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Mansfield LN, Kahn BZ, Kokitkar S, Kritikos KI, Brantz SN, Brewer NT. HPV vaccine standing orders and communication in primary care: A qualitative study. Vaccine 2024; 42:3981-3988. [PMID: 38816304 PMCID: PMC11242613 DOI: 10.1016/j.vaccine.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 04/26/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Standing orders may improve HPV vaccination rates, but clinical staff's readiness to use them has not been well-explored. We sought to explore benefits and challenges to using HPV vaccine standing orders for adolescents ages 9 to 12, understand clinical staff roles in communication about HPV vaccine, and how standing orders can reduce barriers contributing to vaccine disparities among racial and ethnic marginalized groups. METHODS Participants were a sample of 16 U.S. nurses, medical assistants, and healthcare providers working in primary care, recruited from June to September 2022. Trained staff conducted virtual, semi-structured qualitative interviews. We analyzed the resulting data using reflexive thematic analysis. RESULTS Themes reflected benefits and challenges to using HPV vaccine standing orders and strategies to address clinic barriers to improve vaccine access and HPV vaccine communication. Benefits included faster and efficient clinic flow; fewer missed vaccine opportunities and promotion of early vaccination; and normalization of HPV vaccination as routine care. Challenges included possible exacerbation of existing HPV vaccine communication and recommendation barriers; and how the complexity of the vaccine administration schedule lessens nurses' and medical assistants' confidence to use standing orders. Strategies to address vaccine access barriers included using nurse-only visits to empower nurse autonomy and catch up on HPV vaccination; engaging clinical staff to follow up with overdue children; and educating parents on HPV vaccine before their child is vaccine eligible. CONCLUSION Using HPV vaccine standing orders can promote autonomy for nurses and medical assistants and address vaccine access barriers. Clinical staff engagement and clinic support to mitigate existing vaccine communication barriers are needed to empower staff to use of HPV vaccine standing orders.
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Affiliation(s)
- Lisa N Mansfield
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
| | - Benjamin Z Kahn
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Saayli Kokitkar
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Katherine I Kritikos
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Sierra N Brantz
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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2
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Cataldi JR, Fisher ME, Brewer SE, Spina CI, Glasgow RE, Perreira C, Cochran F, O’Leary ST. Motivational interviewing for maternal Immunizations: Intervention development. Vaccine 2022; 40:7604-7612. [PMID: 36371367 PMCID: PMC9729433 DOI: 10.1016/j.vaccine.2022.10.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVE Vaccine uptake during pregnancy remains low. Our objectives were to describe 1) development and adaptation of a clinician communication training intervention for maternal immunizations and 2) obstetrics and gynecology (ob-gyn) clinician and staff perspectives on the intervention and fit for the prenatal care context. METHODS Design of the Motivational Interviewing for Maternal Immunizations (MI4MI) intervention was based on similar communication training interventions for pediatric settings and included presumptive initiation of vaccine recommendations ("You're due for two vaccines today") combined with motivational interviewing (MI) for hesitant patients. Interviews and focus group discussions were conducted with ob-gyn clinicians and staff in five Colorado clinics including settings with obstetric physicians, certified nurse midwives (CNMs), and clinician-trainees. Participants were asked about adapting training to the ob-gyn setting and their implementation experiences. Feedback was incorporated through iterative changes to training components. RESULTS Interview and focus group discussion results from participants before (n = 3), during (n = 11) and after (n = 25) implementation guided intervention development and adaptation. Three virtual, asynchronous training components were created: a video and two interactive modules. This virtual format was favored due to challenges attending group meetings; however, participants noted opportunities to practice skills through role-play were lacking. Training modules were adapted to include common challenging vaccine conversations and live-action videos. Participants liked interactive training components and use of adult learning strategies. Some participants initially resisted the presumptive approach but later found it useful after applying it in their practices. Overall, participants reported that MI4MI training fit well with the prenatal context and recommended more inclusion of non-clinician staff. CONCLUSIONS MI4MI training was viewed as relevant and useful for ob-gyn clinicians and staff. Suggestions included making training more interactive, and including more complex scenarios and non-clinician staff.
