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Razai MS, Mansour R, Ravindran P, Freeman S, Mason-Apps C, Morris J, Majeed A, Ussher M, Hargreaves S, Oakeshott P. Facilitators and barriers to vaccination uptake in pregnancy: A qualitative systematic review. PLoS One 2024; 19:e0298407. [PMID: 38640190 PMCID: PMC11029626 DOI: 10.1371/journal.pone.0298407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 01/25/2024] [Indexed: 04/21/2024] Open
Abstract
INTRODUCTION Vaccination during pregnancy protects both the mother and the foetus from vaccine-preventable diseases. However, uptake of the recommended vaccines (influenza, pertussis, COVID-19) by pregnant women remains low in Europe and the USA. Understanding the reasons for this is crucial to inform strategies to increase vaccination rates in pregnant women. This qualitative systematic review aimed to identify the barriers and facilitators to vaccination against influenza, pertussis/whooping cough and COVID-19 during pregnancy and identify possible strategies to increase vaccination rates. METHODS We conducted a comprehensive search of electronic databases, including Medline, PsycINFO, CINAHL, Web of Science, WHO database, Embase and grey literature to identify qualitative studies that explored barriers and facilitators to vaccine uptake among pregnant women (PROSPERO CRD42023399488). The search was limited to studies published between 2012 and 2022 conducted in high-income countries with established vaccination programmes during pregnancy. Studies were thematically analysed and underwent quality assessment using the Joanna Briggs Institute validated critical appraisal tool for qualitative research. RESULTS Out of 2681 articles screened, 28 studies (n = 1573 participants) were eligible for inclusion. Five overarching themes emerged relating to personal, provider and systemic factors. Barriers to vaccine uptake included concerns about vaccine safety and efficacy, lack of knowledge about vaccines' benefits and necessity, fear of adverse effects on the foetus or mother and low perception of disease severity. Facilitators included recommendations from trusted healthcare providers, easy access to vaccination, clear communication on the benefits and safety of vaccination, and positive social influences from family and friends. Strategies for increasing vaccination uptake included strong and proactive vaccine recommendations by trusted healthcare professionals, provision of vaccines during routine antenatal care, and clear and consistent communication about vaccines addressing pregnant women's concerns. CONCLUSION This review highlights the need for interventions that address the identified barriers to vaccine uptake among pregnant women. Recommendation from a healthcare provider can play a significant role in promoting vaccine uptake, as can clear risk/benefit communication and convenient access to vaccination. Addressing concerns about vaccine safety and providing accurate information about vaccines is also important.
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Affiliation(s)
- Mohammad S. Razai
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Rania Mansour
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | | | - Samuel Freeman
- University Hospitals Sussex NHS Foundation Trust, Sussex, United Kingdom
| | - Charlotte Mason-Apps
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Joan Morris
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Michael Ussher
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
- Institute for Social Marketing and Health, University of Stirling, Stirling, United Kingdom
| | - Sally Hargreaves
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
- The Migrant Health Research Group, Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
| | - Pippa Oakeshott
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
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Chan AHY, Tao M, Marsh S, Petousis-Harris H. Vaccine decision making in New Zealand: a discrete choice experiment. BMC Public Health 2024; 24:447. [PMID: 38347498 PMCID: PMC10863187 DOI: 10.1186/s12889-024-17865-8] [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: 03/31/2023] [Accepted: 01/23/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Vaccine hesitancy is a significant threat to global health. A key part of addressing hesitancy is to ensure that public health messaging prioritises information that is considered important to the public. This study aimed to examine how different vaccine characteristics affect public preferences for vaccines in New Zealand, what trade-offs they are willing to make between different vaccine characteristics, and how their preferences are affected by their vaccine-related conspiracy beliefs and COVID-19 vaccination status. METHODS An online discrete choice experiment (DCE) was designed to elicit individual preferences about vaccines using the 1000minds platform. Members