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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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Simas C, Larson HJ, Paterson P. ''Those who do not vaccinate don't love themselves, or anyone else'': a qualitative study of views and attitudes of urban pregnant women towards maternal immunisation in Panama. BMJ Open 2021; 11:e044903. [PMID: 34417210 PMCID: PMC8381308 DOI: 10.1136/bmjopen-2020-044903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To identify pregnant women's views and attitudes towards maternal immunisation in Panama based on in-depth interviews and focus groups. SETTING Two main urban centres in Panama (San Miguelito and Panama City). PARTICIPANTS Fifty-six pregnant women from Panama City (n=29) and San Miguelito (n=27). METHODS In-depth interviews and focus groups were conducted, audio-recorded, transcribed verbatim and analysed using a deductive-inductive approach. RESULTS Our findings suggest that this population perceives vaccination as a key component of maternal healthcare, not an elective part of it. The pregnant women interviewed disclosed a heightened perception of vulnerability to infectious diseases. For this reason, safety and effectiveness of maternal vaccines were closely associated for many participants (a vaccine was perceived as safe if it was effective against disease). Refusal of maternal vaccination was strongly associated with parental negligence. Participants reported the participation of husbands and partners in the decision-making around their health. Most participants reported high information-seeking behaviour, particularly online; many interviewees confirmed any information obtained online with their healthcare professionals (HCPs). Vaccine recommendations from HCPs appeared to be one of the main predictors of maternal immunisations among the sample interviewed. While acceptability of maternal vaccines was high in this sample, some pregnant women expressed concerns and doubts (e.g., that maternal vaccines could cause miscarriages) which require attention. Finally, many participants reported difficulties in accessing maternal vaccination, pointing to financial and physical barriers. CONCLUSIONS The acceptability of maternal immunisation was high among the interviewed women. The pregnant women's receptiveness to maternal vaccinations, even when information provided was limited, is suggestive of high levels of trust in HCPs. Even so, HCPs and health officials should remain alert to apprehensions expressed by pregnant women. Many participants reported struggles in accessing maternal vaccination, pointing to issues that merit further examination.
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Affiliation(s)
- Clarissa Simas
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Heidi J Larson
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Department of Health Metrics Sciences, University of Washington, Seattle, Washington, USA
| | - Pauline Paterson
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health Research Health Protection Research Unit (NIHR-HPRU) in Immunisation, London School of Hygiene and Tropical Medicine in partnership with Public Health England, London, UK
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Simas C, Larson HJ, Paterson P. "Saint Google, now we have information!": a qualitative study on narratives of trust and attitudes towards maternal vaccination in Mexico City and Toluca. BMC Public Health 2021; 21:1170. [PMID: 34144703 PMCID: PMC8212502 DOI: 10.1186/s12889-021-11184-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/28/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Maternal vaccination is key to decreasing maternal and infant mortality globally. Yet perceptions about maternal vaccines and immunization among pregnant women are often understudied, particularly in low- and middle- income countries. This qualitative study explored trust, views, and attitudes towards maternal immunization among pregnant women in Mexico. A total of 54 women from Mexico City and Toluca participated in the in-depth interviews and focus groups. We explored participants' experiences with maternal vaccination, as well as how they navigated the health system, searched for information, and made decisions around maternal immunization. RESULTS Our findings point to issues around access and quality of maternal healthcare, including immunizations services. While healthcare professionals were recognized for their expertise, participants reported not receiving enough information to make informed decisions and used online search engines and digital media to obtain more information about maternal healthcare. Some participants held strong doubts over the benefits of vaccination and were hesitant about the safety and efficacy of maternal vaccines. These concerns were also shared by pregnant women who had been vaccinated. Some participants disclosed low levels of trust in government and vaccination campaigns. CONCLUSION Pregnant women, soon to be parents and making vaccination decisions for their child, constitute an important target group for policymakers seeking optimal maternal as well as childhood immunization coverage. Our findings highlight the importance of targeted communication, trust-building and engagement strategies to strengthen confidence in immunization amongst this group.
