Understanding Influenza Vaccination During Pregnancy in Canada: Attitudes, Norms, Intentions, and Vaccine Uptake

Abstract

To improve uptake of influenza vaccine in pregnancy, it is important to understand the factors that predict prenatal vaccination. The aim of this study was to test the capability of the theory of planned behavior, augmented with information constructs, to predict and explain influenza vaccination uptake in a sample of 600 pregnant individuals in Canada. A baseline survey at the start of influenza season assessed beliefs, norms, perceived control, and information-seeking behavior related to influenza vaccination in pregnancy, as well as respondent demographics. A follow-up survey at the conclusion of influenza season assessed self-reported influenza vaccine uptake as well as infant vaccination intentions. Multivariable analysis indicated that attitudes toward influenza vaccination in pregnancy, subjective norms, information seeking, and past vaccination behavior predicted intentions to be vaccinated, and intentions predicted vaccine uptake. Neither perceived control nor demographics were significant predictors of intentions or vaccine uptake. These findings suggest that presumptive offering of vaccination in pregnancy by health care providers, as well as patient and public health educational interventions, may be effective in communicating norms and strengthening positive attitudes and intentions concerning influenza vaccination in pregnancy, resulting in higher vaccine coverage.

Does Vaccinating against Influenza in a Given Epidemic Season Have an Impact on Vaccination in the Next Season: A Follow-Up Study

“…In line with some previous studies conducted in other countries, such as the US, Canada, the Netherlands, Spain, Tunisia, and China [16][17][18][19][20]27], this study found a sizable gap between reported influenza immunization intentions and vaccine receipt in the next season. For instance, 64.7% of elderly patients with chronic diseases in Tunisia expressed a willingness to be vaccinated in the next season [27].…”

“…A questionnaire (Supplementary Materials) was designed by the study team using a literature review [9][10][11][12][16][17][18][19][20][21] and was then administered to participants by the medical staff. Before fulfilling this questionnaire, patients were informed about the aim of the study and then assured that they would not be identified in any presentation or publication.…”

“…All our patients who initially presented as unwilling to be vaccinated remained unvaccinated in the next season; vaccine receipt among undecided participants was only 23%. Nevertheless, vaccine-hesitant patients who were on the fence far outnumbered vaccine refusers; therefore, counseling this group might be more effective [19].…”

“…For instance, Ye et al, who conducted a follow-up survey among diabetic patients in China found that vaccination history displayed positive associations with influenza vaccine uptake [18]. The results of a follow-up survey at the conclusion of the influenza season, which assessed self-reported influenza vaccine uptake among Canadian pregnant women, showed that last year's vaccination behavior predicted vaccine uptake [19]. The results of all above-mentioned studies show that if patients have positive initial influenza immunization experiences, they are likely to receive vaccination regularly and get "into the habit" of being immunized [13,18,19,27].…”

“…Such information can assist medical staff in focusing specifically on unvaccinated patients who are most likely to refuse an influenza vaccine. However, previous evidence from non-pandemic influenza seasons shows sizable differences between patient-stated vaccination intentions prior to vaccine availability and later vaccine uptake, indicating a significant lack of follow-through on initial immunization plans [16][17][18][19][20][21]. Most of the above-mentioned follow-up studies assessed how vaccination intent translates into immunization during the current season, surveys which evaluated how to predict and explain influenza vaccination uptake in the next season are rather scant.…”