of the general population of New Zealand aged ≥ 18 years were invited to complete the DCE. Participants were asked to indicate their preference between two options showing different combinations of vaccine characteristics. Data on sociodemographic characteristics were collected. Beliefs were measured using the vaccine conspiracy beliefs scale (VCBS) with scores ≥ 19 indicating strong vaccine-related conspiracy beliefs. The DCE was analysed using the PAPRIKA method (Potentially All Pairwise RanKings of all possible Alternatives) and preferences compared between respondents with high versus low VCBS scores and vaccinated versus unvaccinated respondents for COVID-19. RESULTS A total of 611 respondents from 15 regions completed the DCE. Mean (SD) age was 45.9 (14.7) years with most having had 2 or more doses of the coronavirus vaccine (86%). Mean (SD) VCBS score was 18.5 (12.4) indicating moderate vaccine-related conspiracy beliefs. Risk of severe adverse effects was the most highly valued vaccine characteristic, followed by vaccine effectiveness and duration of protection. Vaccine origin and route of administration were ranked least important. Respondents scoring high on the VCBS placed less value on the effectiveness of vaccines but greater value on development time and total number of doses (p < 0.001). COVID-19 unvaccinated respondents ranked development time and total number of doses more highly than those vaccinated respondents (p < 0.001). CONCLUSIONS Risk of severe adverse effects, vaccine effectiveness and duration of protection were rated by the New Zealand public as the top three most important vaccine characteristics. This information is important for informing public health messaging to promote vaccine uptake and inform vaccine decision-making.
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Affiliation(s)
- Amy Hai Yan Chan
- School of Pharmacy, University of Auckland, Level 3, Building 505, 85 Park Road, Grafton, 1023, Auckland, New Zealand.
| | - Marvin Tao
- School of Medicine, University of Auckland, Building 505, 85 Park Road, Grafton, 1023, Auckland, New Zealand
| | - Samantha Marsh
- School of Population Health, University of Auckland, 85 Park Road, Grafton, 1023, Auckland, New Zealand
| | - Helen Petousis-Harris
- School of Population Health, University of Auckland, 85 Park Road, Grafton, 1023, Auckland, New Zealand
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Chadi A, Thirion DJG, David PM. Vaccine promotion strategies in community pharmacy addressing vulnerable populations: a scoping review. BMC Public Health 2023; 23:1855. [PMID: 37741997 PMCID: PMC10518112 DOI: 10.1186/s12889-023-16601-y] [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: 01/26/2023] [Accepted: 08/23/2023] [Indexed: 09/25/2023] Open
Abstract
CONTEXT Social determinants of health are drivers of vaccine inequity and lead to higher risks of complications from infectious diseases in under vaccinated communities. In many countries, pharmacists have gained the rights to prescribe and administer vaccines, which contributes to improving vaccination rates. However, little is known on how they define and target vulnerable communities. OBJECTIVE The purpose of this study is to describe how vulnerable communities are targeted in community pharmacies. METHODS We performed a systematic search of the Embase and MEDLINE database in August 2021 inspired by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols (PRISMA ScR). Articles in English, French or Spanish addressing any vaccine in a community pharmacy context and that target a population defined as vulnerable were screened for inclusion. RESULTS A total of 1039 articles were identified through the initial search, and 63 articles met the inclusion criteria. Most of the literature originated from North America (n = 54, 86%) and addressed influenza (n = 29, 46%), pneumococcal (n = 14, 22%), herpes zoster (n = 14, 22%) or human papilloma virus vaccination (n = 14, 22%). Lifecycle vulnerabilities (n = 48, 76%) such as age and pregnancy were most often used to target vulnerable patients followed by clinical factors (n = 18, 29%), socio-economical determinants (n = 16, 25%) and geographical vulnerabilities (n = 7, 11%). The most frequently listed strategy was providing a strong recommendation for vaccination, promotional posters in pharmacy, distributing leaflet/bag stuffers and providing staff training. A total of 24 barriers and 25 facilitators were identified. The main barriers associated to each vulnerable category were associated to effective promotional strategies to overcome them. CONCLUSION Pharmacists prioritize lifecycle and clinical vulnerability at the expense of narrowing down the definition of vulnerability. Some vulnerable groups are also under targeted in pharmacies. A wide variety of promotional strategies are available to pharmacies to overcome the specific barriers experienced by various groups.
