Countering Vaccine Hesitancy among Pregnant Women in England: The Case of Boostrix-IPV

Predicting COVID-19 vaccine uptake: Comparing the health belief model and theory of planned behavior

The COVID-19 outbreak has had a significant impact on the global health landscape, underscoring the crucial role that vaccinations play in achieving herd immunity and reducing the effects of pandemics. Given the importance of this issue, it is imperative to gain a deeper understanding of the various factors that influence individuals' decisions to seek vaccination. This study aimed to compare the prediction level of the Health Belief Model (HBM), the Theory of Planned Behavior (TPB), and a combined model in explaining the intention of adults to receive COVID-19 immunization. A cross-sectional online survey was conducted among adults (n = 505) in Saudi Arabia. The survey contained variables related to the HBM and TPB. The prediction level of the two models as well as a combined model were evaluated utilizing Structural Equation Modeling (SEM). Among the recruited 505 participants, 88% fell within the 18 to 30 age range, and 54.5% were male. The proposed HBM model accounted for 68% of the variation in intention, whereas the TPB model explained 78.2% of the variation in COVID-19 vaccination intention. The combined model showed greater explanatory power (82%). The variables of susceptibility (β = 0.20, p < .001), severity (β = 0.49, p < .001), advantages (β = 0.63, p < .001), and obstacles (β = - 0.24, p < .001), perceptions of behavioral control (β = 1.58, p < .001) and attitudes (β = 0.44, p < .001) were found to significantly predict increased vaccination intentions in the combined model. However, the subjective norm construct did not significantly predict vaccination intentions (β = 0.06, p = .34). The TPB has greater explanatory power than the HBM in predicting the intention to obtain COVID-19 vaccination. However, the combined model showed a greater prediction level. Understanding and identifying people's perceived health beliefs and practices is critical for developing successful COVID-19 intervention methods.

Interventions to increase vaccination against COVID-19, influenza and pertussis during pregnancy: a systematic review and meta-analysis

BACKGROUND

Pregnant women and their babies face significant risks from three vaccine-preventable diseases: COVID-19, influenza and pertussis. However, despite these vaccines' proven safety and effectiveness, uptake during pregnancy remains low.

METHODS

We conducted a systematic review (PROSPERO CRD42023399488; January 2012-December 2022 following PRISMA guidelines) of interventions to increase COVID-19/influenza/pertussis vaccination in pregnancy. We searched nine databases, including grey literature. Two independent investigators extracted data; discrepancies were resolved by consensus. Meta-analyses were conducted using random-effects models to estimate pooled effect sizes. Heterogeneity was assessed using the I2 statistics.

RESULTS

From 2681 articles, we identified 39 relevant studies (n = 168 262 participants) across nine countries. Fifteen studies (39%) were randomized controlled trials (RCTs); the remainder were observational cohort, quality-improvement or cross-sectional studies. The quality of 18% (7/39) was strong. Pooled results of interventions to increase influenza vaccine uptake (18 effect estimates from 12 RCTs) showed the interventions were effective but had a small effect (risk ratio = 1.07, 95% CI 1.03, 1.13). However, pooled results of interventions to increase pertussis vaccine uptake (10 effect estimates from six RCTs) showed no clear benefit (risk ratio = 0.98, 95% CI 0.94, 1.03). There were no relevant RCTs for COVID-19. Interventions addressed the 'three Ps': patient-, provider- and policy-level strategies. At the patient level, clear recommendations from healthcare professionals backed by text reminders/written information were strongly associated with increased vaccine uptake, especially tailored face-to-face interventions, which addressed women's concerns, dispelled myths and highlighted benefits. Provider-level interventions included educating healthcare professionals about vaccines' safety and effectiveness and reminders to offer vaccinations routinely. Policy-level interventions included financial incentives, mandatory vaccination data fields in electronic health records and ensuring easy availability of vaccinations.

CONCLUSIONS

Interventions had a small effect on increasing influenza vaccination. Training healthcare providers to promote vaccinations during pregnancy is crucial and could be enhanced by utilizing mobile health technologies.

