Mapping the maternal vaccination journey and influencing factors for Māori women in Aotearoa New Zealand: a qualitative study

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.

Midwives’ perceptions of enablers and barriers to pertussis and influenza vaccination in pregnancy and information sharing

“…Participants identified that accessible and suitable venues for vaccination were important to improve patientcentred care and facilitate vaccination, and that child-friendly environments and easy-to-access drop-in centres would be of use for some pregnant women/people. Other Aotearoa NZ studies also found that pregnant women/people needing to take time off work or arrange for childcare whilst they go to an appointment to receive vaccination may be barriers too difficult to overcome (Duckworth, 2015;Gauld et al, 2022a). Furthermore, a lack of transport and costs for accessing services (e.g., buses, taxis, and accounting for unpaid bills) have also been previously described as barriers (Duckworth, 2015;Healy et al, 2015).…”

“…Some pregnant women/people often remain unvaccinated in Aotearoa NZ and internationally because they do not receive information about vaccinations in pregnancy (Donaldson et al, 2015;Gauld et al, 2016;Young et al, 2022). Other barriers include limited access to care, lack of transport to vaccination venues, costs involved with vaccination and time pressures (Duckworth, 2015;Gauld et al, 2022a;Gauld et al, 2022b;Hill et al, 2018;Larson et al, 2014;Wilson et al, 2015). Unfortunately, some barriers (such as cost and transport issues) are likely to affect those most vulnerable to poor health outcomes in the community and thus worsen existing health inequities.…”

“…Pragmatism supports utilisation of both quantitative and qualitative data to better understand and define the results to address the research aim (Cameron, 2011;Clarke & Visser, 2019;Onwuegbuzie & Leech, 2005). A structured questionnaire was developed by the research team (AY), based on a previously validated questionnaire (Wilcox et al, 2019), other literature (Frawley et al, 2020;Gauld et al, 2022a) and members of the research team's knowledge of clinical practice (i.e., midwife, general practitioner and pharmacist). The questionnaire contained a mix of closed and open-ended questions.…”

From the editors: challenges and opportunities for sustainable and equitable primary care

“…A qualitative study by Gauld and colleagues found that Māori women experienced barriers to uptake of maternal pertussis and influenza vaccinations, including sometimes being insufficiently informed by their healthcare providers of the benefits. 10 Solutions include pharmacists assisting in raising awareness of maternal vaccinations and access, early engagement with midwives, and improving accessibility through funding transport. Jardine and others found that pregnant Māori women may experience barriers to engaging with a midwife and are hopeful that the online tool, Best Start Kōwae, will help reduce this equity gap.…”