Understanding factors that influence the decision to be vaccinated against influenza and pertussis in pregnancy: A qualitative study

Abstract

Aims and Objectives To identify how pregnant women perceive pertussis and influenza and the factors that influence their decision to be vaccinated. Background Suffering from influenza during pregnancy increases complications in the pregnant woman, foetus and newborn. Pertussis in children under six months of age causes severe complications. Maternal vaccination against influenza and pertussis is effective and safe. However, vaccination rates are insufficient. Design We conducted a qualitative descriptive study, using semi‐structured interviews. This research adheres to the COREQ guidelines and checklist. Methods We carried out 18 semi‐structured face‐to‐face interviews with pregnant women, using intentional sampling and thematic analysis. Results We identified an overarching theme, ‘factors that influenced participants’ decision to be vaccinated or not’, which was composed of four subthemes that were in turn made up of 12 categories. The factors that influenced participants’ decision to be vaccinated against influenza and pertussis were related to their knowledge of and their perception of risk for these diseases. Participants perceived the risk of pertussis to be greater, and they focused their concern on the newborn. The recommendations and convictions of nurse‐midwives were the most important factors encouraging vaccination. Participants trusted their nurse‐midwives and most reported that they would have been vaccinated if their midwife had recommended it. Other factors were linked to lack of information, fear and concerns about economic interests. Conclusions The convictions and actions of the nurse‐midwife in recommending vaccination to pregnant women are decisive. Strategies to improve vaccination rates should be directed to helping health professionals understand how their practice affects the final decision of pregnant women. Relevance to clinical practice Understanding the factors that limit vaccination rates among pregnant women provides valuable information to nurse‐midwives that can help to improve vaccination strategies and practices. Increased maternal vaccination rates would reduce morbidity and mortality among pregnant women and newborns.

Knowledge, Perceptions, Attitudes and Practices of Midwives Regarding Maternal Influenza and Pertussis Vaccination: A Qualitative Study

“…According to previous studies, these results also extend to the pregnant women themselves. Understanding influenza as less serious, trivializing it even [ 27 ], not perceiving themselves at risk of contracting it [ 14 , 27 ] and understanding the severity as mostly affecting the mother and not the future child are all factors reported by pregnant women as influential in their final decision to get the influenza vaccine or not [ 14 , 23 , 27 ]. This leads to lower vaccination coverage for influenza than for pertussis.…”

“…Training, professional reflection and management actions must be implemented to reverse this fact. We must not forget that a recommendation from professionals is critical in pregnant women’s final decision [ 27 ].…”

“…The factors reported by pregnant women as influential in their decision to get vaccinated are being informed, the influence of others and having access to vaccines [ 22 , 23 ], although the availability of these does not always guarantee vaccine uptake [ 24 ]. Of all the factors, a recommendation from healthcare providers (HCPs) [ 14 , 25 , 26 ] and more specifically midwives [ 27 ] stands out as the most important. In this sense, the main barrier to vaccination is the lack of recommendations from HCPs and aspects linked to safety [ 14 , 25 , 26 ].…”

“…In this sense, the main barrier to vaccination is the lack of recommendations from HCPs and aspects linked to safety [ 14 , 25 , 26 ]. The fact that some women claim they would have been vaccinated had their HCPs recommended it [ 22 , 27 ] demonstrates the vital role that providers play in maternal vaccination. For their part, HCPs have reported that inadequate training, reimbursement issues, concerns about safety, increased workload and having staff available with the certification required to administer vaccines [ 14 , 20 , 28 ] are the main barriers to recommending vaccination.…”

Facilitators and Barriers to Vaccination Uptake in Pregnancy: A Qualitative Systematic Review

“…Some believed their healthy lifestyle habits and knowledge of hygiene were su cient for maintaining good health [74,75]. Some women believed in alternative medicine or natural remedies [76,77]. In one study, higher engagement with their own healthcare increased vaccine refusal [69].…”