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Affiliation(s)
- Jessica R. Cataldi
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO,Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Mary E. Fisher
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO,Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Sarah E. Brewer
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO,Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Christine I. Spina
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO
| | - Russell E. Glasgow
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO,Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Cathryn Perreira
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO
| | - Fiona Cochran
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO
| | - Sean T. O’Leary
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO,Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
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Curran JA, Gallant AJ, Wong H, Shin HD, Urquhart R, Kontak J, Wozney L, Boulos L, Bhutta Z, Langlois EV. Knowledge translation strategies for policy and action focused on sexual, reproductive, maternal, newborn, child and adolescent health and well-being: a rapid scoping review. BMJ Open 2022; 12:e053919. [PMID: 35039297 PMCID: PMC8765012 DOI: 10.1136/bmjopen-2021-053919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify knowledge translation (KT) strategies aimed at improving sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) and well-being. DESIGN Rapid scoping review. SEARCH STRATEGY A comprehensive and peer-reviewed search strategy was developed and applied to four electronic databases: MEDLINE ALL, Embase, CINAHL and Web of Science. Additional searches of grey literature were conducted to identify KT strategies aimed at supporting SRMNCAH. KT strategies and policies published in English from January 2000 to May 2020 onwards were eligible for inclusion. RESULTS Only 4% of included 90 studies were conducted in low-income countries with the majority (52%) conducted in high-income countries. Studies primarily focused on maternal newborn or child health and well-being. Education (81%), including staff workshops and education modules, was the most commonly identified intervention component from the KT interventions. Low-income and middle-income countries were more likely to include civil society organisations, government and policymakers as stakeholders compared with high-income countries. Reported barriers to KT strategies included limited resources and time constraints, while enablers included stakeholder involvement throughout the KT process. CONCLUSION We identified a number of gaps among KT strategies for SRMNCAH policy and action, including limited focus on adolescent, sexual and reproductive health and rights and SRMNCAH financing strategies. There is a need to support stakeholder engagement in KT interventions across the continuum of SRMNCAH services. Researchers and policymakers should consider enhancing efforts to work with multisectoral stakeholders to implement future KT strategies and policies to address SRMNCAH priorities. REGISTRATION The rapid scoping review protocol was registered on Open Science Framework on 16 June 2020 (https://osf.io/xpf2k).
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Affiliation(s)
- Janet A Curran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Allyson J Gallant
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Helen Wong
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julia Kontak
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
| | - Lori Wozney
- Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
| | - Zulfiqar Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Etienne V Langlois
- The Partnership for Maternal, Newborn & Child Health, World Health Organization, Geneva, Switzerland
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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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Spina CI, Brewer SE, Ellingson MK, Chamberlain AT, Limaye RJ, Orenstein WA, Salmon DA, Omer SB, O'Leary ST. Adapting Center for Disease Control and Prevention's immunization quality improvement program to improve maternal vaccination uptake in obstetrics. Vaccine 2020; 38:7963-7969. [PMID: 33121843 DOI: 10.1016/j.vaccine.2020.10.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Maternal vaccination is critical for improving maternal and child health. Quality Improvement (QI) models1, such as the Centers for Disease Control and Prevention's (CDC) Assessment, Feedback, Incentives, eXchange (AFIX)2 model, have not yet been adapted to maternal vaccinations. This study assesses the impact of AFIX-OB, an adapted version of AFIX for obstetric settings, on maternal vaccination rates. METHODS Between December 2016 and May 2018, state health departments and obstetric practices in Colorado and Georgia implemented the adapted AFIX-OB model. The model addressed unique patterns in patient encounters, practice flow, health records systems and competing clinical priorities in the obstetric setting through a menu of clearly-defined QI strategies, bi-weekly technical assistance meetings with designated immunization champions, incentives for champions/staff, and adapted tools to aid each practice during implementation. Vaccination rates were assessed by random chart reviews pre- and post-intervention. RESULTS The AFIX-OB model was evaluated in eleven obstetric practices in two states as part of a multi-level intervention to increase maternal vaccination. Post AFIX-OB implementation, documented influenza vaccination rates increased from 56% at baseline to 65% (p < 0.01); and tetanus, diphtheria, and acellular pertussis (Tdap) vaccination rates increased from 77% at baseline to 84% (p < 0.02) across all practices. CONCLUSIONS The AFIX-OB model showed improvement in maternal vaccination rates for both influenza and Tdap vaccines. AFIX-OB may provide a useful framework for obstetric practices, as well as for other health care specialties. The focused goal should be on broader dissemination among those interested in adopting an evidence-based model for increasing vaccine uptake.
