
| | - M Z Dudley
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - W A Orenstein
- Department of Pediatrics, School of Medicine, Emory University, 2015 Uppergate Dr, Atlanta, GA 30322, United States; Emory Vaccine Center, Emory University, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - M A Donnelly
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, 12631 E. 17th Avenue, Academic Office 1, Room 4010, Aurora, CO 80045, United States; Denver Health Hospital Authority, 777 Bannock St, Denver, CO 80204, United States
| | - L E Riley
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, Cornell University, 156 William St 7th Floor, New York, NY 10038, United States
| | - K A Ault
- Department of Obstetrics and Gynecology, School of Medicine, University of Kansas, 3901 Rainbow Boulevard, Kansas City, KS 66160, United States
| | - D A Salmon
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - S B Omer
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322, United States; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322, United States; Department of Pediatrics, School of Medicine, Emory University, 2015 Uppergate Dr, Atlanta, GA 30322, United States; Emory Vaccine Center, Emory University, 201 Dowman Drive, Atlanta, GA 30322, United States
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Ellingson MK, Dudley MZ, Limaye RJ, Salmon DA, O'Leary ST, Omer SB. Enhancing uptake of influenza maternal vaccine. Expert Rev Vaccines 2019; 18:191-204. [PMID: 30587042 DOI: 10.1080/14760584.2019.1562907] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Influenza vaccination during pregnancy can offer many benefits to both mother and infant. Despite recommendations from the Advisory Committee on Immunization Practices, vaccine coverage rates among pregnant women during pregnancy are below 40% in the United States. There is a need for a greater understanding of what interventions can improve vaccine uptake among pregnant women. AREAS COVERED This review synthesizes the existing evidence on the effectiveness of interventions to improve maternal influenza vaccine uptake. These interventions are examined within the framework of the three psychological propositions: thoughts and feelings, social processes and changing behavior directly. EXPERT COMMENTARY A number of promising and effective interventions were identified in this review. Nudge-based interventions that build on favorable intentions to vaccinate such as provider prompts and standing orders have demonstrated significant success in improving influenza vaccine uptake. However, substantial gaps in the literature still exist. Provider recommendations are the most important predictor of vaccine receipt among pregnant women, yet few studies evaluated intervening to improve the dialogue between patient and provider. With the potential for even more vaccines to be added to the maternal immunization schedule, it is vitally important to understand how to improve uptake.
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Affiliation(s)
- Mallory K Ellingson
- a Hubert Department of Global Health, Rollins School of Public Health , Emory University , Atlanta , GA , USA
| | - Matthew Z Dudley
- b Department of International Health , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA.,c Institute for Vaccine Safety , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA
| | - Rupali J Limaye
- b Department of International Health , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA.,c Institute for Vaccine Safety , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA.,d Department of Epidemiology , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA.,e Department of Health, Behavior and Society , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA
| | - Daniel A Salmon
- b Department of International Health , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA.,c Institute for Vaccine Safety , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA.,e Department of Health, Behavior and Society , Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA
| | - Sean T O'Leary
- f Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Anschutz Medical Campus and Children's Hospital , Aurora , CO , USA.,g Department of Pediatrics , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
| | - Saad B Omer
- a Hubert Department of Global Health, Rollins School of Public Health , Emory University , Atlanta , GA , USA.,h Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , GA , USA.,i Department of Pediatrics, School of Medicine , Emory University , Atlanta , GA , USA.,j Emory Vaccine Center , Emory University , Atlanta , GA , USA
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Lutz CS, Carr W, Cohn A, Rodriguez L. Understanding barriers and predictors of maternal immunization: Identifying gaps through an exploratory literature review. Vaccine 2018; 36:7445-7455. [PMID: 30377064 PMCID: PMC10431095 DOI: 10.1016/j.vaccine.2018.10.046] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/05/2018] [Accepted: 10/10/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND The Advisory Committee for Immunization Practices recommends that all pregnant women receive the seasonal influenza vaccine and the tetanus toxoid, diphtheria toxoid, and acellular pertussis (Tdap) vaccine during every pregnancy. However, vaccination coverage rates are suboptimal among pregnant women in the United States, leaving these women and their unborn children at risk of vaccine-preventable diseases and their complications. OBJECTIVES We sought to understand the current landscape of published literature regarding maternal immunization, including barriers to and predictors of vaccine acceptance, and identify gaps in the research in order to inform strategies for future programmatic improvement. METHODS We conducted a literature search using MEDLINE (OVID), PsychINFO, and CINAHL (Ebsco) databases. The search included published, English-language manuscripts that identified patient, provider, or system-level barriers to, predictors of, or interventions that improved uptake of maternal vaccines among pregnant women in the US. Studies were reviewed using an inductive thematic analysis approach. RESULTS We included 75 studies in our review. Pregnant women identified 25 different barriers to accepting recommended maternal immunizations; barriers related to vaccine safety perceptions were the most common. Healthcare providers identified 24 different barriers to vaccinating their pregnant patients. The most commonly cited barriers among healthcare providers were financial concerns. Eighteen different predictors of vaccine acceptance were identified. Receipt of a healthcare provider's recommendation was the factor most frequently reported as a reason for vaccination among pregnant women. CONCLUSIONS We were able to identify gaps in the literature regarding maternal immunization and make recommendations for future research. Efforts to address the challenges of maternal immunization in the United States should include increasing the focus on Tdap, implementing more high-level assessments of safety perceptions and associated concerns, and determining most effective interventions.