Examining health sciences students' intention to uptake COVID-19 vaccination using the theory of planned behavior

To examine the association between the theory of planned behavior (TPB) constructs and Health Sciences students' intentions to receive COVID-19 vaccination. A cross-sectional study was conducted in Saudi Arabia by recruiting Health Sciences students as participants. Using Structural Equation Modeling (SEM), the proposed TPB model was evaluated. The sample of 505 individuals consisted of more males (n = 275; 54.5%) than females and was relatively young (88% were between the ages of 18 and 30). The suggested TPB model explained 78.2% of the variation in intention to get COVID-19 immunization. We found that greater levels of perceived behavioral control (β = 1.58, p < .001) and attitude (β = .44, p < .001) strongly predicted increased vaccination intentions. The subjective norm construct was not a significant predictor of vaccination intentions (β = 0.06, p = .34). The findings of this study indicate that the TPB can be utilized effectively to obtain insight into the factors associated with COVID-19 adherence and help in the development of effective COVID-19 intervention strategies.

Factors Associated with Anti-SARS-CoV-2 Vaccine Acceptance among Pregnant Women: Data from Outpatient Women Experiencing High-Risk Pregnancy

Pregnant women are at higher risk of severe Coronavirus disease 2019 (COVID-19) complications than non-pregnant women. The initial exclusion of pregnant women from anti-SARS-CoV-2 vaccines clinical trials has caused a lack of conclusive data about safety and efficacy for this vulnerable population. This cross-sectional study aims to define the factors related to vaccination adherence in a sample of women experiencing high-risk pregnancies. The recruited women completed a questionnaire based on the Health Belief Model. Data were analyzed to evaluate the associations between socio-demographic variables and vaccination acceptance through descriptive, univariate and multivariate logistic analyses. Among the 233 women enrolled, 65.2% (n = 152) declared that they would accept the anti-SARS-CoV-2 vaccine. Multivariate analysis showed that vaccination acceptance was associated with a high educational level (aOR = 4.52, p = 0.001), a low perception of barriers to vaccination (aOR = 1.58, p = 0.005) and the gynecologist's advice (aOR = 3.18, p = 0.01). About a third of pregnant women are still hesitant about the anti-SARS-CoV-2 vaccine, probably because of the conflicting information received from media, friends, acquaintances and health institutions. Determining factors linked to vaccine hesitancy among pregnant women is useful for creating vaccination strategies that increase vaccination uptake.

A systematic review of communication interventions for countering vaccine misinformation

BACKGROUND

Misinformation and disinformation around vaccines has grown in recent years, exacerbated during the Covid-19 pandemic. Effective strategies for countering vaccine misinformation and disinformation are crucial for tackling vaccine hesitancy. We conducted a systematic review to identify and describe communications-based strategies used to prevent and ameliorate the effect of mis- and dis-information on people's attitudes and behaviours surrounding vaccination (objective 1) and examined their effectiveness (objective 2).

METHODS

We searched CINAHL, Web of Science, Scopus, MEDLINE, Embase, PsycInfo and MedRxiv in March 2021. The search strategy was built around three themes(1) communications and media; (2) misinformation; and (3) vaccines. For trials addressing objective 2, risk of bias was assessed using the Cochrane risk of bias in randomized trials tool (RoB2).

RESULTS

Of 2000 identified records, 34 eligible studies addressed objective 1, 29 of which also addressed objective 2 (25 RCTs and 4 before-and-after studies). Nine 'intervention approaches' were identified; most focused on content of the intervention or message (debunking/correctional, informational, use of disease images or other 'scare tactics', use of humour, message intensity, inclusion of misinformation warnings, and communicating weight of evidence), while two focused on delivery of the intervention or message (timing and source). Some strategies, such as scare tactics, appear to be ineffective and may increase misinformation endorsement. Communicating with certainty, rather than acknowledging uncertainty around vaccine efficacy or risks, was also found to backfire. Promising approaches include communicating the weight-of-evidence and scientific consensus around vaccines and related myths, using humour and incorporating warnings about encountering misinformation. Trying to debunk misinformation, informational approaches, and communicating uncertainty had mixed results.

CONCLUSION

This review identifies some promising communication strategies for addressing vaccine misinformation. Interventions should be further evaluated by measuring effects on vaccine uptake, rather than distal outcomes such as knowledge and attitudes, in quasi-experimental and real-life contexts.

Worries, beliefs and factors influencing perinatal COVID-19 vaccination: a cross-sectional survey of preconception, pregnant and lactating individuals

BACKGROUND

COVID-19 vaccines are recommended for pregnant and lactating individuals, and there is substantial evidence for their safety and effectiveness. As the pandemic continues, information on worries and beliefs surrounding perinatal COVID-19 vaccination remains important to inform efforts aimed at improving vaccine uptake. Our objectives were to assess factors associated with COVID-19 vaccination among perinatal individuals; and to explore motivational factors associated with willingness to be vaccinated among unvaccinated perinatal individuals.

