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Shankar M, Hazfiarini A, Zahroh RI, Vogel JP, McDougall ARA, Condron P, Goudar SS, Pujar YV, Somannavar MS, Charantimath U, Ammerdorffer A, Rushwan S, Gülmezoglu AM, Bohren MA. Factors influencing the participation of pregnant and lactating women in clinical trials: A mixed-methods systematic review. PLoS Med 2024; 21:e1004405. [PMID: 38814991 PMCID: PMC11139290 DOI: 10.1371/journal.pmed.1004405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/19/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Poor representation of pregnant and lactating women and people in clinical trials has marginalised their health concerns and denied the maternal-fetal/infant dyad benefits of innovation in therapeutic research and development. This mixed-methods systematic review synthesised factors affecting the participation of pregnant and lactating women in clinical trials, across all levels of the research ecosystem. METHODS AND FINDINGS We searched 8 databases from inception to 14 February 2024 to identify qualitative, quantitative, and mixed-methods studies that described factors affecting participation of pregnant and lactating women in vaccine and therapeutic clinical trials in any setting. We used thematic synthesis to analyse the qualitative literature and assessed confidence in each qualitative review finding using the GRADE-CERQual approach. We compared quantitative data against the thematic synthesis findings to assess areas of convergence or divergence. We mapped review findings to the Theoretical Domains Framework (TDF) and Capability, Opportunity, and Motivation Model of Behaviour (COM-B) to inform future development of behaviour change strategies. We included 60 papers from 27 countries. We grouped 24 review findings under 5 overarching themes: (a) interplay between perceived risks and benefits of participation in women's decision-making; (b) engagement between women and the medical and research ecosystems; (c) gender norms and decision-making autonomy; (d) factors affecting clinical trial recruitment; and (e) upstream factors in the research ecosystem. Women's willingness to participate in trials was affected by: perceived risk of the health condition weighed against an intervention's risks and benefits, therapeutic optimism, intervention acceptability, expectations of receiving higher quality care in a trial, altruistic motivations, intimate relationship dynamics, and power and trust in medicine and research. Health workers supported women's participation in trials when they perceived clinical equipoise, had hope for novel therapeutic applications, and were convinced an intervention was safe. For research staff, developing reciprocal relationships with health workers, having access to resources for trial implementation, ensuring the trial was visible to potential participants and health workers, implementing a woman-centred approach when communicating with potential participants, and emotional orientations towards the trial were factors perceived to affect recruitment. For study investigators and ethics committees, the complexities and subjectivities in risk assessments and trial design, and limited funding of such trials contributed to their reluctance in leading and approving such trials. All included studies focused on factors affecting participation of cisgender pregnant women in clinical trials; future research should consider other pregnancy-capable populations, including transgender and nonbinary people. CONCLUSIONS This systematic review highlights diverse factors across multiple levels and stakeholders affecting the participation of pregnant and lactating women in clinical trials. By linking identified factors to frameworks of behaviour change, we have developed theoretically informed strategies that can help optimise pregnant and lactating women's engagement, participation, and trust in such trials.
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Affiliation(s)
- Mridula Shankar
- Gender and Women’s Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Alya Hazfiarini
- Gender and Women’s Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Rana Islamiah Zahroh
- Gender and Women’s Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Annie R. A. McDougall
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Patrick Condron
- University Library, University of Melbourne, Carlton, Victoria, Australia
| | - Shivaprasad S. Goudar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Yeshita V. Pujar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Manjunath S. Somannavar
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - Umesh Charantimath
- Women’s and Children’s Health Research Unit, KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | | | - Sara Rushwan
- Concept Foundation, Geneva, Switzerland/Bangkok, Thailand
| | | | - Meghan A. Bohren
- Gender and Women’s Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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Searles M, Jose Ronquillo Mora Y, Carlo L, Heydari N, Takyiwaa Y, Borbor-Cordova MJ, Campagna CD. Zika virus knowledge and vaccine acceptance among undergraduate students in Guayaquil, Ecuador. Vaccine X 2022; 13:100258. [PMID: 36686399 PMCID: PMC9850025 DOI: 10.1016/j.jvacx.2022.100258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 11/17/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose Zika virus (ZIKV) was declared a Public Health Emergency of International Concern (PHEIC) in 2016. Concerns surrounding the effects of ZIKV persist today and several vaccine candidates are currently in various stages of development worldwide. There is limited research on ZIKV vaccine acceptability worldwide, and little research specific to Latin American countries. This research aims to identify the general beliefs and acceptance of a potential ZIKV vaccine in the undergraduate population at Escuela Superior Politécnica del Litoral (ESPOL) in Guayaquil, Ecuador. Methods Between January and November 2019, 429 undergraduate students at ESPOL responded anonymously to a ZIKV vaccine survey. Frequencies, percentages, simple correspondence analysis, and bivariate inferential analyses were conducted using Kendall's tau-b test. Tests explored associations between likelihood of receiving a ZIKV vaccine and demographic, ZIKV information seeking, ZIKV psychosocial variables, and ZIKV information source variables. Results Among the eligible participants, 241 (56.2%) were willing to receive a ZIKV vaccine if one was made commercially available. Most students were male (61.5%), age 20-25 (63.3%), and of mixed (Mestizo) race (95.3%). Results provided insight into student's knowledge on ZIKV, revealed television as the most common information source, and found most students were willing to receive a ZIKV vaccine were one to become available. Bivariate results revealed most respondents reported feeling neutral or likely to receive a ZIKV vaccine regardless of their agreeability with ZIKV information seeking behavior and psychosocial variables. Conclusions This study provides insight into ZIKV knowledge among ESPOL university students and reveals most respondents obtained ZIKV related information from television. The most common reason for not wanting to receive a hypothetical ZIKV vaccine was vaccine hesitancy. Likelihood of receiving a ZIKV vaccine was associated with several information seeking behavior and psychosocial variables. Public health campaigns should focus on comprehensive ZIKV education efforts in this population.