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Affiliation(s)
- Chelsea S Lutz
- Oak Ridge Institute for Science and Education, United States Department of Energy, Washington DC, United States; Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Wendy Carr
- Office of the Director, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Amanda Cohn
- Office of the Director, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Leslie Rodriguez
- Office of the Director, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
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Wilcox CR, Bottrell K, Paterson P, Schulz WS, Vandrevala T, Larson HJ, Jones CE. Influenza and pertussis vaccination in pregnancy: Portrayal in online media articles and perceptions of pregnant women and healthcare professionals. Vaccine 2018; 36:7625-7631. [PMID: 30401620 PMCID: PMC6263273 DOI: 10.1016/j.vaccine.2018.10.092] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/05/2018] [Accepted: 10/29/2018] [Indexed: 11/13/2022]
Abstract
Introduction Online media may influence women’s decision to undergo vaccination during pregnancy. The aims of this mixed-methods study were to: (1) examine the portrayal of maternal vaccination in online media and (2) establish the perceived target of vaccine protection as viewed by pregnant women and maternity healthcare professionals (HCPs). Methods Online media articles on maternal vaccination (published July-December 2012 or November 2015-April 2016) were identified through the London School of Hygiene & Tropical Medicine’s Vaccine Confidence Database and thematically analysed. Questionnaires for pregnant women and HCPs were distributed within four English hospitals (July 2017-January 2018). Results Of 203 articles identified, 60% related to pertussis vaccination, 33% to influenza and 6% both. The majority positively portrayed vaccination in pregnancy (97%), but inaccurate, negative articles persist which criticize pertussis vaccination’s safety and efficacy. Positively-worded articles about pertussis tended to focus on infant protection and highlight examples of recent cases, whereas positively-worded articles about influenza focused on maternal protection. These themes were reflected in questionnaire responses from 314 pregnant women and 204 HCPs, who perceived pertussis vaccination as protecting the baby, and influenza vaccination as protecting the mother, or mother and baby equally. A minority of the pregnant women surveyed intended to decline influenza (22%) or pertussis (8%) vaccination. Conclusions The majority of online articles support pertussis and influenza vaccination during pregnancy. The portrayal of pertussis vaccination as primarily benefiting the child, using real-examples, may influence its higher uptake compared with influenza. This approach should be considered by HCPs when recommending vaccination. HCPs should be prepared to provide advice to women hesitant about vaccination, including addressing any negative media, and consider educational strategies to counteract inaccurate information. Future studies should directly assess the influence of media on vaccine decision-making and establish which media platforms are typically used by pregnant women to gather information.
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Affiliation(s)
- Christopher R Wilcox
- NIHR Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Kathryn Bottrell
- Paediatric Infectious Diseases Research Group, St George's, University of London, UK
| | - Pauline Paterson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - William S Schulz
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Heidi J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Christine E Jones
- Paediatric Infectious Diseases Research Group, St George's, University of London, UK; Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Lin L, McCloud RF, Bigman CA, Viswanath K. Tuning in and catching on? Examining the relationship between pandemic communication and awareness and knowledge of MERS in the USA. J Public Health (Oxf) 2018; 39:282-289. [PMID: 27084759 PMCID: PMC7107521 DOI: 10.1093/pubmed/fdw028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Large-scale influenza outbreaks over the last decade, such as SARS and H1N1, have brought to global attention the importance of emergency risk communication and prompted the international community to develop communication responses. Since pandemic outbreaks are relatively infrequent, there is a dearth of evidence addressing the following questions: (i) Have the resources invested in strategic and routine communication for past pandemic outbreaks yielded public health preparedness benefits? (ii) Have past efforts sensitized people to pay attention to new pandemic threats? The Middle East Respiratory Syndrome (MERS) that was followed closely by major media outlets in the USA provides an opportunity to examine the relationship between exposure to public communication about epidemics and public awareness and knowledge about new risks. Methods In December, 2013, we surveyed a nationally representative sample of 627 American adults and examined the associations between people's awareness to prior pandemics and their awareness of and knowledge about MERS. Results Awareness of prior pandemics was significantly associated with awareness and knowledge of MERS. The most common sources from which people first heard about MERS were also identified. Conclusions Communication inequalities were observed between racial/ethnic and socioeconomic positions, suggesting a need for more effective pandemic communication.