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Affiliation(s)
- Alexandre Chadi
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada.
| | - Daniel J G Thirion
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
- McGill University Health Centre, Montreal, QC, Canada
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Davies B, Olivier J, Amponsah-Dacosta E. Health Systems Determinants of Delivery and Uptake of Maternal Vaccines in Low- and Middle-Income Countries: A Qualitative Systematic Review. Vaccines (Basel) 2023; 11:vaccines11040869. [PMID: 37112781 PMCID: PMC10144938 DOI: 10.3390/vaccines11040869] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Maternal vaccination is considered a key component of the antenatal care package for improving maternal and child health. Low- and middle-income countries (LMICs) fall short of global targets to prevent maternal and neonatal deaths, with a disproportionate burden of vaccine-preventable diseases. Strategies towards ending preventable maternal mortality necessitate a health systems approach to adequately respond to this burden. This review explores the health systems determinants of delivery and uptake of essential maternal vaccines in LMICs. We conducted a qualitative systematic review of articles on maternal vaccination in LMICs, published between 2009 and 2023 in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Thematic analysis was conducted to identify key themes in the literature, interpreted within a conceptual framing that explores the systems determinants influencing maternal vaccines. Our search yielded 1309 records, of which 54 were included, covering 34 LMICs. Most of the included studies were from South America (28/54) and included pregnant women as the primary study population (34/54). The studies explored influenza (25/54) and tetanus toxoid (20/54) vaccines predominantly. The findings suggest that systems hardware (lack of clear policy guidelines, ineffective cold-chain management, limited reporting and monitoring systems) are barriers to vaccine delivery. Systems software (healthcare provider recommendations, increased trust, higher levels of maternal education) are enablers to maternal vaccine uptake. Findings show that formulation, dissemination and communication of context-specific policies and guidelines on maternal vaccines should be a priority for decision-makers in LMICs.
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Affiliation(s)
- Bronte Davies
- Health Policy and Systems Division, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
- Vaccines for Africa Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Jill Olivier
- Health Policy and Systems Division, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
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Young A, Charania NA, Gauld N, Norris P, Turner N, Willing E. Informing women about maternal vaccination in Aotearoa New Zealand: Is it effective? Midwifery 2023; 120:103636. [PMID: 36827756 DOI: 10.1016/j.midw.2023.103636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/06/2023] [Accepted: 02/14/2023] [Indexed: 02/20/2023]
Affiliation(s)
- Amber Young
- School of Pharmacy, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
| | - Nadia A Charania
- Department of Public Health, School of Public Health and Interdisciplinary Studies, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand
| | - Natalie Gauld
- Department of Paediatrics: Child and Youth Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; School of Pharmacy, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Pauline Norris
- Va'a o Tautai-Centre for Pacific Health, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Nikki Turner
- Immunisation Advisory Centre, University of Auckland, Grafton Campus, Building 507, Level 3, 22-30 Park Avenue, Grafton, Auckland 1023, New Zealand
| | - Esther Willing
- Kōhatu-Centre for Hauora Māori, Otago Medical School, University of Otago, PO Box 56, Dunedin 9054, New Zealand
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Gauld N, Martin SNP, Sinclair OTR, Dumble F, Petousis-Harris H, Grant CC. Mapping the maternal vaccination journey and influencing factors for Māori women in Aotearoa New Zealand: a qualitative study. J Prim Health Care 2022; 14:352-362. [PMID: 36592768 DOI: 10.1071/hc21166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/31/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction Uptake of maternal vaccinations (MVs) is suboptimal in Aotearoa New Zealand, particularly for Māori. Aim To describe Māori women's journeys regarding maternal pertussis and influenza vaccinations and explore influences on uptake. Methods Semi-structured interviews were conducted in Waikato, Aotearoa New Zealand, with pregnant or recently pregnant Māori women, and separately with Māori healthcare professionals (HCPs) to understand women's decisions regarding MVs and enablers and barriers to uptake. Results Nine women and nine HCPs were interviewed. Verbal communications from midwives, general practice and pharmacy strongly influenced women's journeys. Women's decisions appeared largely straight-forward, with influences including awareness, knowledge, underlying beliefs and previous MVs. Enablers for MV uptake included HCPs' discussions, pro-vaccination beliefs, and accessibility. Barriers for MV uptake included poverty (and transport), lack of awareness, insufficient knowledge of benefits, late presentation to the midwife and other commitments or challenges in the women's lives affecting prioritisation of the vaccine. Misconceptions, seasonality, and lower HCP emphasis impaired influenza vaccination uptake. Discussion With multiple barriers to accessing MVs, HCPs who see pregnant women are the primary resource to improve awareness, knowledge, and access through kōrero (discussions) with the woman and, where possible, being able to administer the vaccinations. These HCPs need to be well-informed, aware of likely concerns women may have and how to address them, encourage these discussions and preferably be trusted.