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Affiliation(s)
- Clarissa Simas
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Heidi J Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Department of Health Metrics Sciences, University of Washington, Seattle, USA
| | - Pauline Paterson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- National Institute for Health Research Health Protection Research Unit (NIHR-HPRU) in Immunisation, London School of Hygiene and Tropical Medicine in partnership with Public Health England, London, UK
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Erazo CE, Erazo CV, Grijalva MJ, Moncayo AL. Knowledge, attitudes and practices on influenza vaccination during pregnancy in Quito, Ecuador. BMC Public Health 2021; 21:72. [PMID: 33413252 PMCID: PMC7791889 DOI: 10.1186/s12889-020-10061-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/13/2020] [Indexed: 02/07/2023] Open
Abstract
Background Vaccination is the most effective way to prevent infection and severe outcomes caused by influenza viruses in pregnant women and their children. In Ecuador, the coverage of seasonal influenza vaccination in pregnant women is low. The aim of this study was to assess the knowledge, attitudes, and practices (KAP) of pregnant women toward influenza vaccination in Quito-Ecuador. Methods A cross-sectional study enrolled 842 women who delivered at three main public gynecological-obstetric units of the Metropolitan District of Quito. A questionnaire regarding demographics, antenatal care, risk conditions and knowledge, attitudes and practices related to influenza vaccination was administered. We examined factors associated with vaccination using log-binomial regression models. Results A low vaccination rate (36.6%) against influenza was observed among pregnant women. The factors associated with vaccination included the recommendations from health providers (adjusted PR: 15.84; CI 95% 9.62–26.10), belief in the safety of the influenza vaccine (adjusted PR: 1.53; CI 95% 1.03–2.37) and antenatal care (adjusted PR: 1.21; CI 95% 1.01–1.47). The most common reasons for not vaccinating included the lack of recommendation from health care providers (73.9%) and lack of access to vaccine (9.0%). Conclusions Health educational programs aimed at pregnant women and antenatal care providers have the most potential to increase influenza vaccination rates. Further studies are needed to understand the barriers of health care providers regarding influenza vaccination in Ecuador. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10061-4.
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Affiliation(s)
- Carlos E Erazo
- Centro de Investigación para la Salud en América Latina (CISeAL), Escuela de Ciencias Biológicas, Facultad de Ciencias Exactas y Naturales, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador
| | - Carlos V Erazo
- Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador
| | - Mario J Grijalva
- Centro de Investigación para la Salud en América Latina (CISeAL), Escuela de Ciencias Biológicas, Facultad de Ciencias Exactas y Naturales, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador.,Department of Biomedical Sciences, Infectious and Tropical Disease Institute, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, 45701, USA
| | - Ana L Moncayo
- Centro de Investigación para la Salud en América Latina (CISeAL), Escuela de Ciencias Biológicas, Facultad de Ciencias Exactas y Naturales, Pontificia Universidad Católica del Ecuador, Apartado, 1701-2184, Quito, Ecuador.