METHODS

This was a cross-sectional web-based survey of preconception, pregnant, and lactating individuals in Canada. The outcomes of interest were vaccination with at least one dose of any COVID-19 vaccine and willingness to be vaccinated among unvaccinated individuals. Sample characteristics were summarized using frequencies and percentages. The association between eight prespecified risk factors and two outcomes (vaccination status and willingness to be vaccinated) was assessed by logistic regression. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for the total sample, and across perinatal sub-groups.

RESULTS

Among 3446 survey respondents, there were 447 (13.0%) preconception, 1832 (53.2%) pregnant, and 1167 (42.4%) lactating. There were 1460 (42.4%) and 1982 (57.5%) who were vaccinated and unvaccinated, respectively. Factors positively associated with COVID-19 vaccine status were speaking to a healthcare provider about vaccination during the perinatal period (aOR:2.35, 95% CI:1.97-2.80) and believing that the COVID-19 vaccine is effective (aOR:1.91, 95% CI:1.46-2.48). Factors negatively associated with vaccine status included worries about fetal growth and development (aOR:0.55, 95% CI:0.43-0.70) and future child behavioral/neurodevelopmental problems (aOR:0.59, 95% CI:0.46-0.75). Among unvaccinated individuals specifically, characteristics positively associated with willingness to vaccinate were speaking to a healthcare provider (aOR:1.67, 95% CI:1.32-2.12) and believing the COVID-19 vaccine is effective (aOR:3.56, 95% CI:2.70-4.69). Factors negatively associated with willingness were concerns over infertility (aOR:0.66, 95% CI:0.49-0.88), fetal growth and development (aOR:0.33, 95% CI:0.24-0.46), and future child behavioral/neurodevelopmental problems (aOR:0.64, 95% CI:0.48-0.84).

CONCLUSIONS

In this Canadian perinatal population, approximately 42% reported COVID-19 vaccination. Among unvaccinated individuals, willingness to receive vaccination was high (73%). Factors enhancing vaccine willingness included discussions with healthcare providers and believing the vaccine was effective. Concerns regarding vaccine safety, particularly with respect to fetal/child development, were the greatest barriers to vaccine uptake.

Message testing in India for COVID-19 vaccine uptake: What appeal and what messenger are most persuasive?

Few studies have examined the relationships between the different aspects of vaccination communication and vaccine attitudes. We aimed to evaluate the influence of three unique messaging appeal framings of vaccination from two types of messengers on COVID-19 vaccine acceptance in India. We surveyed 534 online participants in India using Amazon Mechanical Turk (MTurk) from December 2021 through January 2022. We assessed participants' perception of three messaging appeals of vaccination - COVID-19 disease health outcomes, social norms related to vaccination, and economic impact of COVID-19 - from two messengers, healthcare providers (HCP) and peers. Using a multivariable multinomial logistic regression, we examined participants' ad preference and vaccine hesitancy. Participants expressed a high level of approval for all of the ads, with >80% positive responses for all questions across ads. Overall ads delivered by health care workers were preferred by a majority of participants in our study (n = 381, 71.4%). Ad preference ranged from 3.6% (n = 19) social norm/peer ad to 32.4% (n = 173) health outcome/HCP ad and half of participants preferred the health outcome ad (n = 279, 52.3%). Additionally, vaccine hesitancy was not related to preference (p = .513): HCP vs. peer ads (p = .522); message type (p = .284). The results suggest that all three appeals tested were generally acceptable, as well as the two messenger types, although preference was for the health care provider messenger and health outcome appeal. Individuals are motivated and influenced by a multitude of factors, requiring vaccine messaging that is persuasive, salient, and induces contextually relevant action.

Models of determinants of COVID-19 vaccine hesitancy in non-pregnant and pregnant population: Review of current literature"

Vaccination has proven to be the most effective tool in controlling the COVID-19 pandemic. While pregnant individuals are considered to be a high-risk population and are more likely to experience adverse effects from COVID-19, vaccination rates among pregnant individuals are significantly lower than in the general population. The Health Belief Model (HBM), Theory of Planned Behavior (TPB), 3C model, 5C model, and 5A model have been used to assess vaccination hesitancy behaviors. In this paper, we review the use of each of these models to address vaccine hesitancy, with a focus on the pregnant population and the COVID-19 vaccine. The HBM, TPB, 3C model, and 5C model have demonstrated great versatility in their ability to evaluate, explain, and modify vaccine hesitancy and behavior. Up to date, the HBM and 3C models appear to be the most effective models to study and address vaccination hesitancy within the pregnant persons.