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Affiliation(s)
- Leesa Lin
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Policy Translation and Leadership Development, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rachel F McCloud
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Cabral A Bigman
- Department of Communication, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Kasisomayajula Viswanath
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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To vaccinate or not to vaccinate? Women's perception of vaccination in pregnancy: a qualitative study. BJGP Open 2018; 2:bjgpopen18X101457. [PMID: 30564712 PMCID: PMC6184095 DOI: 10.3399/bjgpopen18x101457] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/08/2018] [Indexed: 02/01/2023] Open
Abstract
Background Vaccination against influenza and pertussis in pregnancy can reduce the significant morbidity and mortality associated with these infections. Despite this, there is poor uptake of both vaccines in pregnancy. Aim To explore women’s perception of vaccination in pregnancy and thereby determine the reasons behind such low vaccination rates. Design & setting This is a qualitative study undertaken at a large maternity hospital. Method Seventeen post-partum women completed a semi-structured interview discussing vaccination. They were recruited from a quantitative study looking at vaccination rates in pregnancy. The interview transcripts were discussed among three researchers and underwent thematic analysis. Results Three themes emerged. The first theme explored the influencing factors that shaped the women’s decision to vaccinate in pregnancy. The recommendation of a healthcare provider was the most important influencing factor for this study's cohort of women. The second theme highlighted the deficiency in knowledge women had regarding vaccine safety. The last theme related to the pertussis vaccine, and the reluctance of healthcare providers to discuss and offer this vaccine in pregnancy. Conclusion The qualitative approach gives voice to the thoughts and concerns of women as they make the complex decision to vaccinate in pregnancy. Clinicians must be cognizant of the important role they play in advising women to vaccinate in pregnancy. They must advise women that the vaccine is safe and address any of their concerns. Lastly, a message on vaccine safety should be included in future public health campaigns to promote vaccination in pregnancy.
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Penţa MA, Băban A. Message Framing in Vaccine Communication: A Systematic Review of Published Literature. HEALTH COMMUNICATION 2018; 33:299-314. [PMID: 28059557 DOI: 10.1080/10410236.2016.1266574] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Suboptimal vaccination rates are a significant problem in many countries today, in spite of improved access to vaccine services. As a result, there has been a recent expansion of research on how best to communicate about vaccines. The purpose of the present article is to provide an updated review of published, peer-reviewed empirical studies that examined the effectiveness of gain versus loss framing (i.e., goal framing) in the context of vaccine communication. To locate studies, we examined the reference list from the previous meta-analytic review (O'Keefe & Nan, 2012), and we conducted systematic searches across multiple databases. We included 34 studies in the qualitative synthesis. The relative effectiveness of goal-framed vaccine messages was often shown to depend on characteristics of the message recipient, perceived risk, or situational factors, yet most effects were inconsistent across studies, or simply limited by an insufficient number of studies. Methodological characteristics and variations are noted and discussed. The review points to several directions concerning moderators and mediators of framing effects where additional rigorous studies would be needed.
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Affiliation(s)
| | - Adriana Băban
- a Department of Psychology , Babeş-Bolyai University
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22
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Bushar JA, Kendrick JS, Ding H, Black CL, Greby SM. Text4baby Influenza Messaging and Influenza Vaccination Among Pregnant Women. Am J Prev Med 2017; 53:845-853. [PMID: 28867143 PMCID: PMC5813485 DOI: 10.1016/j.amepre.2017.06.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/01/2017] [Accepted: 06/22/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Pregnant women are at risk for severe influenza-related complications; however, only 52% reported receiving an influenza vaccination during the 2013-2014 influenza season. Text4baby, a free national text service, provides influenza vaccination education and reminders to pregnant women. This study examined reported influenza vaccination during pregnancy among Text4baby participants who reported receiving influenza messages and women who reported never participating in Text4baby. METHODS Opt-in Internet Panel Surveys (April 2013 and 2014) of pregnant women collected demographic and other characteristics; influenza vaccination knowledge, attitudes, and behaviors; and Text4baby participation. Women aged 18-49 years, pregnant anytime from October to January (N=3,321) were included. Text4baby influenza message recallers reported receiving Text4baby influenza messages during their current/most recent pregnancy (n=377). Text4baby non-participants reported never receiving Text4baby messages (n=2,824). Multivariable logistic regression was performed (2014-2016) controlling for demographic and other characteristics, high-risk conditions, and provider recommendation and offer to vaccinate. Adjusted prevalence ratios (APRs) were calculated. Random sampling was assumed for this non-probability sample. RESULTS Text4baby recallers were more likely than non-participants to report influenza vaccination regardless of receipt of provider recommendation and/or offer to vaccinate (provider recommendation/offer APR=1.29, 95% CI=1.21, 1.37, provider recommendation/no offer APR=1.52, 95% CI=1.07, 2.17). Among women receiving neither a provider recommendation nor offer to vaccinate, Text4baby recallers were more than three times as likely to report influenza vaccination compared with non-participants (APR=3.39, 95% CI=2.03, 5.67). CONCLUSIONS Text4baby status was associated with higher influenza vaccination, especially among women whose provider did not recommend or offer the vaccine. Encouraging Text4baby enrollment may help ensure influenza vaccination is given to protect mothers and infants.
