Influences on Pregnant Women’s and Health Care Professionals’ Behaviour Regarding Maternal Vaccinations: A Qualitative Interview Study

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.

Increasing Uptake of Maternal Pertussis Vaccinations through Funded Administration in Community Pharmacies

“…Our qualitative research component of this project found multiple barriers to maternal vaccination uptake [21]. The provision of funded maternal vaccinations in pharmacy can help address awareness, provide information, aid opportunistic vaccination, and reduce barriers to access, such as requiring an appointment, Monday to Friday availability only in general practices, and a concern about sitting in a waiting room with sick people.…”

“…While ideally maternal vaccinations would be available from multiple locations, and particularly from antenatal care providers who could administer them during the antenatal appointment, this might not be practical for all antenatal care providers. For example, in NZ, barriers to midwives providing maternal vaccinations include challenges of administering a vaccine then being called urgently elsewhere, travelling to women's homes and maintaining cold chain, or purchasing a vaccine fridge and not being funded for this service [21]. Many midwives in NZ work alone or in a partnership, and may visit the woman at home, rather than working in a hospital or larger birthing centre where vaccinations may work better logistically.…”

“…However, the location of delivery of maternal vaccinations varies within and between countries, and antenatal providers might not vaccinate [20]. In NZ, for example, many antenatal providers work independently, and for logistical reasons (e.g., cold chain) are unlikely to provide maternal vaccinations [21].…”

Flu and pertussis vaccination during pregnancy in Geneva during the COVID-19 pandemic: A multicentric, prospective, survey-based study

“…The other factor that significantly reduced influenza vaccine uptake in univariate and multivariate analysis was delivering in a midwife-lead setting. Recommendations from healthcare professionals play a key role in encouraging vaccination during pregnancy [37] , with women often valuing the recommendations and convictions of midwives over that of other health professionals [38] . However, a Canadian survey found that recommendations for influenza vaccination during pregnancy vary among healthcare members, with midwives (38%) being less likely than physicians (80%) to recommend the influenza vaccine to their patients [39] .…”

Knowledge and decisions about maternal immunisation by pregnant women in Aotearoa New Zealand

“…Trusting midwives recommendations is a known factor to support vaccine uptake [ 13 ]. However, the reasons that pregnant women remain unimmunised are often complex and multifactorial [ 14 , 15 ]. Some women may not receive adequate information about recommended vaccinations during pregnancy [ 14 ], particularly if they live in areas of high deprivation [ 16 ], resulting in lack of awareness in these groups that vaccinations are recommended during pregnancy [ 14 ].…”