Evidence-based vaccination strategies in obstetrics and gynecology settings: Current practices and methods for assessment

Abstract

Obstetrician-gynecologists have the potential to play an important role in the delivery of immunizations to women. However, despite national recommendations, immunization rates among pregnant women and adults in general remain low. Pragmatic immunization delivery trials are needed to demonstrate how best to deliver vaccines in such settings. We report the development and implementation of 2 novel methodologies for immunization delivery research and quality improvement in such settings. The first was the development and application of a 47-point Immunization Delivery Scale that formally assessed variability among practices in their engagement in a variety of evidence-based practices for improving immunization rates. The second was a covariate-constrained randomization technique -a method for achieving balance between study arms in cluster-randomized trials that is especially applicable to pragmatic trials.. To best achieve meaningful and interpretable findings, we recommend use of these or similar techniques in future immunization research and quality improvement projects in OB/GYN settings.

Enhancing uptake of influenza maternal vaccine

“…By creating multi-component interventions, investigators can expect relatively larger effect sizes. Methods have been developed to help overcome some of the barriers to implementing large trials in the obstetric care setting [91].…”

Motivational Interviewing for Maternal Immunisation (MI4MI) study: a protocol for an implementation study of a clinician vaccine communication intervention for prenatal care settings

“…Finally, we will assess organisational contextual factors and practice characteristics using a validated scale for evidence-based vaccination strategies conducted both pre-implementation and at 9 months later with an practice representative. 88 …”

“…Finally, we will assess organisational contextual factors and practice characteristics using a validated scale for evidence-based vaccination strategies conducted both pre-implementation and at 9 months later with an practice representative. 88 Provider surveys A provider survey will assess provider time and self-efficacy in discussing maternal immunisations with patients. Surveys will be administered by paper or electronically immediately prior to baseline provider training, at 3 months after the initial provider training, and postintervention surveys will be administered at the time of the postintervention provider focus groups approximately 9 months after initial training.…”

Clinician perspectives on strategies to improve patient maternal immunization acceptability in obstetrics and gynecology practice settings

“…[43][44][45][46][47][48][49] The barriers for increasing coverage of recommended maternal vaccines and addressing parental concerns for infant v0accines are complex and multifactorial, ranging from systems level barriers (e.g., vaccine supply, inadequate standing orders) to individual provider and patient attitudes. [50][51][52][53][54][55] A comprehensive approach that addresses multiple barriers would be most likely to increase coverage of maternal and infant vaccination rates. 53,56 We conducted this study to facilitate the introduction of an effective, comprehensive maternal vaccine promotion strategy in obstetrics and gynecology (ob-gyn) clinical settings.…”

“…[50][51][52][53][54][55] A comprehensive approach that addresses multiple barriers would be most likely to increase coverage of maternal and infant vaccination rates. 53,56 We conducted this study to facilitate the introduction of an effective, comprehensive maternal vaccine promotion strategy in obstetrics and gynecology (ob-gyn) clinical settings. Using established behavioral theories to guide our work (i.e., Elaboration Likelihood Model (ELM), the Stages of Change Model, and the Systems Model of Clinical and Preventive Care), we specifically sought to identify a set of clinic, provider, and staff-related attributes and facilitators that could be utilized for intervention development and implementation.…”