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Affiliation(s)
| | | | - Helen Ding
- CFD Research Corporation, Huntsville, Alabama
| | - Carla L Black
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stacie M Greby
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Vishram B, Letley L, Jan Van Hoek A, Silverton L, Donovan H, Adams C, Green D, Edwards A, Yarwood J, Bedford H, Amirthalingam G, Campbell H. Vaccination in pregnancy: Attitudes of nurses, midwives and health visitors in England. Hum Vaccin Immunother 2017; 14:179-188. [PMID: 29048989 DOI: 10.1080/21645515.2017.1382789] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To examine amongst healthcare professionals in England; knowledge of vaccinations in pregnancy, their perceived roles in these programmes and whether they recommend scheduled vaccines to pregnant women. DESIGN Cross sectional survey (online questionnaire) Setting: Healthcare workers in contact with pregnant women in England. PARTICIPANTS The survey analysis included 3441 healthcare workers who had been surveyed during May to August 2015. The participants were midwives, practice nurses and health visitors, working in England who were members of the Royal College of Midwives, Royal College of Nursing and the Institute of Health Visiting. RESULTS We found that knowledge of vaccination in pregnancy was high in all professional groups. Seventy three percent of all respondents would recommend the influenza vaccine and 74% would recommend the pertussis vaccine to pregnant women. They were more likely to recommend vaccination in pregnancy if they would personally have the influenza and pertussis vaccines themselves and/or if they had the influenza vaccine as a healthcare worker. Practice nurses were significantly more likely to recommend the pertussis and influenza vaccines to pregnant women than midwives and health visitors. Health professionals who had received immunisation training were more confident in giving advice to pregnant women. CONCLUSION Immunisation training is essential if healthcare workers are to be informed and confident in effectively delivering the maternal immunisation programme and thus improving uptake of vaccines in pregnancy. These findings are important in tailoring educational programmes and addressing the training needs of different healthcare professional groups.
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Affiliation(s)
- Bhavita Vishram
- a Immunisation, Hepatitis and Blood Safety Department , Public Health England , London , UK
| | - Louise Letley
- a Immunisation, Hepatitis and Blood Safety Department , Public Health England , London , UK
| | - Albert Jan Van Hoek
- b Department of Infectious Disease Epidemiology , London School of Hygiene and Tropical Medicine , London , UK
| | | | | | | | - David Green
- a Immunisation, Hepatitis and Blood Safety Department , Public Health England , London , UK
| | - Angela Edwards
- a Immunisation, Hepatitis and Blood Safety Department , Public Health England , London , UK
| | - Joanne Yarwood
- a Immunisation, Hepatitis and Blood Safety Department , Public Health England , London , UK
| | - Helen Bedford
- f University College London, Institute of Child health , London , UK
| | - Gayatri Amirthalingam
- a Immunisation, Hepatitis and Blood Safety Department , Public Health England , London , UK
| | - Helen Campbell
- a Immunisation, Hepatitis and Blood Safety Department , Public Health England , London , UK
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Frew PM, Lutz CS. Interventions to increase pediatric vaccine uptake: An overview of recent findings. Hum Vaccin Immunother 2017; 13:2503-2511. [PMID: 28949819 PMCID: PMC5703404 DOI: 10.1080/21645515.2017.1367069] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/15/2017] [Accepted: 08/09/2017] [Indexed: 01/17/2023] Open
Abstract
Although much is known about factors contributing to variation in pediatric immunization uptake, there is a need for synthesis of effective vaccine promotion strategies. With growing public health concern on how to best sustain high pediatric immunization rates, and improve where the rates are suboptimal, this review offers evidence gathered from several studies on the achievement of these goals. We identified and analyzed reported findings on childhood (primarily ≤ 7 years) immunization outcomes from tested intervention strategies that focused on parents, guardians, and caregivers, as well as providers, clinics/practices, and communities. The findings suggest that targeted and tailored interventions offer substantial possibilities, especially in a combined manner. We describe promising intervention models that have been operationalized with success and provide evidence for scalability across contexts. Moreover, they are sensitive to parents' and providers' needs, are feasibly integrated in daily clinical practice, and account for broader community concerns and issues.
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Affiliation(s)
- Paula M. Frew
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
- Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, USA
- Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Atlanta, GA, USA
| | - Chelsea S. Lutz
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
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Duncan CL, Walker HA, Brabson L, Williford DN, Hynes L, Hogan MB. Developing pictorial asthma action plans to promote self-management and health in rural youth with asthma: A qualitative study. J Asthma 2017; 55:915-923. [PMID: 28933570 DOI: 10.1080/02770903.2017.1371743] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Asthma action plans (AAPs) provide asthma management instructions to families; however, AAPs typically are written at a 7th-9th grade reading level, making them less useful in lower literacy families. There is a need to develop simpler AAP formats and content to optimize their utility across all families, including those who are rural and may be at a risk for literacy concerns. Because using pictures can simplify and enhance health education, our study's aim was to develop a pictorial AAP through a series of focus groups with key stakeholders - youth with asthma, caregivers, and physicians. METHODS Fourteen caregiver/youth dyads and four physicians participated in separate focus groups where their preferences for pictorial AAP structure and content were obtained. Focus groups were audio recorded, transcribed, coded with ATLAS.ti, and analyzed for themes. RESULTS Youth and their caregivers prefer that the AAPs include simple, cartoon-like pictures customized to the patient. Physicians emphasized AAP's capability to display pictures of controller medication given its importance in preventing asthma exacerbations. A stoplight format, currently used in most written AAPs, received positive reviews. Specific suggestions for pictures showing symptoms, medications, and how to take medication were suggested. Words and short phrases accompanying the pictures were thought to add clarity. CONCLUSIONS Key stakeholders viewed pictorial AAPs as positive and potentially effective alternatives to standard written AAPs. It is expected that low literacy youth and caregivers would more easily understand a pictorial AAP presentation, which should facilitate better medication adherence and asthma outcomes in these children.