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Guzman-Holst A, DeAntonio R, Prado-Cohrs D, Juliao P. Barriers to vaccination in Latin America: A systematic literature review. Vaccine 2020; 38:470-481. [DOI: 10.1016/j.vaccine.2019.10.088] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/14/2019] [Accepted: 10/18/2019] [Indexed: 11/16/2022]
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Mendoza-Sassi RA, Linhares AO, Schroeder FMM, Maas NM, Nomiyama S, César JA. Vaccination against influenza among pregnant women in southern Brazil and associated factors. CIENCIA & SAUDE COLETIVA 2019; 24:4655-4664. [DOI: 10.1590/1413-812320182412.08382018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 04/30/2018] [Indexed: 02/07/2023] Open
Abstract
Abstract This article aims to identify the prevalence and factors associated with influenza vaccination in pregnant women. This is a cross-sectional study conducted in a municipality in the southernmost region of Brazil, which included all women giving birth in 2016. The outcome was having received the vaccine against influenza during pregnancy. Sociodemographic, behavioral and prenatal care characteristics and morbidities were analyzed. The analysis included sample description, the prevalence of vaccination for each independent variable and a multivariate analysis. Two thousand six hundred ninety-four pregnant women were interviewed, of which 53.9% reported having been vaccinated. Factors associated with increased prevalence of vaccination were mother’s higher schooling, prenatal care, tetanus vaccination and prenatal care performed in a public service. On the other hand, prenatal care onset after the first quarter reduced the prevalence of vaccination. The results point to the need to reinforce the importance of vaccination against influenza among pregnant women and among health professionals, regardless of the severity of the current epidemiological setting.
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Carlisle N, Seed PT, Gillman L. Can common characteristics be identified as predictors for seasonal influenza vaccine uptake in pregnancy? A retrospective cohort study from a South London Hospital. Midwifery 2019; 72:67-73. [DOI: 10.1016/j.midw.2019.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/09/2018] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
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Schmid P, Rauber D, Betsch C, Lidolt G, Denker ML. Barriers of Influenza Vaccination Intention and Behavior - A Systematic Review of Influenza Vaccine Hesitancy, 2005 - 2016. PLoS One 2017; 12:e0170550. [PMID: 28125629 PMCID: PMC5268454 DOI: 10.1371/journal.pone.0170550] [Citation(s) in RCA: 727] [Impact Index Per Article: 103.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/06/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Influenza vaccine hesitancy is a significant threat to global efforts to reduce the burden of seasonal and pandemic influenza. Potential barriers of influenza vaccination need to be identified to inform interventions to raise awareness, influenza vaccine acceptance and uptake. OBJECTIVE This review aims to (1) identify relevant studies and extract individual barriers of seasonal and pandemic influenza vaccination for risk groups and the general public; and (2) map knowledge gaps in understanding influenza vaccine hesitancy to derive directions for further research and inform interventions in this area. METHODS Thirteen databases covering the areas of Medicine, Bioscience, Psychology, Sociology and Public Health were searched for peer-reviewed articles published between the years 2005 and 2016. Following the PRISMA approach, 470 articles were selected and analyzed for significant barriers to influenza vaccine uptake or intention. The barriers for different risk groups and flu types were clustered according to a conceptual framework based on the Theory of Planned Behavior and discussed using the 4C model of reasons for non-vaccination. RESULTS Most studies were conducted in the American and European region. Health care personnel (HCP) and the general public were the most studied populations, while parental decisions for children at high risk were under-represented. This study also identifies understudied concepts. A lack of confidence, inconvenience, calculation and complacency were identified to different extents as barriers to influenza vaccine uptake in risk groups. CONCLUSION Many different psychological, contextual, sociodemographic and physical barriers that are specific to certain risk groups were identified. While most sociodemographic and physical variables may be significantly related to influenza vaccine hesitancy, they cannot be used to explain its emergence or intensity. Psychological determinants were meaningfully related to uptake and should therefore be measured in a valid and comparable way. A compendium of measurements for future use is suggested as supporting information.