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Affiliation(s)
- Christine I Spina
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States.
| | - Sarah E Brewer
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Mallory K Ellingson
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
| | - Allison T Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Rupali J Limaye
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Walter A Orenstein
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Emory Vaccine Center, Emory University, Atlanta, GA, United States; Department of Medicine, School of Medicine, Emory University, Atlanta, GA, United States
| | - Daniel A Salmon
- Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Saad B Omer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States; Yale Institute for Global Health, Yale University, New Haven, CT, United States; Department of Internal Medicine (Infectious Disease), Yale School of Medicine, New Haven, CT, United States; Yale School of Nursing, Yale University, New Haven, CT, United States
| | - Sean T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Unvaccinated children as community parasites in National Qualitative Study from Turkey. BMC Public Health 2020; 20:1087. [PMID: 32652961 PMCID: PMC7353754 DOI: 10.1186/s12889-020-09184-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 06/30/2020] [Indexed: 12/31/2022] Open
Abstract
Background This national qualitative study explores (1) the experiences, observations, and opinions of health care workers (HCWs) about beliefs, socioeconomic, cultural, and environmental characteristics of parents refusing vaccination and (2) regional differences in the identified risk factors; (3) recommended solutions to improve vaccine acceptance in each of 12 regions in Turkey. Methods In total, we carried out 14 individual semi-structured in-depth interviews and 10 focus group discussions with 163 HCWs from 36 provinces. A thematic analysis was performed to explore HCWs’ observations about the parents’ decisions to reject vaccination and possible solutions for vaccine advocacy. Results Within the analyzed data framework, vaccine refusal statements could be defined as vaccine safety, the necessity of vaccines, assumptions of freedom of choice, health workers’ vaccine hesitancy, lack of information about national vaccination schedule and components, not trusting the health system, anti-vaccine publications in social media and newspapers, and refugees. Suggestions based on the HCWs suggestions can be summarized as interventions including (1) creating visual cards with scientific data on vaccine content and disease prevention and using them in counseling patients, (2) writing the vaccine components in a way understandable to ordinary people, (3) highlighting the national quality control and production in the vaccine box and labels, (4) conducting interviews with community opinion leaders, (5) training anti-vaccine HCWs with insufficient scientific knowledge and (6) reducing the tax of parents whose children are fully and punctually vaccinated. Conclusions The solution to vaccine rejection begins with the right approaches to vaccination during pregnancy. Prepared written and visual information notes should present the information as “vaccination acceptance” rather than “vaccination refusal”. Further studies on vaccine refusal rates should be carried out in various regions of the world so that region-specific actions are implemented to decrease the anti-vaxxer movement and to prevent an outbreak of infectious diseases.
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ACOG Committee Opinion No. 772: Immunization Implementation Strategies for Obstetrician-Gynecologists. Obstet Gynecol 2020; 133:e254-e259. [PMID: 30801479 DOI: 10.1097/aog.0000000000003130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Immunization against vaccine-preventable diseases is an essential component of women's primary and preventive health care. Many studies have shown that a recommendation from an obstetrician-gynecologist or other health care provider for a vaccine is one of the strongest influences on patient acceptance. Obstetrician-gynecologists and other health care providers should develop a standard process for assessing and documenting the vaccination status of patients and for recommending and administering vaccines. If allowed by state law, obstetrician-gynecologists and other health care providers are encouraged to institute standing orders for indicated immunizations. Obstetrician-gynecologists and other health care providers are encouraged to stock and, ideally, administer commonly recommended vaccines in their offices. Studies show that immunization rates are higher when a health care provider can offer and administer the vaccine during the same visit, as opposed to recommending vaccination and referring the patient elsewhere to receive the vaccine. Given the demonstrated efficacy and safety of vaccines and the large potential for prevention of many infectious diseases that affect adolescents, adults, pregnant women, and newborns, obstetrician-gynecologists should include immunizations as an integral part of their practice. This Committee Opinion has been revised to incorporate additional strategies for obstetrician-gynecologists to consider implementing to enhance their immunization programs.