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Affiliation(s)
- Christina L Duncan
- a Department of Psychology , West Virginia University , Morgantown , WV , USA
| | - Heather A Walker
- a Department of Psychology , West Virginia University , Morgantown , WV , USA
| | - Laurel Brabson
- a Department of Psychology , West Virginia University , Morgantown , WV , USA
| | - Desireé N Williford
- a Department of Psychology , West Virginia University , Morgantown , WV , USA
| | - Lisa Hynes
- a Department of Psychology , West Virginia University , Morgantown , WV , USA
| | - Mary Beth Hogan
- b University of Nevada-Las Vegas , Reno School of Medicine , Reno , NV , USA
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Bednarczyk RA, Frew PM, Salmon DA, Whitney E, Omer SB. ReadyVax: A new mobile vaccine information app. Hum Vaccin Immunother 2017; 13:1149-1154. [PMID: 28059610 PMCID: PMC5443394 DOI: 10.1080/21645515.2016.1263779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Vaccine information of varying quality is available through many different sources. We describe the creation, release and utilization of ReadyVax, a new mobile smartphone app providing access to trustworthy, evidence-based vaccine information for a target audience of healthcare providers, pharmacists, and patients (including parents of children). We describe the information content and technical development of ReadyVax. Between the hard launch of the app on February 12, 2015 and October 8, 2016, the app has been downloaded by 5,142 unique users, with 6,841 total app sessions initiated, comprising a total of 15,491 screen views (2.3 screens/session on average). ReadyVax has been downloaded by users in 102 different countries; most users (52%) are from the United States. We are continuing outreach efforts to increase app use, and planning for development of an Android-compatible version of ReadyVax, to increase the available market for the app.
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Affiliation(s)
- Robert A Bednarczyk
- a Hubert Department of Global Health , Rollins School of Public Health, Emory University , Atlanta , GA , USA.,b Department of Epidemiology , Rollins School of Public Health, Emory University , Atlanta , GA , USA.,c Emory Vaccine Center, Emory University , Atlanta , GA , USA
| | - Paula M Frew
- a Hubert Department of Global Health , Rollins School of Public Health, Emory University , Atlanta , GA , USA.,d Department of Medicine, Division of Infectious Diseases , School of Medicine, Emory University , Atlanta , GA , USA.,e Department of Behavioral Sciences and Health Education , Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Daniel A Salmon
- f Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Ellen Whitney
- g Center for Public Health Preparedness and Research, Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Saad B Omer
- a Hubert Department of Global Health , Rollins School of Public Health, Emory University , Atlanta , GA , USA.,b Department of Epidemiology , Rollins School of Public Health, Emory University , Atlanta , GA , USA.,c Emory Vaccine Center, Emory University , Atlanta , GA , USA.,h Department of Pediatrics , School of Medicine, Emory University , Atlanta , GA , USA
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Abstract
Active immunization during pregnancy for maternal and neonatal benefit is a remarkably promising strategy to reduce infectious morbidity in both women and infants. The aim of this review is to present current clinical guidelines for vaccination during pregnancy and review evidence-based strategies for the implementation of maternal immunization recommendations. Observational studies, clinical trials, cost-effectiveness analyses, systematic reviews, and meta-analyses were evaluated to generate the evidence base for this review. In addition, recommendations from major national professional and public health organizations were examined. We present current clinical recommendations for vaccination during pregnancy and review medical and public health strategies to implement these guidelines. We also discuss a research agenda to advance the field of maternal immunization and achieve further improvements in maternal and child health.