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Affiliation(s)
- Madison Searles
- Institute for Global Health and Translational Science, State University of New York Upstate Medical University, 505 Irving Avenue Suite 4200, Syracuse, NY, 13210, USA
| | - Ysai Jose Ronquillo Mora
- Facultad de Ingeniería Marítima y Ciencias del Mar, Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Lorena Carlo
- Department of Health Informatics, School of Health Professions, Rutgers University, Piscataway, NJ, 08854, USA,Facultad de Ingeniería Electricidad y Computación, Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador
| | - Naveed Heydari
- Institute for Global Health and Translational Science, State University of New York Upstate Medical University, 505 Irving Avenue Suite 4200, Syracuse, NY, 13210, USA
| | - Yaa Takyiwaa
- Institute for Global Health and Translational Science, State University of New York Upstate Medical University, 505 Irving Avenue Suite 4200, Syracuse, NY, 13210, USA,College of Medicine, State University of New York Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - Mercy J Borbor-Cordova
- Facultad de Ingeniería Marítima y Ciencias del Mar, Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador,Pacific International Center for Disaster Risk Reduction (-RRD), ESPOL, Campus Gustavo Galindo Km. 30.5 Vía Perimetral, Guayaquil, Ecuador
| | - Christina D Campagna
- Institute for Global Health and Translational Science, State University of New York Upstate Medical University, 505 Irving Avenue Suite 4200, Syracuse, NY, 13210, USA,Department of Public Health and Preventive Medicine, State University of New York Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA,Corresponding author.
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Demir R, Kaya Odabaş R. A systematic review to determine the anti-vaccination thoughts of pregnant women and the reasons for not getting vaccinated. J OBSTET GYNAECOL 2022; 42:2603-2614. [PMID: 36018038 DOI: 10.1080/01443615.2022.2114327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The aim of this study was to determine the anti-vaccination thoughts of pregnant women and the reasons for not getting vaccinated. In this study, data was obtained by retrospectively scanning the cross-sectional and qualitative studies published in the databases of 'PubMed, Cochrane, EBSCOhost, ULAKBİM and Google Scholar' in Turkish and English languages between 2011-2021. The PRISMA method was used in the preparation of the systematic review. In the studies reviewed, it was determined that the rate of pregnant women who were against the vaccine ranged from 6.2% to 98.6%, and the opinions of pregnant women against vaccination and the reasons for not getting vaccinated are presented under seven themes. The results of the study were considered important in terms of showing that quality and important studies were carried out in the literature on the subject and that the data were presented.IMPACT STATEMENTWhat is already known on this subject? Today, with the global coronavirus pandemic, vaccines and their effects are on the agenda again. Especially in pregnant women, opposition to vaccination and not getting vaccinated have emerged for various reasons.What do the results of this study add? The anti-vaccine thoughts of the pregnant women and the reasons for not getting vaccinated were mostly as follows: insufficient level of knowledge, mistrust of vaccines, perception of low infection risk, misconceptions and beliefs about the safety, content, side effects and efficacy of vaccines, worry and fear about the side effects of vaccines, the thought that the vaccine will harm herself and the baby, causes arising from healthcare professionals, financial, temporal and logistical barriers.What the implications are of these findings for clinical practice and/or further research? Scientific studies that can provide comprehensive and strong evidence about vaccine hesitancy and its causes, methods of increasing social approval in vaccination, and solutions should be proposed in the light of these researches in the fight against vaccine rejection.