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Affiliation(s)
- Natalie Gauld
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, and School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | | | | | - Felicity Dumble
- Public Health, Waikato District Health Board, Waikato, New Zealand
| | - Helen Petousis-Harris
- Department of General Practice, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Cameron C Grant
- Department of Paediatrics: Child and Youth Health, The University of Auckland, and Starship Children's Health, Auckland, New Zealand
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Young A, Charania NA, Gauld N, Norris P, Turner N, Willing E. Knowledge and decisions about maternal immunisation by pregnant women in Aotearoa New Zealand. BMC Health Serv Res 2022; 22:779. [PMID: 35698133 PMCID: PMC9192336 DOI: 10.1186/s12913-022-08162-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal vaccinations for influenza and pertussis are recommended in New Zealand to protect mothers and their infant from infection. However, maternal immunisation coverage in New Zealand is suboptimal. Furthermore, there is unacceptable inequitable maternal immunisation rates across the country with Māori and Pacific women having significantly lower maternal immunisation rates than those of other New Zealanders. METHODS This research set out to explore what pregnant/recently pregnant Māori and Pacific women knew about immunisation during pregnancy and what factors influenced their decision to be vaccinated. A semi-structured interview guide was developed with questions focusing on knowledge of pertussis and influenza vaccination during pregnancy and decision-making. Māori and Pacific women aged over 16 years were purposively sampled and interviewed in Dunedin and Gisborne, New Zealand between May and August 2021. Interviews were analysed following a directed qualitative content approach. Data were arranged into coding nodes based on the study aims (deductive analysis) informed by previous literature and within these participant experiences were inductively coded into themes and subthemes. RESULTS Not all women were aware of maternal vaccine recommendations or they diseases they protected against. Many underestimated how dangerous influenza and pertussis could be and some were more concerned about potential harms of the vaccine. Furthermore, understanding potential harms of infection and protection provided by vaccination did not necessarily mean women would choose to be vaccinated. Those who decided to vaccinate felt well-informed, had vaccination recommended by their healthcare provider, and did so to protect their and their infant's health. Those who decided against vaccination were concerned about safety of the vaccines, lacked the information they needed, were not offered the vaccine, or did not consider vaccination a priority. CONCLUSIONS There is a lack of understanding about vaccine benefits and risks of vaccine-preventable diseases which can result in the reinforcement of negative influences such as the fear of side effects. Furthermore, if vaccine benefits are not understood, inaccessibility of vaccines and the precedence of other life priorities may prevent uptake. Being well-informed and supported to make positive decisions to vaccinate in pregnancy is likely to improve vaccine coverage in Māori and Pacific Island New Zealanders.
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Affiliation(s)
- Amber Young
- Division of Health Sciences , Kōhatu-Centre for Hauora Māori, Otago Medical School, University of Otago, PO Box 56 , 9054, Dunedin, New Zealand.