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Chamberlain AT, Seib K, Ault KA, Rosenberg ES, Frew PM, Cortes M, Whitney EAS, Berkelman RL, Orenstein WA, Omer SB. Impact of a multi-component antenatal vaccine promotion package on improving knowledge, attitudes and beliefs about influenza and Tdap vaccination during pregnancy. Hum Vaccin Immunother 2016; 12:2017-2024. [PMID: 27082036 PMCID: PMC4994750 DOI: 10.1080/21645515.2015.1127489] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/17/2015] [Accepted: 11/28/2015] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Understanding whether interventions designed to improve antenatal vaccine uptake also change women's knowledge about vaccination is critical for improving vaccine coverage. This exploratory study evaluates the effectiveness of a multi-component influenza and tetanus, diphtheria, and acellular pertussis (Tdap) vaccine promotion package on improving women's knowledge, attitudes and beliefs toward antenatal vaccination. STUDY DESIGN In 2012/2013 a cluster-randomized trial was conducted to test the effectiveness of a vaccine promotion package on improving antenatal vaccine coverage. Participants included 325 unvaccinated pregnant women from 11 obstetric practices in Georgia. Eleven health beliefs measures were assessed at baseline and 2-3 months post-partum. Outcomes were differences in proportions of women citing favorable responses to each measure between study groups at follow-up. RESULTS Women enrolled in their third trimester had a higher probability of asking family members to vaccinate to protect the infant if they were in the intervention group versus the control group (36% vs. 22%; risk ratio [RR] = 1.65, 95% confidence interval [CI]: 1.21, 2.26). A similar association was not observed among women enrolled before their third trimester (39% vs. 44%; RR = 0.93, 95% CI: 0.50, 1.73). There were no other significant differences at follow-up between study groups. CONCLUSIONS While exposure to the intervention package may have raised awareness that vaccinating close contacts can protect an infant, there is little evidence that the package changed women's attitudes and beliefs toward antenatal vaccination. Future research should ensure adequate exposure to the intervention and consider study design aspects including power to assess changes in secondary outcomes, discriminatory power of response options, and social desirability bias. This study is registered with clinicaltrials.gov, study ID NCT01761799.
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Affiliation(s)
- Allison T. Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Katherine Seib
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA, USA
| | - Kevin A. Ault
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Eli S. Rosenberg
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Paula M. Frew
- Department of Medicine, Division of Infectious Diseases, Decatur, GA, USA
| | - Marielysse Cortes
- Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Ellen A. S. Whitney
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ruth L. Berkelman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Walter A. Orenstein
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA, USA
| | - Saad B. Omer
- Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
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Predictors of maternal vaccination in the United States: An integrative review of the literature. Vaccine 2016; 34:3942-9. [DOI: 10.1016/j.vaccine.2016.06.042] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 06/03/2016] [Accepted: 06/07/2016] [Indexed: 02/07/2023]
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Dekker RL, King S, Lester K. Social Media and Evidence-Based Maternity Care: A Cross-Sectional Survey Study. J Perinat Educ 2016; 25:105-15. [PMID: 27445448 PMCID: PMC4944453 DOI: 10.1891/1058-1243.25.2.105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to describe how people use social media to find and disseminate information about evidence-based maternity care. We used a cross-sectional Internet-based survey design in which 1,661 participants were recruited from childbirth-related blogs. Participants answered questions about how they find, use, and share evidence-based maternity information using social media. Overall, women in this study were highly engaged in using social media to find and share maternity information. Most respondents were very interested in reading evidence-based maternity care articles online. Most intend to use this information that they found, despite the fact that a substantial percentage had no intentions of discussing this information with their childbirth educators or physician.
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Wong VWY, Lok KYW, Tarrant M. Interventions to increase the uptake of seasonal influenza vaccination among pregnant women: A systematic review. Vaccine 2015; 34:20-32. [PMID: 26602267 DOI: 10.1016/j.vaccine.2015.11.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/26/2015] [Accepted: 11/06/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pregnant women and their infants under 6 months of age infected with influenza have a high risk of serious morbidity and mortality. Influenza vaccine during pregnancy offers 3-for-1 benefits to pregnant women, fetuses and newborn infants. Current vaccination uptake rates during pregnancy, however, are often lower than other high-risk groups and the general population. METHODS We systematically reviewed evidence on the effectiveness of interventions to improve influenza vaccination coverage in pregnant women. Risk differences (RDs) were calculated from the included studies. RESULTS Eleven studies were included in the review, of which four were randomized controlled trials (RCTs). Three cohort studies assessed provider-focused interventions while four RCTs and one cohort study evaluated pregnant women-focused interventions. Two cohort studies and a prospective intervention study assessed the effectiveness of bundled interventions. No study solely assessed the effectiveness of interventions to enhance access to influenza vaccination. One moderate quality RCT showed that an influenza pamphlet, with or without a verbalized benefit statement, improved the vaccination rate (RD=0.26; RD=0.39). The other reviewed RCTs showed discordant results, with RDs ranging from -0.15 to 0.03. Although all observational studies significantly improved vaccination rates (RDs ranged from 0.03 to 0.44), the quality of the evidence varied. CONCLUSIONS There is a lack of effective interventions to increase the influenza vaccination rate in pregnant women. Based on the existing research, we recommend that clinicians provide influenza pamphlets to pregnant women with a verbalized statement about the benefits of influenza vaccine to newborns. Further high-quality RCTs are needed to develop successful maternal influenza vaccination programs. Increased clarity in reporting the content of interventions would help to improve the comparability and generalizability of the published studies.
