Skewed risk perceptions in pregnant women: the case of influenza vaccination

Abstract

Background: Pregnant women and their newborns have an increased risk of developing severe influenza and influenza-related complications. In Germany, seasonal influenza vaccination is recommended for pregnant women since 2010. However, little is known about pregnant women's vaccination-related knowledge and attitudes, as well as their risk perceptions. This study therefore assessed pregnant women's vaccination-related knowledge, risk perceptions related to influenza disease and influenza vaccination during pregnancy, and aimed to identify determinants of influenza vaccination uptake during pregnancy in Germany. Methods: Between 2012 and 2014, a nationwide web-based prospective cohort study with follow-up interviews was conducted in initially pregnant women who gave birth over the study period. Control groups were set up in a cross-sectional fashion during the follow-up interviews. Women who participated in both, the baseline interview before giving birth and in the 1st interview after giving birth were included in the analysis. Univariate and multiple logistic regression were used to identify associations between influenza vaccination uptake and sociodemographic characteristics as well as items assessing attitude and knowledge. Results: In total, 838 women were included in the analyses. Pregnant women had a positive attitude towards vaccination in general, but only modest vaccination knowledge. Overall, 10.9 % of women were vaccinated against seasonal influenza during pregnancy. While pregnant women perceived classical childhood diseases to be more risky than the respective vaccinations, this relation reversed for influenza: The risk of vaccination was perceived higher than the risk of the disease. These two types of risk perceptions independently determined influenza vaccination uptake-higher perception of disease risk and lower perceptions of vaccination-related risks increased uptake. Additionally, knowledge about the vaccination recommendation for pregnant women and a positive gynaecologist's attitude towards vaccination during pregnancy influenced the uptake significantly. Conclusions: Influenza vaccination uptake in pregnant women is low in Germany. Tailored communication strategies for pregnant women should focus especially on changing the perceptions of personal risks regarding influenza and influenza vaccination during pregnancy. Gynaecologists should be made aware about their crucial role in supporting vaccination decision-making of pregnant women and the need to provide relevant information to counteract misconceptions.

Knowledge, attitudes and practices about influenza vaccination among pregnant women and healthcare providers serving pregnant women in Managua, Nicaragua

“…Specifically, of the 40% that received a recommendation and an offer of influenza vaccination, 95% were vaccinated; however, among those who received neither a vaccination recommendation nor an offer, only 5% were vaccinated. This finding supports the literature that healthcare provider recommendation and offer of influenza vaccination are leading predictors of vaccination among pregnant women [6–12] and substantiates that healthcare providers with up-to-date knowledge, good practices and attitudes towards influenza vaccination foster acceptance of the vaccine among pregnant women [13,14]. …”

Seasonal influenza vaccination in pregnant women: knowledge, attitudes, and behaviors in Italy

“…Therefore, it is important to design and to implement interventions in order to increase the vaccination rate. The value observed in the present study is higher than those reported in other countries, since no women had received influenza vaccination in the already mentioned study in India [34], 3% in Turkey [36], 4% in Thailand [26], and it is almost identical to the 6% in Iran [37], 10.9% in Germany [38], and 16% in Canada [39]. Whereas, it is substantially below the levels observed in Australia with an uptake of 27% [20], in France of 39% [40], in Belgium of 42.8% [41], and in the United States with levels ranging from 35% [14] to 66.4% [42].…”

“…Women of older age had higher level of knowledge and, not surprisingly, those with higher education level were more likely to know that the influenza is dangerous for pregnant women and to report a positive attitude towards the utility of the vaccination during pregnancy. Prior study has shown similar findings [38]. The fact that women with a high-risk pregnancy were more likely to know that the influenza is dangerous for pregnant can serve as a focus when promoting health education interventions.…”

Wissen und Einstellungen über die saisonale Influenza-Impfung von Hebammenschülerinnen in Nordrhein-Westfalen: Ergebnisse einer Querschnittsstudie

“…Trotzdem sind die Impfraten in dieser Hochrisikogruppe der Schwangeren in Deutschland gering, für das Jahr 2014 wurde nur eine Impfrate von 10,6 % ermittelt [6]. Weiterhin weisen Studien darauf hin, dass das Wissen unter Schwangeren und werdende Eltern über Impfungen unzureichend und von Fehlvorstellungen geprägt ist [7]. Weiterführende Untersuchungen belegen zudem, dass Impfentscheidungen neben subjektiver Wahrnehmung auch durch Internetrecherche beeinflusst werden.…”