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Abstract
OBJECTIVE To describe 1) obstetrician-gynecologists' (ob-gyns') perceptions of the frequency of vaccine refusal among pregnant patients and perceived reasons for refusal and 2) ob-gyns' strategies used when encountering vaccine refusal and perceived effectiveness of those strategies. METHODS We conducted an email and mail survey among a nationally representative network of ob-gyns from March 2016 to June 2016. RESULTS The response rate was 69% (331/477). Health care providers perceived that pregnant women more commonly refused influenza vaccine than tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine: 62% of respondents reported 10% or greater of pregnant women they care for in a typical month refused influenza vaccine compared with 32% reporting this for Tdap vaccine. The most commonly reported reasons for vaccine refusal were patients' belief that influenza vaccine makes them sick (48%), belief they are unlikely to get a vaccine-preventable disease (38%), general worries about vaccines (32%), desire to maintain a natural pregnancy (31%), and concern that their child could develop autism as a result of maternal vaccination (25%). The most commonly reported strategies ob-gyns used to address refusal were stating that it is safe to receive vaccines in pregnancy (96%), explaining that not getting the vaccine puts the fetus or newborn at risk (90%), or that not getting the vaccine puts the pregnant woman's health at risk (84%). The strategy perceived as most effective was stating that not getting vaccinated puts the fetus or newborn at risk. CONCLUSION Ob-gyns perceive vaccine refusal among pregnant women as common and refusal of influenza vaccine as more common than refusal of Tdap vaccine. Emphasizing the risk of disease to the fetus or newborn may be an effective strategy to increase vaccine uptake.
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O'Leary ST, Narwaney KJ, Wagner NM, Kraus CR, Omer SB, Glanz JM. Efficacy of a Web-Based Intervention to Increase Uptake of Maternal Vaccines: An RCT. Am J Prev Med 2019; 57:e125-e133. [PMID: 31471001 DOI: 10.1016/j.amepre.2019.05.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines are recommended for pregnant women in each pregnancy, yet uptake is suboptimal. This study tested the efficacy of an online vaccine resource in increasing uptake of Tdap and influenza vaccines among pregnant women. STUDY DESIGN RCT. SETTING/PARTICIPANTS This study was conducted among women in the third trimester of pregnancy in an integrated healthcare system in Colorado in September 2013-July 2016, with data analysis in 2017-2018. INTERVENTION Women were randomly assigned to 1 of 3 arms: website with vaccine information and interactive social media components, website with vaccine information only, or usual care. Participants in the website with vaccine information and interactive social media components and website with vaccine information only arms had access to the same base vaccine content. The website with vaccine information and interactive social media components also included a blog, discussion forum, and "Ask a Question" portal. MAIN OUTCOME MEASURES Tdap and influenza vaccination. These outcomes were analyzed separately. RESULTS For influenza (n=289), women in both the website with vaccine information and interactive social media components (OR=2.19, 95% CI=1.06, 4.53) and website with vaccine information only (OR=2.20, 95% CI=1.03, 4.69) arms had higher vaccine uptake than the usual care arm. The proportions of women receiving the influenza vaccine were 57%, 55%, and 36% in the website with vaccine information and interactive social media components, website with vaccine information only, and usual care arms, respectively. For Tdap (n=173), there were no significant differences in vaccine uptake between study arms. The proportions of women receiving Tdap were 71%, 69%, and 68% in the website with vaccine information and interactive social media components, website with vaccine information only, and usual care arms, respectively. CONCLUSIONS Web-based vaccination information sent to pregnant women can positively influence maternal influenza vaccine uptake. Because of potential scalability, the impact of robust vaccination information websites should be studied in other settings. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01873040.
