Views and experiences of maternal healthcare providers regarding influenza vaccine during pregnancy globally: A systematic review and qualitative evidence synthesis

Abstract

Background The World Health Organization (WHO) recommends that pregnant women receive influenza vaccination; however, uptake of the vaccine remains low. Maternity health care professionals (MHCPs) play an important role in motivating pregnant women to receive the influenza vaccine. However, factors such as MHCPs’ views and knowledge about the vaccine, and time constraints due to workload may influence MHCPs’ practices and opinions about women receiving the influenza vaccine during pregnancy. To date, the qualitative evidence exploring MHCPs’ views and experiences around influenza vaccine uptake in pregnant women has not been synthesised. Aim To systematically review and thematically synthesise qualitative evidence that explores the views and experiences of MHCPs involved in the provision of the maternal influenza vaccine worldwide. Methods Five databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science) were searched, supplemented with searches of included paper reference lists and grey literature. Study selection was conducted by up to three researchers applying pre-specified inclusion/exclusion criteria. Quality assessment was undertaken, data were extracted, coded and synthesised to develop descriptive and analytical themes. Results Eight studies involving 277 participants were included. Seventeen descriptive themes were interpreted, embedded within six analytical themes. MHCPs perceived that maternal influenza vaccination delivery can be facilitated by trusting relationships, good communication, knowledge about the vaccine leading to confidence in recommending vaccine, electronic vaccination prompts, and presence of national guidelines. However, workload, time constraints, MHCP’s perception of pregnant women’s concerns, and social/cultural/environmental influences could prevent the likelihood of delivery of influenza vaccine. Knowledgeable MHCPs who were regularly updated about vaccination based on scientific evidence were more confident when discussing and recommending the influenza vaccine to pregnant women. In addition, the presence of national policies and guidelines and electronic prompts for maternal influenza vaccination would enhance the delivery of the vaccine. Conclusion Our findings suggest that approaches to enhance the vaccination uptake rate in pregnant women include addressing MHCPs barriers to discussing influenza vaccination through education, sufficient time for discussions, and electronic prompts about vaccination, as well as evidence based local and national guidelines.

“Figuring stuff out myself” – A qualitative study on maternal vaccination in socially and ethnically diverse areas in England

“…Our study provides important new insights on speci c structural and organisational factors and con rms general insights from previous studies conducted among different populations and/or prior to the availability of maternal Covid-19 vaccines. For example, previous research found electronic vaccination prompts could facilitate maternal u vaccine provision [45] and requested better IT solutions for call/recall systems [21]. Our study has provided crucial new details on why such prompts and systems are still not in place or feasible, including because GP databases no longer routinely show if a patient is pregnant, or because midwives and pregnant women often do know how to use the limited functions of their maternity apps.…”

Impact of the COVID-19 Pandemic on Influenza Vaccination and Associated Factors among Pregnant Women: A Cross-Sectional Study in Korea

“…In the present study, trust in healthcare providers was also significantly correlated with the acceptance of the influenza vaccine among pregnant women. A previous qualitative evidence synthesis showed that pregnant women’s trust in healthcare providers can promote making the decision to get vaccinated against influenza [ 67 ]. Therefore, acceptance of the influenza vaccine could be improved by increasing the opportunity for healthcare providers who established a good relationship of trust with pregnant women to provide accurate information regarding the influenza vaccine.…”

“…Therefore, acceptance of the influenza vaccine could be improved by increasing the opportunity for healthcare providers who established a good relationship of trust with pregnant women to provide accurate information regarding the influenza vaccine. Furthermore, evidence-based and professional training or education is a necessity for healthcare providers to promote the discussion of influenza vaccination and address the concerns of pregnant women [ 67 ].…”

Guidelines of the Polish Society of Gynecologists and Obstetricians, the Polish Society for Vaccinology, and the Polish Society for Family Medicine on vaccinating women with reproductive plans and pregnant or breastfeeding women

“…Immunization of pregnant women against influenza has been validated by the PTGiP, together with the National Flu Immunization Program (OPZG), as well as international expert organizations, e.g., ACIP, ACOG. WHO also recommends that all pregnant women without absolute contraindications, temporary or permanent, should be immunized, irrespective of the pregnancy trimester [14][15][16].…”

“…Live Attenuated Influenza Vaccine (LAIV) registered in Europe for nasal administration to children and adolescents, between the ages of 2 and 18, is contraindicated in pregnancy [16]. Breastfeeding is not a contraindication to influenza vaccine.…”