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Affiliation(s)
- Valerie W Y Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - Kris Y W Lok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Marie Tarrant
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
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Chamberlain AT, Seib K, Ault KA, Rosenberg ES, Frew PM, Cortés M, Whitney EAS, Berkelman RL, Orenstein WA, Omer SB. Improving influenza and Tdap vaccination during pregnancy: A cluster-randomized trial of a multi-component antenatal vaccine promotion package in late influenza season. Vaccine 2015; 33:3571-9. [PMID: 26044495 DOI: 10.1016/j.vaccine.2015.05.048] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/15/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Evidence-based interventions to improve influenza vaccine coverage among pregnant women are needed, particularly among those who remain unvaccinated late into the influenza season. Improving rates of antenatal tetanus, diphtheria and acellular pertussis (Tdap) vaccination is also needed. PURPOSE To test the effectiveness of a practice-, provider-, and patient-focused influenza and Tdap vaccine promotion package on improving antenatal influenza and Tdap vaccination in the obstetric setting. METHODS A cluster-randomized trial among 11 obstetric practices in Georgia was conducted in 2012-2013. Intervention practices adopted the intervention package that included identification of a vaccine champion, provider-to-patient talking points, educational brochures, posters, lapel buttons, and iPads loaded with a patient-centered tutorial. Participants were recruited from December 2012-April 2013 and included 325 unvaccinated pregnant women in Georgia. Random effects regression models were used to evaluate primary and secondary outcomes. RESULTS Data on antenatal influenza and Tdap vaccine receipt were obtained for 300 (92.3%) and 291 (89.5%) women, respectively. Although antenatal influenza and Tdap vaccination rates were higher in the intervention group than the control group, improvements were not significant (For influenza: risk difference (RD)=3.6%, 95% confidence interval (CI): -4.0%, 11.2%; for Tdap: RD=1.3%, 95% CI: -10.7%, 13.2%). While the majority of intervention package components were positively associated with antenatal vaccine receipt, a provider's recommendation was the factor most strongly associated with actual receipt, regardless of study group or vaccine. CONCLUSIONS The intervention package did not significantly improve antenatal influenza or Tdap vaccine coverage. More research is needed to determine what motivates women remaining unvaccinated against influenza late into the influenza season to get vaccinated. Future research should quantify the extent to which clinical interventions can bolster a provider's recommendation for vaccination. This study is registered with clinicaltrials.gov, study ID NCT01761799.
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Affiliation(s)
- A T Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR Room 3040Z, Atlanta, GA 30322, USA.
| | - K Seib
- Division of Infectious Diseases, School of Medicine, Emory University, 1462 Clifton Rd. NE, Room 446, Atlanta, GA 30322, USA.
| | - K A Ault
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, 1365 Clifton Road, Building A, 4th Floor, Atlanta, GA 30322, USA.
| | - E S Rosenberg
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, GCR Room 472, Atlanta, GA 30322, USA.
| | - P M Frew
- Department of Medicine, Division of Infectious Diseases, 500 Irvin Court, Decatur, GA 30030, USA.
| | - M Cortés
- Hubert Department of Global Health, Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - E A S Whitney
- Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Rd. NE, CNR Room 3047, Atlanta, GA 30322, USA.
| | - R L Berkelman
- Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Road NE, CNR Room 3045, Atlanta, GA 30322, USA.
| | - W A Orenstein
- Division of Infectious Diseases, School of Medicine, Emory University, 1462 Clifton Rd. NE, Room 446, Atlanta, GA 30322, USA.
| | - S B Omer
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR Room 7017, Atlanta, GA 30322, USA.
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Frew PM, Saint-Victor DS, Isaacs MB, Kim S, Swamy GK, Sheffield JS, Edwards KM, Villafana T, Kamagate O, Ault K. Recruitment and retention of pregnant women into clinical research trials: an overview of challenges, facilitators, and best practices. Clin Infect Dis 2014; 59 Suppl 7:S400-7. [PMID: 25425718 PMCID: PMC4303058 DOI: 10.1093/cid/ciu726] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Pregnant women are a vulnerable group who are needed in clinical research studies to advance prevention and treatment options for this population. Yet, pregnant women remain underrepresented in clinical research. Through the lens of the socioecological model, we highlight reported barriers and facilitators to recruitment and retention of pregnant women in studies that sought their participation. We trace historical, policy-based reasons for the exclusion of pregnant women in clinical studies to present-day rationale for inclusion of this group. The findings highlight why it has been difficult to recruit and retain this population over time. A body of literature suggests that integrative sampling and recruitment methods that leverage the influence and reach of prenatal providers will overcome recruitment challenges. We argue that these strategies, in combination with building strong engagement with existing community-based organizations, will enable teams to more effectively promote and retain pregnant women in future longitudinal cohort studies.
