Risk Perceptions, Worry, or Distrust: What Drives Pregnant Women’s Decisions to Accept the H1N1 Vaccine?

Abstract

To determine how risk perceptions, worry, and distrust relate to pregnant women's intentions to accept the H1N1 vaccine. Cross-sectional survey of 173 pregnant women recruited from two OB/GYN practices at an urban academic medical center. Survey items were adapted from validated measures of risk, worry, and health care distrust. Vaccination intention was analyzed as a dichotomous variable. Analyses were with student's t tests, chi squared tests, and logistic regression. Study participants were, on average, 25.6 years old with parity=2.8. 55% of respondents were Black; 32% completed a high school diploma or less; and half were publically or un- insured. 63% of the respondents reported that they "definitely" or "probably" would accept the H1N1 vaccine. Intention to receive the H1N1 vaccine did not vary by sociodemographic factors nor by source of health information. In univariate analysis, intention was related to higher risk perceptions about probability of and susceptibility to H1N1 influenza (57.9 vs. 31.8%, P=.001 and 67.0 vs. 45.3%, P=.005, respectively), worry about getting H1N1 influenza (48.1 vs. 15.6%, P=<.001), and less distrust in the health care system (mean score 1.07 vs. 1.51, P<.001). In multivariable analysis, only worry about getting H1N1 was related to vaccination intention (OR=3.43, P=.04). Worry about acquiring disease was a stronger predictor of vaccine intention than risk perceptions, distrust, or worry about vaccine safety. With growing numbers of vaccines being offered during pregnancy and immediately postpartum, these results have important implications for future vaccination intervention, education, and messaging efforts in urban settings.

Risk management of seasonal influenza during pregnancy: current perspectives

“…Surveys of pregnant women reveal that a significant proportion believe that the influenza vaccine can increase the risk of miscarriage, birth defects, and fever, and may be harmful during pregnancy or breastfeeding 62,71,72. Women with these beliefs are less likely to accept vaccination during pregnancy, while women who believe that influenza in pregnancy poses a significant risk to either themselves or the pregnancy, and women who believe the vaccine is safe, are more likely to be vaccinated 63–65,71,73–75. Interventions to increase knowledge (such as patient education) have been shown to increase vaccination rates,76 and newer technologies such as text messaging may show promise in promoting women to consider the vaccine 77.…”

Factors Affecting Intention to Receive and Self-Reported Receipt of 2009 Pandemic (H1N1) Vaccine in Hong Kong: A Longitudinal Study

“…Empirical studies have found that history of seasonal influenza vaccination [12,[15][16][17][18], perceived risk of pandemic influenza [17,[19][20][21][22][23][24][25][26], worry [17,22,26,27], and attitudes towards vaccine, such as vaccine efficacy and side-effects [12,15,20,[24][25][26] were significantly associated with intention to receive a vaccine against the influenza pandemic. This is consistent with the findings related to determinants of vaccination against seasonal influenza [28][29][30][31][32].…”

“…The vaccination was free for priority group members [10], but cost HK$100-150 (US$13-20, 1-1.5% of Hong Kong's median monthly income of HK$10,000/ US$1,286/J991) per dose for the general population. A study in July 2009 of 301 respondents projected that vaccine uptake would be influenced by end-user cost, with 45%, of Hong Kong's general population being ''highly likely'' to take up pH1N1 vaccine if free, and 24% if costing HK$100-200 (US$ [13][14][15][16][17][18][19][20][21][22][23][24][25] [11,12].…”

“…It seems probable that the adverse media reports had impeded vaccination uptake among general population. We collected baseline data between 12-25 January, 2010, immediately before pH1N1 vaccine was made available to the general population and then two months later (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) March 2010) we recorded their reported vaccination status ( Figure 2) with the intention of modelling how general population decision-making regarding pH1N1 vaccination might predict subsequent vaccine uptake.…”

Influenza vaccination acceptance among diverse pregnant women and its impact on infant immunization

“…14, [21][22][23][24] Low rates of vaccine acceptance and awareness in this population provide an epidemiologic argument for outreach to racial and ethnical minority women. To our knowledge, little immunization messaging and research has been done among racial and ethnic minority women, who have much lower vaccination rates compared with whites, and higher rates of influenza associated mortality and complications.…”