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

Abstract

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.

Determinants of Influenza and Pertussis Vaccination Uptake in Pregnancy

“…White British women (79%) were significantly more accepting of influenza (85% vs. 61%, OR 3.25, 95% CI: 1.67-6.32) and pertussis vaccination (96% vs. 83%, OR 4.83, 95% CI: 1.77-13. 19) compared with non-white-British women. Among HCPs, 25%…”

Understanding the barriers to uptake of antenatal vaccination by women from culturally and linguistically diverse backgrounds: A cross-sectional study

“…While recall bias and difficulties with language may contribute to these findings, they nevertheless suggest room for improvement as HCP recommendation has consistently been demonstrated to be a key driver of vaccine uptake. 11,16,[19][20][21] It is incumbent on HCP to engage women from CALD backgrounds in timely, evidencebased, and culturally appropriate discussions about indications for, and safety of vaccines during their routine pregnancy care.…”

“…The strengths of our study are the large sample size and inclusion of women from a diverse range of backgrounds. Most studies published to date pertain to Black or Hispanic 11,16,17 women who do not make up a large proportion of the population in Australia. Our survey captures the experience of women from Asia and Sub-Saharan Africa, which has been missing from the narrative until now.…”

“…In addition, women who did not converse or read in the dominant language have frequently been excluded from published studies. Of minority groups, the experiences of Black and Hispanic women in the US and UK have been described 11,16,17 but pertinent to the Australian context, the experiences of women from Asia and recently arrived migrants and refugees are not as well understood. In this study we aim to address these knowledge gaps by surveying women attending for pregnancy care in a public healthcare network known to service a culturally diverse population.…”

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

“…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].…”