"Maternal Vaccination Greatly Depends on Your Trust in the Healthcare System": A Qualitative Study on the Acceptability of Maternal Vaccines among Pregnant Women and Healthcare Workers in Barcelona, Spain

The World Health Organization (WHO) identified vaccine hesitancy as one of the top 10 threats to global health in 2019. Health promotion and education have been seen to improve knowledge and uptake of vaccinations in pregnancy. This qualitative study was conducted based on phenomenology, a methodological approach to understand first-hand experiences, and grounded theory, an inductive approach to analyse data, where theoretical generalisations emerge. Data were collected through semi-structured interviews with pregnant women attending antenatal care services and healthcare workers (HCWs) in Barcelona, Spain. Interviews were audio-recorded, transcribed, and coded, and notes were taken. Inductive thematic analysis was performed, and data were manually coded. Pertussis was reported as the most trusted vaccine among pregnant women due to its long-standing background as a recommended vaccine in pregnancy. The influenza vaccine was regarded as less important since it was perceived to cause mild disease. The COVID-19 vaccine was the least trustworthy for pregnant women due to uncertainties about effectiveness, health effects in the mid- and long-term, the fast development of the vaccine mRNA technology, and the perceptions of limited data on vaccine safety. However, the necessity to be vaccinated was justified by pregnant women due to the exceptional circumstances of the COVID-19 pandemic. The recommendations provided by HCW and the established relationship between the HCW, particularly midwives, and pregnant women were the main factors affecting decision-making. The role of mass media was perceived as key to helping provide reliable messages about the need for vaccines during pregnancy. Overall, vaccines administered during pregnancy were perceived as great tools associated with better health and improved quality of life. Pregnancy was envisioned as a vulnerable period in women's lives that required risk-benefits assessments for decision-making about maternal vaccinations. A holistic approach involving the community and society was considered crucial for health education regarding maternal vaccines in support of the work conducted by HCWs.

COVID-19 vaccine hesitancy and its associated factors in Malaysia

The success of the COVID-19 vaccination programme to achieve herd immunity depends on the proportion of the population inoculated. COVID-19 vaccination hesitancy is a barrier to reaching a sufficient number of people to achieve herd immunity. This study aims to determine the prevalence of COVID-19 vaccine hesitancy and to identify the reasons contributing to vaccine hesitancy using the Theory of Planned Behavior. A cross-sectional online survey was conducted between May 2021 to June 2021. Using exponential non-discriminative snowball sampling, participants were recruited via social media and telecommunication platforms. We used a questionnaire that obtained information on participant socio-demographics, vaccine hesitancy, pseudoscientific practices, conspiracy beliefs, subjective norms, perceived behavioural control, main reasons for not intending to get the COVID-19 vaccine; influential leaders, gatekeepers and anti-or pro-vaccination lobbies; and global vaccine hesitancy. A total of 354 responses (mean age = 32.5 years old ±13.6; 70.3% females) were included for analysis. The prevalence of COVID-19 vaccine hesitancy was 11.6%. COVID-19 vaccine hesitancy was significantly and positively associated with those who agreed with influential leaders, gatekeepers, and anti- or pro-vaccination lobbies (adjusted B coefficient = 1.355, p = 0.014), having a “wait and see” attitude to see if the COVID-19 vaccine is safe (adjusted B coefficient = 0. 822, p <0.001), perceiving that the vaccine will give them COVID-19 (adjusted B coefficient = 0.660, p <0.002), planned to use masks/others precautions instead (adjusted B coefficient = 0.345, p = 0.038) and having higher scores in conspiracy beliefs (adjusted B coefficient = 0.128, p <0.001). Concern about the costs associated with the vaccine (adjusted B coefficient = -0.518, p <0.001), subjective norms (adjusted B coefficient = -0.341, p <0.001), and perceived behavioural control (adjusted B coefficient = -0.202, p = 0.004) were negatively associated with vaccine hesitancy. COVID-19 vaccine hesitancy in Malaysia is low. Several factors were identified as being associated with vaccine hesitancy. Factors associated with vaccine hesitancy would be useful in tailoring specific interventions involving positive messages by influential leaders, which address vaccine misinformation and the wait-and-see attitude which may delay the uptake of COVID-19 vaccines.

COVID-19 vaccine hesitancy among pregnant women: a systematic review and meta-analysis

OBJECTIVE

The aim of this study was to perform a systematic review and meta-analysis to estimate the vaccines' acceptance level and to find the factors influencing pregnant women's vaccination decisions, with the goal of assisting in the development of interventions and promoting more research in this area.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, Embase, CINAHL and PubMed.