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Affiliation(s)
- Sean T O'Leary
- Department of Pediatrics, University of Colorado, Aurora, Colorado.
| | - Komal J Narwaney
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Nicole M Wagner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Courtney R Kraus
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Saad B Omer
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado
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Use of Electronic Health Records to Improve Maternal Vaccination. Womens Health Issues 2019; 29:341-348. [DOI: 10.1016/j.whi.2019.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 04/17/2019] [Accepted: 04/30/2019] [Indexed: 01/02/2023]
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O'Leary ST, Pyrzanowski J, Brewer SE, Sevick C, Miriam Dickinson L, Dempsey AF. Effectiveness of a multimodal intervention to increase vaccination in obstetrics/gynecology settings. Vaccine 2019; 37:3409-3418. [DOI: 10.1016/j.vaccine.2019.05.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/23/2019] [Accepted: 05/09/2019] [Indexed: 01/05/2023]
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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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Frew PM, Randall LA, Malik F, Limaye RJ, Wilson A, O'Leary ST, Salmon D, Donnelly M, Ault K, Dudley MZ, Fenimore VL, Omer SB. Clinician perspectives on strategies to improve patient maternal immunization acceptability in obstetrics and gynecology practice settings. Hum Vaccin Immunother 2018; 14:1548-1557. [PMID: 29313458 DOI: 10.1080/21645515.2018.1425116] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Pregnancy is an ideal time to communicate with women about vaccines for themselves and their infants, yet maternal immunization rates remain suboptimal. This study aimed to identify clinic, provider, and staff-related attributes and facilitators to be utilized for a comprehensive vaccine intervention in ob-gyn clinical settings. We conducted in-depth interviews with 24 providers, both healthcare providers (e.g., physicians, nurse practitioners, midwives) and practice managers, from urban and suburban ob-gyn practices in Georgia and Colorado about their immunization attitudes, practices, and patient experiences. Qualitative analyses included Pearson correlation tests to evaluate patterns and relationships within the data to determine themes. Six major themes emerged: 1) strong provider "buy in" for maternal immunization; 2) the supporting role of clinical/interpersonal cues for vaccine promotion; 3) varying provider-patient communication approaches and its influence on maternal and pediatric uptake; 4) an urgent need for a designated office immunization champion; 5) reimbursement and practice implementation challenges; and 6) region differences in attitudes and values toward maternal immunization. Although providers expressed strong support for maternal immunization practices and offered environmental cues for vaccine promotion, practices often lacked a designated, structured role for an immunization champion equipped to manage delicate conversations with patients. The findings reflect needs for immunization champion identification, training, and support, along with best practices guidelines to improve coordination of vaccine promotion and delivery efforts in ob-gyn provider offices. Additionally, provider training on communication approaches to enhance acceptance and uptake of maternal vaccines is warranted.
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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.,b Emory University Rollins School of Public Health , Hubert Department of Global Health , Atlanta , GA , USA
| | - Laura A Randall
- a Emory University School of Medicine , Department of Medicine, Division of Infectious Diseases , Atlanta , GA , USA
| | - Fauzia Malik
- b Emory University Rollins School of Public Health , Hubert Department of Global Health , Atlanta , GA , USA
| | - Rupali J Limaye
- c Johns Hopkins Bloomberg School of Public Health , Department of International Health, Division of Global Disease Epidemiology and Control , Baltimore , MD , USA
| | - Andrew Wilson
- b Emory University Rollins School of Public Health , Hubert Department of Global Health , Atlanta , GA , USA
| | - Sean T O'Leary
- d University of Colorado Denver , Department of Pediatrics, Division of Infectious Diseases , Denver , CO , USA
| | - Daniel Salmon
- c Johns Hopkins Bloomberg School of Public Health , Department of International Health, Division of Global Disease Epidemiology and Control , Baltimore , MD , USA
| | - Meghan Donnelly
- e University of Colorado School of Medicine , Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Denver , CO , USA
| | - Kevin Ault
- f University of Kansas Medical Center , Department of Obstetrics and Gynecology , Kansas City , KS , USA
| | - Matthew Z Dudley
- c Johns Hopkins Bloomberg School of Public Health , Department of International Health, Division of Global Disease Epidemiology and Control , Baltimore , MD , USA
| | - Vincent L Fenimore
- a Emory University School of Medicine , Department of Medicine, Division of Infectious Diseases , Atlanta , GA , USA
