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

Self Cite

Background Vaccination coverage with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in pregnancy or immediately postpartum has been low. Limited data exist on rigorously evaluated interventions to increase maternal vaccination, including Tdap. Tailored messaging based on the Elaboration Likelihood Model (ELM) framework has been successful in improving uptake of some public health interventions. We evaluated the effect of two ELM-based vaccine educational interventions on Tdap vaccination among pregnant African American women, a group of women who tend to have lower vaccine uptake compared with other groups. Methods We conducted a prospective randomized controlled trial to pilot test two interventions – an affective messaging video and a cognitive messaging iBook – among pregnant African American women recruited during routine prenatal care visits. We measured Tdap vaccination during the perinatal period (during pregnancy and immediately postpartum), reasons for non-vaccination, and intention to receive Tdap in the next pregnancy. Results Among the enrolled women (n=106), 90% completed follow-up. Tdap vaccination in the perinatal period was 18% in the control group; 50% in the iBook group (Risk Ratio [vs. control group]: 2.83; 95% CI, 1.26–6.37), and 29% in the video group (RR: 1.65; 95% CI, 0.66–4.09). From baseline to follow-up, women’s reported intention to receive Tdap during the next pregnancy improved in all three groups. Among unvaccinated women, the most common reason reported for non-vaccination was lack of a recommendation for Tdap by the woman’s physician. Conclusions Education interventions that provide targeted information for pregnant women in an interactive manner may be useful to improve Tdap vaccination during the perinatal period. However, larger studies including multiple ethnic groups are needed to evaluate robustness of our findings.

Section: Methodsmentioning

confidence: 99%

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

Kriss

Frew

Cortés

et al. 2017

Self Cite

“…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.…”

Section: Randomised Control Trialsmentioning

confidence: 99%

“…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].…”

Section: Information and Education For Patientsmentioning

confidence: 99%

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

Bisset

Paterson

2018

Twenty-two articles were included in the review. The majority of the papers included were conducted in the USA and looked at strategies to increase influenza vaccination in pregnancy. There is limited high quality evidence for strategies in high-income countries to increase coverage of pertussis and influenza vaccination in pregnancy. A number of strategies have been found to be effective; reminders about vaccination on antenatal healthcare records, midwives providing vaccination, and education and information provision for healthcare staff and patients. Future interventions to increase vaccination in pregnancy should be evaluated to ensure efficacy and to contribute to the evidence base.

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Frew

Chung

Fisher

et al. 2016

Self Cite

Objective We examined Vaccine Information Statements (VIS) dissemination practices and parental use and perceptions. Methods We conducted a national online panel survey of 2603 US parents of children aged <7. Primary outcomes included reported VIS receipt, delivery timing, reading experiences, and perceived utility. Results Most parents received a VIS (77.2%; [95% CI: 74.5–79.7%]), 59.7% [56.6–62.7%] before vaccination but 14.5% [12.5–16.8%] reported receiving it after their child’s immunization; 15.1% [13.0–17.6%] were unsure of receipt status or timing; another 10.7% [9.0–12.6%] reported non-receipt of a VIS. Less than half who received a VIS before vaccination completed it before vaccination (46.2% [42.4, 50.0%]), but most who read at least some found the information useful (95.7% [93.8–97.0%]). Parents who delayed or refused at least one recommended non-influenza vaccine reported fewer opportunities to ask providers VIS questions. Conclusions Most parents report receiving VIS before vaccination as per federal guidelines. Continued effort is needed to enhance VIS distribution practice and parent-provider VIS content communication.