ELIGIBILITY CRITERIA

Studies providing any kind of quantitative assessment of overall COVID-19 vaccination acceptance among pregnant women in any country or region across the globe.

DATA EXTRACTION AND SYNTHESIS

The pooled prevalence of COVID-19 vaccine acceptance among pregnant women was calculated using the random-effects model. Subgroup (sensitivity) analysis was performed to determine the overall COVID-19 vaccine acceptance level to understand the sources of substantial heterogeneity.

RESULTS

Out of the 375 studies identified, 17 studies from four continents assessing 25 147 participants (pregnant women) were included in this study. Among the participants, only 49% (95% CI 42% to 56%, p<0.001) had COVID-19 vaccine acceptance. High-income countries (47%; 95% CI 38% to 55%, p<0.001), participants with fewer than 12 years of education (38%; 95% CI 19% to 58%, p<0.001) and multiparous women (48%; 95% CI 31% to 66%, p<0.001) had lower COVID-19 vaccine acceptance. Overall heterogeneity was high (I² ≥98%), and publication bias was present (p<0.001). A very weak positive correlation between COVID-19 knowledge and COVID-19 vaccine acceptance was observed (r=0.164; 95% CI -0.946 to 0.972; p=0.8359).

CONCLUSION

Overall, COVID-19 vaccine acceptance among pregnant women was low across the studies and considerably low among some specific subgroups of participants. These research findings have implications for the development of effective interventions that could increase the COVID-19 vaccine acceptance level among pregnant women to attain herd immunity.

PROSPERO REGISTRATION NUMBER

CRD42021277754.

Understanding the content of COVID-19 vaccination and pregnancy videos on YouTube: An analysis of videos published at the start of the vaccine rollout

Over 2 years into the COVID-19 pandemic, information on the safety and efficacy of COVID-19 vaccination, particularly for people in high-risk populations, has become a popular topic of discussion. The purpose of this study was to analyze the content and characteristics of YouTube videos related to COVID-19 vaccination and pregnancy. The 50 most viewed English language videos on pregnancy and COVID-19 vaccination were included in this study. The 50 YouTube videos were viewed 4,589,613 times, with 6% uploaded by consumers, 40% by medical professionals, and 44% by television or internet-based news. Videos from consumer sources more often mentioned a human trial of the COVID-19 vaccine (75% of consumer videos vs. 65% of medical professional videos and 31.8% of television or internet-based news videos, P = .036) and more often mentioned anti-vaccination sentiment, fear, or distrust of the vaccines (37.5% of consumer videos vs 5.0% of medical professional videos and 4.5% of television or internet-based news videos, P = .018). Videos uploaded by medical professionals more often mentioned emergency use of the COVID-19 vaccines (P = .016), passive immunity in general (P = .011), and that the COVID-19 vaccine is either unlikely to or will not cause harm in breastfeeding more often than did videos from consumer or television-based news sources (P = .034). New information regarding COVID-19 vaccination and pregnancy is continuing to emerge, and this study highlights that the information found in the most viewed YouTube videos on this topic can quickly become outdated.

Influenza and pertussis vaccine uptake during pregnancy among Australian women in south-east Queensland, Australia

OBJECTIVES

Population-specific studies of vaccine uptake in pregnancy are necessary to monitor progress and ensure enablers to vaccination are locally relevant. We aimed to determine the uptake of influenza and pertussis vaccine during pregnancy in women in south-east Queensland and the reasons why women were choosing not to vaccinate.

METHODS

A secondary analysis of data collected in a prospective cohort study. Data were collected at enrolment during pregnancy and within six weeks of giving birth. The primary outcome was the proportion of women vaccinated during pregnancy.

RESULTS

Among 310 pregnant women, 45.8% and 69.7% were vaccinated against influenza and pertussis, respectively; 123 (39.7%) had received both vaccines. The common predictor of vaccine uptake for influenza, pertussis or both was having had any vaccine in the 12 months prior to pregnancy. Not considering the vaccines necessary and perceptions of the risk of infection were common reasons for not intending to vaccinate.

CONCLUSIONS

Antenatal vaccine uptake remains suboptimal in women in south-east Queensland. Barriers to vaccination during pregnancy are complex and vary depending on context and population. Implications for public health: More efforts are needed to promote antenatal uptake, particularly for influenza vaccine and having both the influenza and pertussis vaccines during pregnancy.