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Affiliation(s)
- Philipp Schmid
- Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Erfurt, Germany
- Department of Media and Communication Sciences, University of Erfurt, Erfurt, Germany
| | - Dorothee Rauber
- Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Erfurt, Germany
- Department of Media and Communication Sciences, University of Erfurt, Erfurt, Germany
| | - Cornelia Betsch
- Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Erfurt, Germany
- Department of Media and Communication Sciences, University of Erfurt, Erfurt, Germany
| | - Gianni Lidolt
- Department of Media and Communication Sciences, University of Erfurt, Erfurt, Germany
| | - Marie-Luisa Denker
- Department of Media and Communication Sciences, University of Erfurt, Erfurt, Germany
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Pfitscher LC, Cecatti JG, Pacagnella RC, Haddad SM, Parpinelli MA, Souza JP, Quintana SM, Surita FG, Sousa MH, Costa ML. Severe maternal morbidity due to respiratory disease and impact of 2009 H1N1 influenza A pandemic in Brazil: results from a national multicenter cross-sectional study. BMC Infect Dis 2016; 16:220. [PMID: 27207244 PMCID: PMC4894555 DOI: 10.1186/s12879-016-1525-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 04/26/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the burden of respiratory disease, considering the influenza A pandemic season (H1N1pdm09), within the Brazilian Network for Surveillance of Severe Maternal Morbidity, and factors associated with worse maternal outcome. METHODS A multicenter cross-sectional study, involving 27 referral maternity hospitals in five Brazilian regions. Cases were identified in a prospective surveillance by using the WHO standardized criteria for potentially life-threatening conditions (PLTC) and maternal near miss (MNM). Women with severe complications from respiratory disease identified as suspected or confirmed cases of H1N1 influenza or respiratory failure were compared to those with other causes of severe morbidity. A review of suspected H1N1 influenza cases classified women as non-tested, tested positive and tested negative, comparing their outcomes. Factors associated with severe maternal outcome (SMO = MNM + MD) were assessed in both groups, in comparison to PLTC, using PR and 95 % CI adjusted for design effect of cluster sampling. RESULTS Among 9555 cases of severe maternal morbidity, 485 (5 %) had respiratory disease. Respiratory disease occurred in one-quarter of MNM cases and two-thirds of MD. H1N1 virus was suspected in 206 cases with respiratory illness. Around 60 % of these women were tested, yielding 49 confirmed cases. Confirmed H1N1 influenza cases had worse adverse outcomes (MNM:MD ratio < 1 (0.9:1), compared to 12:1 in cases due to other causes), and a mortality index > 50 %, in comparison to 7.4 % in other causes of severe maternal morbidity. Delay in medical care was associated with SMO in all cases considered, with a two-fold increased risk among respiratory disease patients. Perinatal outcome was worse in cases complicated by respiratory disease, with increased prematurity, stillbirth, low birth weight and Apgar score < 7. CONCLUSIONS Respiratory disease, especially considering the influenza season, is a very severe cause of maternal near miss and death. Increased awareness about this condition, preventive vaccination during pregnancy, early diagnosis and treatment are required to improve maternal health.
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Affiliation(s)
- L C Pfitscher
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medicine, Alexander Fleming, 101, 13083-881, Campinas, São Paulo, Brazil
| | - J G Cecatti
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medicine, Alexander Fleming, 101, 13083-881, Campinas, São Paulo, Brazil
| | - R C Pacagnella
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medicine, Alexander Fleming, 101, 13083-881, Campinas, São Paulo, Brazil
| | - S M Haddad
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medicine, Alexander Fleming, 101, 13083-881, Campinas, São Paulo, Brazil
| | - M A Parpinelli
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medicine, Alexander Fleming, 101, 13083-881, Campinas, São Paulo, Brazil
| | - J P Souza
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medicine, Alexander Fleming, 101, 13083-881, Campinas, São Paulo, Brazil
- Department of Obstetrics and Gynecology, University of São Paulo School of Medicine in Ribeirão Preto (USPRP), São Paulo, Brazil
| | - S M Quintana
- Department of Obstetrics and Gynecology, University of São Paulo School of Medicine in Ribeirão Preto (USPRP), São Paulo, Brazil
| | - F G Surita
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medicine, Alexander Fleming, 101, 13083-881, Campinas, São Paulo, Brazil
| | - M H Sousa
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medicine, Alexander Fleming, 101, 13083-881, Campinas, São Paulo, Brazil
| | - M L Costa
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medicine, Alexander Fleming, 101, 13083-881, Campinas, São Paulo, Brazil.
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