| | - Saad B Omer
- b Emory University Rollins School of Public Health , Hubert Department of Global Health , Atlanta , GA , USA.,g Emory University Rollins School of Public Health , Department of Epidemiology , Atlanta , GA , USA.,h Emory University School of Medicine , Department of Medicine, Division of Pediatrics , Atlanta , GA , USA
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14
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Krishnaswamy S, Wallace EM, Buttery J, Giles ML. Strategies to implement maternal vaccination: A comparison between standing orders for midwife delivery, a hospital based maternal immunisation service and primary care. Vaccine 2018; 36:1796-1800. [PMID: 29395531 DOI: 10.1016/j.vaccine.2017.12.080] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/11/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Abstract
Maternal vaccination is a safe and effective strategy to reduce maternal and neonatal morbidity and mortality from pertussis and influenza. However, despite recommendations for maternal vaccination since 2010, uptake remains suboptimal. Barriers to uptake have been studied widely and include lack of integration of vaccination into routine pregnancy care and access to vaccination services. Standing orders for administration of vaccines without the need for a physician review or prescription have been demonstrated to improve uptake as part of multi-model interventions to increase antenatal influenza and post-partum pertussis vaccination. Monash Health is a university-affiliated, public healthcare network in Melbourne, Australia providing maternity services across three hospitals. In this study we compared three different immunisation models - an immunisation nurse-led immunisation service, standing orders for midwife-administered pertussis vaccination within pregnancy care clinics, and delivery by general practitioners in primary care. Uptake of maternal pertussis vaccine was measured as recorded in the state-wide perinatal data collection tool. Uptake improved significantly at all three hospitals over the study period with the most significant change (39% to 91%, p < .001) noted at the hospital where standing orders were introduced. Our study highlights the diversity of immunisation service models available in maternity care settings. We demonstrated significant improvement in uptake of maternal pertussis vaccination with introduction of midwife-administered vaccination but each maternity service should consider the model best suited to their needs.
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Affiliation(s)
- Sushena Krishnaswamy
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia; Monash Infectious Diseases, Monash Health, Melbourne, Australia.
| | - Euan M Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia; Safer Care Victoria, Victorian Department of Health and Human Services, Melbourne, Australia
| | - Jim Buttery
- Infection and Immunity, Monash Children's Hospital, Melbourne, Australia; Monash Centre for Health Research and Implementation, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michelle L Giles
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia; Monash Infectious Diseases, Monash Health, Melbourne, Australia
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15
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Thompson EL, Best AL, Vamos CA, Daley EM. "My mom said it wasn't important": A case for catch-up human papillomavirus vaccination among young adult women in the United States. Prev Med 2017; 105:1-4. [PMID: 28823755 DOI: 10.1016/j.ypmed.2017.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 12/26/2022]
Abstract
The human papillomavirus (HPV) vaccine prevents HPV-related diseases, including anogenital cancers and genital warts. In the United States, while it is recommended to adolescents ages 11 to 12, catch-up vaccination is available for those previously unvaccinated until age 26. Parental decisions or lack of provider recommendation during adolescence are barriers to on-time vaccination. Young adult women, ages 18 to 26, are a key catch-up vaccination population as this is a period for autonomous decision-making, high healthcare utilization, and other recommended prevention behaviors. Additional intervention research is required to promote HPV vaccine uptake among young adult women. Evidence-based and theory-informed interventions need to be developed and evaluated to reach a large number of women. In order to improve HPV vaccination among young adult women, future research should integrate the themes of health literacy, alternative healthcare settings, and OB/GYN providers to facilitate improved access and shared decision-making for the vaccine. This last chance for HPV-related cancer prevention should not be forgotten in public health efforts.
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Affiliation(s)
- Erika L Thompson
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Alicia L Best
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Cheryl A Vamos
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
| | - Ellen M Daley
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd. MDC 56, Tampa, FL 33612, USA.
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