| | - Nadia A Charania
- Department of Public Health, School of Public Health and Interdisciplinary Studies, Auckland University of Technology, Auckland, New Zealand
| | - Natalie Gauld
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.,School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Pauline Norris
- Va'a o Tautai - Centre for Pacific Health, University of Otago, Dunedin, New Zealand
| | - Nikki Turner
- Immunisation Advisory Centre, Department of General Practice and Primary Care, University of Auckland, Auckland, New Zealand
| | - Esther Willing
- Division of Health Sciences , Kōhatu-Centre for Hauora Māori, Otago Medical School, University of Otago, PO Box 56 , 9054, Dunedin, New Zealand
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Howe AS, Gauld NJ, Cavadino AY, Petousis-Harris H, Dumble F, Sinclair O, Grant CC. Increasing Uptake of Maternal Pertussis Vaccinations through Funded Administration in Community Pharmacies. Vaccines (Basel) 2022; 10:vaccines10020150. [PMID: 35214609 PMCID: PMC8876756 DOI: 10.3390/vaccines10020150] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 01/27/2023] Open
Abstract
Although maternal pertussis vaccination is recommended, uptake is suboptimal in New Zealand (NZ), despite full funding in general practice and hospitals. We determined whether funding maternal pertussis vaccination in community pharmacy increases its uptake. Pertussis vaccination during pregnancy was compared between non-contiguous, demographically similar regions of NZ. The pertussis vaccine was funded at pharmacies from Nov 2016 in one NZ region (Waikato), but not in comparator regions (Northland, Hawkes Bay). Vaccinations during pregnancy were determined from the National Immunisation Register, general practice and pharmacy claims data, and a maternity database. Comparisons were made using adjusted odds ratios (OR) and 95% confidence intervals (CI) for Nov 2015 to Oct 2016 versus Nov 2016 to Oct 2019. The odds of pregnancy pertussis vaccination increased in the post-intervention versus pre-intervention period with this increase being larger (p = 0.0014) in the intervention (35% versus 21%, OR = 2.07, 95% CI 1.89–2.27) versus the control regions (38% versus 26%, OR = 1.67, 95% CI 1.52–1.84). Coverage was lower for Māori versus non-Māori, but increased more for Māori in the intervention versus control regions (117% versus 38% increase). It was found that funding maternal pertussis vaccination in pharmacy increases uptake, particularly for Māori women. Measures to increase coverage should include reducing barriers to vaccines being offered by non-traditional providers, including pharmacies.
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Affiliation(s)
- Anna S. Howe
- Department of General Practice and Primary Health Care, University of Auckland, Auckland 1023, New Zealand;
- School of Health Sciences, University of Canterbury, Christchurch 1023, New Zealand
- Correspondence: ; Tel.: +64-99-232-130
| | - Natalie J. Gauld
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland 1023, New Zealand; (N.J.G.); (C.C.G.)
- School of Pharmacy, University of Auckland, Auckland 1023, New Zealand
| | - Alana Y. Cavadino
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland 1023, New Zealand;
| | - Helen Petousis-Harris
- Department of General Practice and Primary Health Care, University of Auckland, Auckland 1023, New Zealand;
| | | | - Owen Sinclair
- Child, Women and Family Services, Waitakere Hospital, Waitemata District Health Board, Auckland 0610, New Zealand;
| | - Cameron C. Grant
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland 1023, New Zealand; (N.J.G.); (C.C.G.)
- General Paediatrics, Starship Children’s Hospital, Auckland District Health Board, Auckland 1023, New Zealand
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Gauld N, Martin S, Sinclair O, Petousis-Harris H, Dumble F, Grant CC. Influences on Pregnant Women's and Health Care Professionals' Behaviour Regarding Maternal Vaccinations: A Qualitative Interview Study. Vaccines (Basel) 2022; 10:76. [PMID: 35062737 PMCID: PMC8779619 DOI: 10.3390/vaccines10010076] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 12/16/2022] Open
Abstract
The uptake of maternal influenza and pertussis vaccinations is often suboptimal. This study explores the factors influencing pregnant women's and health care professionals' (HCPs) behaviour regarding maternal vaccinations (MVs). Pregnant/recently pregnant women, midwives, pharmacists and general practice staff in Waikato, New Zealand, were interviewed. The analysis used the behaviour change wheel model. Interviews of 18 women and 35 HCPs revealed knowledge about MVs varied with knowledge deficiencies hindering the uptake, particularly for influenza vaccination. HCPs, especially midwives, were key in raising women's awareness of MVs. Experience with vaccinating, hospital work (for midwives) and training increased HCPs' knowledge and proactivity about MVs. A "woman's choice" philosophy saw midwives typically encouraging women to seek information and make their own decision. Women's decisions were generally based on knowledge, beliefs, HCPs' emphasis and their perceived risk, with little apparent influence from friends, family, or online or promotional material. General practice's concentration on children's vaccination and minimal antenatal contact limited proactivity with MVs. Busyness and prioritisation appeared to affect HCPs' proactivity. Multi-pronged interventions targeting HCPs and pregnant women and increasing MV access are needed. All HCPs seeing pregnant women should be well-informed about MVs, including how to identify and address women's questions or concerns about MVs to optimise uptake.