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Affiliation(s)
- Rukiye Demir
- Department of Midwifery, Faculty of Health Sciences, Canakkale Onsekiz Mart University, Canakkale, Turkiye
| | - Resmiye Kaya Odabaş
- Department of Midwifery, Faculty of Health Sciences, Kocaeli University, Kocaeli, Turkiye
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Gagneux-Brunon A, Guyot E, Detoc M, Botelho-Nevers E, Raia-Barjat T. Midwives’ attitudes toward participation of pregnant individuals in a preventive vaccine hypothetical clinical trial. Vaccine 2022; 40:5459-5463. [DOI: 10.1016/j.vaccine.2022.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 06/20/2022] [Accepted: 07/29/2022] [Indexed: 10/16/2022]
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Jaffe E, Lyerly AD, Goldfarb IT. Pregnant women's perceptions of risks and benefits when considering participation in vaccine trials. Vaccine 2020; 38:6922-6929. [PMID: 32893036 PMCID: PMC7471759 DOI: 10.1016/j.vaccine.2020.08.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Despite historical exclusion, there has been recent recognition of the need to address the health of pregnant women in research on vaccines against emerging pathogens. However, pregnant women's views and decision-making processes about vaccine research participation during infectious disease outbreaks remain underexplored. This study aims to examine women's decision-making processes around vaccine research participation during infectious disease outbreaks. METHODS We conducted qualitative semi-structured in-depth interviews with pregnant and recently pregnant women (n = 13), eliciting their views on four hypothetical Zika Virus vaccine research scenarios and probing their decision-making processes around participation. After recorded interviews were transcribed, thematic analysis was conducted based on a priori and emergent themes. RESULTS Most women interviewed were accepting of vaccine research scenarios. Three broad themes-evidence, risk, and trust-characterized women's decision-making processes. Women varied in how different types and levels of evidence impacted their considerations, which risks were most salient to their decision-making processes, and from whom they trusted recommendations about vaccine research participation. Exemplary quotes from each theme are presented, and lessons for vaccine development during the current COVID-19 pandemic and future outbreaks are discussed. CONCLUSION Some pregnant women are accepting of participation in vaccine research during infectious disease outbreaks. Incorporating their priorities into trial design may facilitate their participation and generation of evidence for this important population.
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Affiliation(s)
- Elana Jaffe
- Center for Bioethics and Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Maternal, Child, and Family Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Anne Drapkin Lyerly
- Center for Bioethics and Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ilona Telefus Goldfarb
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States.
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Marbán-Castro E, Villén-Gonzalvo A, Enguita-Fernàndez C, Romero-Acosta KC, Marín-Cos A, Arrieta GJ, Mattar S, Menéndez C, Maixenchs M, Bardají A. Acceptability of a Hypothetical Zika Vaccine among Women from Colombia and Spain Exposed to ZIKV: A Qualitative Study. Vaccines (Basel) 2020; 8:vaccines8040580. [PMID: 33022907 PMCID: PMC7711833 DOI: 10.3390/vaccines8040580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 12/20/2022] Open
Abstract
Zika virus (ZIKV) can cause pregnancy loss and congenital Zika syndrome, among other poor health outcomes. The ZIKV epidemic in 2015-2017 disproportionately affected pregnant women in poor-resource settings. We aimed to understand perceptions and attitudes towards a hypothetical ZIKV vaccine, women's willingness to be vaccinated, and potential barriers and facilitators for vaccine acceptance in 1) migrant women living in Spain who travelled to their countries of origin and were diagnosed with ZIKV infection during pregnancy, and their healthcare providers, and 2) women living in Colombia who delivered a child with microcephaly. An exploratory qualitative study based on phenomenology and grounded theory was conducted. Data were collected through in-depth, paired and semi-structured interviews. Overall, women from both sites were willing to receive a hypothetical ZIKV vaccine. However, some expressed concerns of being vaccinated during pregnancy, yet they would accept it if the vaccine was recommended by a healthcare professional they trust. Main fears towards vaccination were related to vaccine safety and potential adverse effects on child's health. Women reported feeling hesitant to participate in a ZIKV vaccine trial. These results may contribute to guiding the effective delivery of future ZIKV vaccines among populations most at risk and particularly vulnerable.
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Affiliation(s)
- Elena Marbán-Castro
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-93-227-1851
| | - Ana Villén-Gonzalvo
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
| | - Cristina Enguita-Fernàndez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Kelly Carolina Romero-Acosta
- Faculty of Humanities and Education, Corporación Universitaria del Caribe (CECAR), Sincelejo, Sucre 700001, Colombia; (K.C.R.-A.); (G.J.A.)
| | - Anna Marín-Cos
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
| | - Germán J. Arrieta
- Faculty of Humanities and Education, Corporación Universitaria del Caribe (CECAR), Sincelejo, Sucre 700001, Colombia; (K.C.R.-A.); (G.J.A.)
- Clínica Salud Social, Sincelejo, Sucre 700001, Colombia;
| | - Salim Mattar
- Clínica Salud Social, Sincelejo, Sucre 700001, Colombia;
- Instituto de Investigaciones Biológicas del Trópico, Universidad de Córdoba, Montería 230002, Córdoba, Colombia
| | - Clara Menéndez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Azucena Bardají
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
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Regan AK, Håberg SE, Fell DB. Current Perspectives on Maternal Influenza Immunization. CURRENT TROPICAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40475-019-00188-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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