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Affiliation(s)
- Paula M. Frew
- Emory University School of Medicine, Departmentof Medicine, Division of Infectious Diseases
- Emory Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University,Atlanta, Georgia
| | - Diane S. Saint-Victor
- Emory University School of Medicine, Departmentof Medicine, Division of Infectious Diseases
| | | | - Sonnie Kim
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | - Ouda Kamagate
- Emory University School of Medicine, Departmentof Medicine, Division of Infectious Diseases
| | - Kevin Ault
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City
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Frew PM. Commentary on "Moniz and Beigi's maternal immunization: clinical experiences, challenges, and opportunities in vaccine acceptance". Hum Vaccin Immunother 2014; 10:2571-3. [PMID: 25483456 DOI: 10.4161/21645515.2014.970960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Maternal immunization faces an array of structural, sociocultural, and individual challenges that must be effectively addressed to realize widespread improvements in vaccination uptake. As Moniz and Beigi correctly detail in their review, immunization during this period offers unique opportunity to make substantial improvements in maternal and neonatal health. Moving beyond the existing Health Belief Model, we learn that immunization uptake can be significantly improved by shaping messages, addressing logistical challenges such as out-of-pocket (i.e., "copay") barriers, and delivering provider education on maternal immunization to encourage future provider recommendations and facilitate the patient convenience of in-office vaccine administration. The resulting approach of "Educate, Recommend, Normalize, Maximize Convenience" is consistent with the evidence on maternal immunization. In its systematic application, such a model may usher in unprecedented opportunity to improve immunization uptake in decades ahead.
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Affiliation(s)
- Paula M Frew
- a Emory University School of Medicine ; Department of Medicine; Division of Infectious Diseases ; Atlanta , GA USA
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Frew PM, Owens LE, Saint-Victor DS, Benedict S, Zhang S, Omer SB. Factors associated with maternal influenza immunization decision-making. Evidence of immunization history and message framing effects. Hum Vaccin Immunother 2014; 10:2576-83. [PMID: 25483468 PMCID: PMC4977431 DOI: 10.4161/hv.32248] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/23/2014] [Accepted: 08/03/2014] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE We examined pregnant women's intention to obtain the seasonal influenza vaccine via a randomized controlled study examining the effects of immunization history, message exposure, and sociodemographic correlates. METHODS Pregnant women ages 18-50 participated in a randomized message framing study from September 2011 through May 2012. Venue-based sampling was used to recruit racial and ethnic minority women throughout Atlanta, Georgia. Key outcomes were evaluated using bivariate and multivariate analyses. RESULTS History of influenza immunization was positively associated with intent to immunize during pregnancy [OR=2.31, 90%CI: (1.06, 5.00)]. Significant correlates of intention to immunize included perceived susceptibility to influenza during pregnancy [OR=3.8, 90% CI: (1.75, 8.36)] and vaccine efficacy [OR=10.53, 90% CI: (4.34, 25.50)]. Single message exposure did not influence a woman's intent to vaccinate. CONCLUSIONS Prior immunization, perceived flu susceptibility and perceived vaccine effectiveness promoted immunization intent among this population of pregnant minority women. Vaccine efficacy and disease susceptibility are critical to promoting immunization among women with no history of seasonal influenza immunization, while those who received the vaccine are likely to do so again. These findings provide evidence for the promotion of repeated exposure to vaccine messages emphasizing vaccine efficacy, normative support, and susceptibility to influenza.
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Affiliation(s)
- Paula M Frew
- Emory University School of Medicine; Department of Medicine; Division of Infectious Diseases; Atlanta, GA USA
| | - Lauren E Owens
- Emory University; Rollins School of Public Health; Department of Epidemiology; Atlanta, GA USA
| | - Diane S Saint-Victor
- Emory University School of Medicine; Department of Medicine; Division of Infectious Diseases; Atlanta, GA USA
| | - Samantha Benedict
- Emory University; Rollins School of Public Health; Department of Epidemiology; Atlanta, GA USA
| | - Siyu Zhang
- Emory University; Rollins School of Public Health; Department of Epidemiology; Atlanta, GA USA
| | - Saad B Omer
- Emory University; Rollins School of Public Health; Hubert Department of Global Health; Atlanta, GA USA
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Moniz MH, Beigi RH. Maternal immunization. Clinical experiences, challenges, and opportunities in vaccine acceptance. Hum Vaccin Immunother 2014; 10:2562-70. [PMID: 25483490 DOI: 10.4161/21645515.2014.970901] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Maternal immunization holds tremendous promise to improve maternal and neonatal health for a number of infectious conditions. The unique susceptibilities of pregnant women to infectious conditions, as well as the ability of maternally-derived antibody to offer vital neonatal protection (via placental transfer), together have produced the recent increased attention on maternal immunization. The Advisory Committee on Immunization Practices (ACIP) currently recommends 2 immunizations for all pregnant women lacking contraindication, inactivated Influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap). Given ongoing research the number of vaccines recommended during pregnancy is likely to increase. Thus, achieving high vaccination coverage of pregnant women for all recommended immunizations is a key public health enterprise. This review will focus on the present state of vaccine acceptance in pregnancy, with attention to currently identified barriers and determinants of vaccine acceptance. Additionally, opportunities for improvement will be considered.
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Affiliation(s)
- Michelle H Moniz
- a Robert Wood Johnson Foundation Clinical Scholars® Program; Department of Obstetrics and Gynecology; Institute for Healthcare Policy and Innovation ; University of Michigan ; Ann Arbor , MI USA
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37
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Moniz MH, Beigi RH. Maternal immunization: Clinical experiences, challenges, and opportunities in vaccine acceptance. Hum Vaccin Immunother 2014. [DOI: 10.4161/hv.29588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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