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Affiliation(s)
- Natalie Gauld
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland 1023, New Zealand;
- School of Pharmacy, University of Auckland, Auckland 1023, New Zealand
| | | | | | - Helen Petousis-Harris
- Department of General Practice and Primary Health Care, University of Auckland, Auckland 1023, New Zealand;
| | | | - Cameron C. Grant
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland 1023, New Zealand;
- General Paediatrics, Starship Children’s Hospital, Auckland 1023, New Zealand
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10
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Toth JM, Nsiah I, Nair S, Ramachandran S. Association between a usual source of care and influenza vaccination rates among pregnant women. Pharmacoepidemiol Drug Saf 2021; 31:361-369. [PMID: 34888983 DOI: 10.1002/pds.5394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 11/21/2021] [Accepted: 12/06/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE Pregnant women and infants less than 6 months of age have a higher risk of complications from influenza. Vaccination is recommended for pregnant women to decrease risk of infection and hospitalizations between both the women themselves and infants. However, vaccination rates remain low in pregnant women. The objective of this study was to determine the association between having a usual source of care and seasonal influenza vaccination rates among women who were pregnant between 2012 and 2016. METHODS A retrospective study was conducted using pooled data from the 2012-2016 Medical Expenditure Panel Survey. Frequencies of seasonal influenza vaccinations and other sociodemographic factors were estimated. A multivariable log-binomial regression model was used to examine the association between having a usual source of care and seasonal influenza vaccination rates. RESULTS The weighted influenza vaccination rate among pregnant women was 54.5%. About one third did not have a usual source of care. The adjusted prevalence ratio of receiving an influenza vaccine for pregnant women without a usual source of care was 0.76 (95% confidence interval = 0.60-0.98). The top three main reasons for not having a usual source of care were being seldom or never sick (55.7%), not having health insurance (10.6%), and having recently moved to an area (9.9%). CONCLUSIONS Pregnant women without a usual source of care had significantly lower probability of being vaccinated against seasonal influenza. Improving access to care through greater insurance coverage, addressing cost barriers, and providing patient education may help improve vaccination rates in this population.
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Affiliation(s)
- Jennifer M Toth
- Department of Pharmacy Administration, University of Mississippi, Oxford, Mississippi, USA
| | - Irene Nsiah
- Department of Pharmacy Administration, University of Mississippi, Oxford, Mississippi, USA
| | - Sonam Nair
- Department of Pharmacy Administration, University of Mississippi, Oxford, Mississippi, USA.,ICON plc, Tennessee, USA
| | - Sujith Ramachandran
- Department of Pharmacy Administration, University of Mississippi, Oxford, Mississippi, USA
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Gauld N, Johnstone E, McMichael I, Braund R. Pharmacists' views and desires regarding pharmacist administration of vaccines in New Zealand. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2020; 29:126-133. [PMID: 33729528 DOI: 10.1093/ijpp/riaa012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 10/12/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To explore pharmacists' views and experiences of pharmacist-administered vaccinations, motivators and barriers to pharmacists administering vaccinations and their preferences for expansions to such services. METHODS All practising pharmacist members (n = 3400) of the Pharmaceutical Society of New Zealand were invited to participate in an online survey in 2017. KEY FINDINGS A total of 468 pharmacists completed the survey (14%). Most (86%) strongly agreed/agreed that pharmacists should provide vaccinations, primarily citing patient benefit, for example, convenience, potential for increased vaccination uptake, easing general practice burden and better utilisation of the pharmacist. Half had completed vaccinator training, mainly for professional satisfaction, to help public or community health and/or to provide a new service for their community. Trained pharmacists had administered influenza (95%), pertussis (47%), zoster (45%) and/or meningococcal vaccines (13%), with patient cost limiting some vaccination uptake. Cost or workplace constraints were leading reasons for the 17% not planning to undertake vaccinator training. Key barriers for pharmacy owners not offering vaccinations were set-up or other costs, insufficient funding (62%) or staffing/time concerns (27%). Some trained vaccinators (39%) wanted the recipient age lowered below 13 years, and 44% wanted intern pharmacists to be able to administer vaccinations. CONCLUSION This study found strong support for this service, including benefits for patients, and for customer relationships. Identified barriers including service setup and patient costs could be reduced by expanding the categories (e.g. pharmacy students and technicians) of staff able to vaccinate and having more government funded vaccines available through pharmacies, therefore, improving access for patients.
