Understanding the barriers to uptake of antenatal vaccination by women from culturally and linguistically diverse backgrounds: A cross-sectional study

Abstract

The role of maternal vaccination in reducing neonatal morbidity and mortality is expanding but uptake remains suboptimal. While the barriers to uptake have been well described, women from minority groups have not been well represented in previous studies. In this study we examine the facilitators and barriers to uptake of antenatal vaccination by women from culturally and linguistically diverse backgrounds in Melbourne, Australia. 537 women attending antenatal care completed a survey; 69% were born overseas. 63% had or intended to receive pertussis vaccine and 57% had or intended to receive influenza vaccine during their pregnancy. On multivariable analysis, predictors of uptake of pertussis vaccine were healthcare provider recommendation (OR 10, 95% CI 5-21, p < 0.001) and belief maternal pertussis vaccination is safe (OR 36, 95% CI 18-70, p < 0.001). For influenza vaccine, predictors of uptake were previous receipt of influenza vaccine (OR 8, 95% CI 5-15, p < 0.001) and healthcare provider recommendation (OR 30, 95% CI 16-56, p < 0.001). Lack of healthcare provider recommendation was the main reason for non-vaccination (17/46, 37%). While most women were aware of and intended to receive recommended vaccinations, recently arrived migrant women (resident in Australia for less than two years) were less likely to be aware of pertussis vaccine (15/22, 68% vs 452/513, 88%, p = 0.01) and less likely to believe it to be safe during pregnancy (4/22, 18% vs 299/514, 58%, p < 0.001). This highlights the important role of healthcare providers in recommending and educating women, particularly newly arrived migrant women, in their decisions about vaccination during pregnancy.

Factors influencing the uptake of influenza vaccine vary among different groups in the hard‐to‐reach population

“…This is in contrast to the non‐pregnant participants, the majority of whom reported being worried about influenza as the main reason. This finding is consistent with the literature around maternal influenza vaccination: that the lack of healthcare worker recommendations is frequently identified as the main barrier for pregnant women to receive vaccines in pregnancy 12,16 . Similarly, recommendation by healthcare provider is often the most important determinant of vaccine uptake among pregnant women 12,17,18 .…”

“…This finding is consistent with the literature around maternal influenza vaccination: that the lack of healthcare worker recommendations is frequently identified as the main barrier for pregnant women to receive vaccines in pregnancy. 12,16 Similarly, recommendation by healthcare provider is often the most important determinant of vaccine uptake among pregnant women. 12,17,18 This finding reinforces the importance of ongoing involvement of healthcare workers in promoting influenza vaccination among pregnant women.…”

“…12,16 Similarly, recommendation by healthcare provider is often the most important determinant of vaccine uptake among pregnant women. 12,17,18 This finding reinforces the importance of ongoing involvement of healthcare workers in promoting influenza vaccination among pregnant women. Most pregnant women are likely to be healthy before pregnancy and perceive themselves to be at low risk of severe influenza.…”

“…This finding suggests that having access to medical care and immunisation service is an important determinant of vaccine uptake in hard‐to‐reach populations. On the other hand, factors identified in the published literature that reduce vaccine uptake in the at‐risk population include vaccine recipients’ underestimation of risk and morbidity of influenza and lack of recommendation by healthcare workers 11–13 . Overall, the complexity and variability in the factors influencing influenza vaccine uptake in hard‐to‐reach and at‐risk populations warrant innovative, context‐specific vaccine delivery programs that involve local stakeholders to optimise vaccine uptake.…”

Antenatal influenza and pertussis vaccination in Western Australia: a cross-sectional survey of vaccine uptake and influencing factors

“…A 2016 survey of 136 Victorian pregnant women found recommendation of the pertussis vaccine by a health care provider and belief in protection for the unborn child against pertussis was a main determinant of vaccine uptake [ 12 ]. The importance of health care provider recommendation was also demonstrated in surveys of Aboriginal mothers in Western Australia [ 13 ] and women from culturally and linguistically diverse backgrounds in Melbourne [ 14 ].…”