A randomized trial of maternal influenza immunization decision-making: A test of persuasive messaging models

Abstract

Objective: We sought to examine the effectiveness of persuasive communication interventions on influenza vaccination uptake among black/African American pregnant women in Atlanta, Georgia. Methods: We recruited black/African American pregnant women ages 18 to 50 y from Atlanta, GA to participate in a prospective, randomized controlled trial of influenza immunization messaging conducted from January to April 2013. Eligible participants were randomized to 3 study arms. We conducted followup questionnaires on influenza immunization at 30-days post-partum with all groups. Chi-square and t tests evaluated group differences, and outcome intention-to-treat assessment utilized log-binomial regression models. Results: Of the 106 enrolled, 95 women completed the study (90% retention), of which 31 were randomly assigned to affective messaging intervention ("Pregnant Pause" video), 30 to cognitive messaging intervention ("Vaccines for a Healthy Pregnancy" video), and 34 to a comparison condition (receipt of the Influenza Vaccine Information Statement). The three groups were balanced on baseline demographic characteristics and reported health behaviors. At baseline, most women (63%, n D 60) reported no receipt of seasonal influenza immunization during the previous 5 y. They expressed a low likelihood (2.1 § 2.8 on 0-10 scale) of obtaining influenza immunization during their current pregnancy. At 30-days postpartum follow-up, influenza immunization was low among all participants (7-13%) demonstrating no effect after a single exposure to either affective messaging (RR D 1.10; 95% CI: 0.30-4.01) or cognitive messaging interventions (RR D 0.57; 95% CI: 0.11-2.88). Women cited various reasons for not obtaining maternal influenza immunizations. These included concern about vaccine harm (47%, n D 40), low perceived influenza infection risk (31%, n D 26), and a history of immunization nonreceipt (24%, n D 20). Conclusion: The findings reflect the limitations associated with a single exposure to varying maternal influenza immunization message approaches on vaccine behavior. For this population, repeated influenza immunization exposures may be warranted with alterations in message format, content, and relevance for coverage improvement.

Evaluation of two vaccine education interventions to improve pertussis vaccination among pregnant African American women: A randomized controlled trial

“…Recruitment occurred during the 2013 influenza season (January 30–April 3, 2013); this period was chosen for recruitment because one of the study outcomes of interest was influenza vaccination (results published previously[18]). Pregnant African American women ages 18–50 years with an expected delivery date of January 30–June 30, 2013 were eligible for inclusion in the study.…”

Strategies for increasing uptake of vaccination in pregnancy in high-income countries: A systematic review

“…Of the nine RCTs, three were assessed as 'strong' [28,29,30], three 'moderate' [31,32,33] and three 'weak' [34,35,36] in quality. The weak-quality studies had methodological flaws with allocation concealment, blinding and power.…”

“…Three papers [28,34,48] used an educational video (providing information on the importance of vaccination based on theoretic methods of behaviour change) as the intervention to increase vaccination uptake and found no difference between the control and intervention arms of their study. However, two of the papers [34,48] had small sample sizes (n< 35 in each arm of the RCT), meaning they are unlikely to be sufficiently powered to detect any effect. For one study the educational video intervention did positively influence vaccination health beliefs but not actual vaccine behaviour [28].…”

Parental experiences with vaccine information statements: Implications for timing, delivery, and parent-provider immunization communication

“…A substantial body of research exists on exposure to vaccine information and its role in shaping parental attitudes toward immunizations [4–7]. Although VIS provision is mandated, few studies describe VIS and vaccine consent-dissemination practice [8] and how they inform vaccine decision-making [9] and facilitate parent-provider communication [10].…”