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Affiliation(s)
- Natalie Gauld
- Natalie Gauld Ltd, Auckland, New Zealand.,Pharmaceutical Society of New Zealand, Wellington, New Zealand
| | | | - Ian McMichael
- Pharmaceutical Society of New Zealand, Wellington, New Zealand.,Pharmacy 547, Hamilton, New Zealand
| | - Rhiannon Braund
- Pharmaceutical Society of New Zealand, Wellington, New Zealand.,New Zealand Pharmacovigilance Centre, University of Otago, New Zealand
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Howe AS, Pointon L, Gauld N, Paynter J, Willing E, Turner N. Pertussis and influenza immunisation coverage of pregnant women in New Zealand. Vaccine 2020; 38:6766-6776. [PMID: 32868133 DOI: 10.1016/j.vaccine.2020.08.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Immunisation is an important public health policy and measuring coverage is imperative to identify gaps and monitor trends. New Zealand (NZ), like many countries, does not routinely publish coverage of immunisations given during pregnancy. Therefore, this study examined pregnancy immunisation coverage of all pregnant NZ women between 2013 and 2018, and what factors affected uptake. METHODS A retrospective cohort study of pregnant women who delivered between 2013 and 2018 was undertaken using administrative datasets. Maternity and immunisation data were linked to determine coverage of pertussis and influenza vaccinations in pregnancy. Generalised estimating equations were used to estimate the odds of receiving a vaccination during pregnancy. RESULTS From 2013 to 2018 data were available for 323,622 pregnant women, of whom 21.7% received maternal influenza immunisations and 25.7% maternal pertussis immunisations. Coverage for both vaccines increased over time, pertussis increased from 10.2% to 43.6% and influenza from 11.2% to 30.8%. The odds of being vaccinated, with either vaccine, during pregnancy increased with increasing age and decreasing deprivation. Compared to NZ European or Other women, Māori and Pacific women had lower odds of receiving a maternal pertussis (OR:0.55, 95% CI: 0.54, 0.57; OR:0.60, 95% CI: 0.58, 0.62, respectively) and influenza (OR: 0.69, 95% CI: 0.67, 0.71; OR:0.90, 95% CI: 0.87, 0.94, respectively) immunisations during pregnancy. Women were also more likely to be vaccinated against pertussis if they received antenatal care from a General Practitioner or Obstetrician compared to a Midwife. A similar pattern was seen for influenza vaccination. CONCLUSION Gaps in maternal coverage for pertussis and influenza exist and work is needed to reduce immunisation inequities.
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Affiliation(s)
- Anna S Howe
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand.
| | - Leah Pointon
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand.
| | - Natalie Gauld
- Department of Paediatrics: Child and Youth Health, University of Auckland, New Zealand; School of Pharmacy, University of Auckland, New Zealand.
| | - Janine Paynter
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand.
| | - Esther Willing
- Kōhatu - Centre for Hauora Māori, Division of Health Sciences, University of Otago, New Zealand.
| | - Nikki Turner
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, New Zealand; Immunisation Advisory Centre, University of Auckland, New Zealand.
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