A Systematic Review of Barriers to Vaccination During Pregnancy in the Canadian Context

Abstract

Objective: While vaccination in pregnancy has the potential to dramatically impact maternal and infant morbidity and mortality, uptake of recommended vaccinations in pregnancy remains low. Our objective was to identify barriers and facilitators of vaccination during pregnancy in Canada. Methods: The MEDLINE database, as well as the table of contents of four relevant Canadian journals were screened to identify all studies that considered barriers and/or facilitators to vaccination during pregnancy, specifically in Canadian settings. Citations were screened and a narrative synthesis of findings was undertaken given the heterogeneity of study design. Results: In total, 17 studies met inclusion criteria, most with a focus on the seasonal and pandemic influenza vaccines. Facilitators and barriers were identified at the level of the patient and the provider. At both levels, knowledge was an important facilitator of vaccine acceptance during pregnancy and was notably improved in studies following the 2009 pandemic H1N1 influenza compared to earlier studies. Vaccine endorsement by a prenatal care provider and clear messages of safety for the fetus emerged as key motivators. Few studies addressed system level barriers or interventions for improving vaccine uptake during pregnancy in the Canadian setting. Conclusions: Common themes have emerged from the Canadian literature addressing barriers and facilitators of vaccination during pregnancy. However, there is a paucity of literature to suggest strategies to improve the uptake of vaccination during pregnancy in Canadian settings. Further research is urgently needed given the expanding role of vaccination during routine prenatal care.

Factors that influence vaccination decision-making among pregnant women: A systematic review and meta-analysis

“…Previous reviews have established a narrative of evidence that suggests a broad range of factors (vaccine cost, accessibility, maternal knowledge, social influences, context, healthcare professional (HCP) recommendation and the perception of risks and benefits) all contribute to vaccine uptake. Consensus within the field and across four prior literature reviews indicate that receiving a recommendation from an HCP for vaccination is the most important factor in maternal decision-making, irrespective of geographic or social context [11][12][13][14][15]. In general, there is limited data on maternal vaccination uptake and records of HCP recommendations at a national level.…”

“…Prior literature and systematic reviews tend to characterize the factors influencing maternal vaccination decisions as either barriers or facilitators [11][12][13][14][15]. We sought to quantify the association between beliefs, attitudes and prior behaviours that influence maternal vaccination uptake.…”

Vaccines safety and maternal knowledge for enhanced maternal immunization acceptability in rural Uganda: A qualitative study approach

“…This can partly be attributed to limited knowledge among pregnant women, their poor attitude about immunization, their failure to attend all ANC visits, lack of training of the Village Health Teams (VHTs) on the importance of TT vaccination for pregnant mothers, limited health education to pregnant mothers, and maternal vaccine safety concerns. Studies have shown that healthcare providers [16,17], knowledge of patient and provider [18], improved ANC attendance and surveillance systems [17,19] play an important role in maternal vaccination uptake.…”

Understanding Influenza Vaccination During Pregnancy in Canada: Attitudes, Norms, Intentions, and Vaccine Uptake

“…Identifying determinants of influenza vaccine uptake in pregnancy may help target education efforts and intervention strategies to most efficiently promote vaccination in pregnancy. Previous studies have identified patient-level factors associated with acceptance of influenza vaccination during pregnancy in Canada, including perception of disease susceptibility and severity, perception of benefits—including safety and effectiveness—of vaccination, being cared for in pregnancy by a family practitioner, greater knowledge about influenza and vaccinations, and demographic factors including multiparity, comorbidities, higher income, higher education, married status, and older maternal age (Poliquin et al, 2019). Some studies have applied the health belief model (Bettinger et al, 2016; Fabry et al, 2011), but most have not been theory driven, instead using cross-sectional data to identify demographic factors associated with vaccination (Brien et al, 2012; Gracie et al, 2011; Hilderman et al, 2011; Legge et al, 2014; Liu et al, 2012; Yudin et al, 2009), or exploring of the knowledge, attitudes, and beliefs of mothers (Halperin et al, 2014; Kowal et al, 2015), practitioners (Desjardins et al, 2017; Lee et al, 2005), or both (Tong et al, 2008).…”