Influences on Pregnant Women’s and Health Care Professionals’ Behaviour Regarding Maternal Vaccinations: A Qualitative Interview Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Setting—New Zealand and Specifically the Waikato Region
2.2. Study Design
2.3. Recruitment and Interview Process
2.4. Analysis
2.5. Researchers’ Roles and Perspectives
3. Results
3.1. The Sample
3.2. Capability Opportunity Motivation-Behaviour (COM-B)
3.2.1. Women’s Behaviour with Respect to Maternal Vaccinations
“If I could have just gotten it done [at the pharmacy or hospital] all then and there it would have been fine. You don’t have to think about it, you don’t have to go anywhere. It’s done.”W10
3.2.2. Capability for Women
“…all through my pregnancy of course my midwife recommended… all the shots…”W8 (influenza vaccine only)
“I feel like I’ve had to seek all the information out… I think my first midwife was maybe a bit anti-vaccinations, I got that vibe from her… I think I got a hand-out about whooping cough. And then the second time round… my midwife hasn’t mentioned it at all I don’t think. Then I went to the pharmacy for something else, and the pharmacist just popped her head over and she’s like oh are you pregnant?... [R]eminded me that I needed to get the whooping cough the second time round, coz I actually didn’t know...”W11 (pertussis vaccine only)
“I don’t think I trust much on Facebook myself. I’d be more inclined to probably book an appointment with the doctor or something and ask all those questions.”W1 (neither MV)
“…we can only do so much because immunisations [are] only a small part of our discussions and a lot of women aren’t focused on immunisations when they’re so scared of the… birth.”M2
“… if… my midwife or someone told me I need to be vaccinated against influenza then I would have done it.”W18
3.2.3. Capability for Health Care Professionals
“I forget about these vaccines always. And I go to nurses and they know, and I can’t hold all, so much information…”D2
“… the biggest barrier for a lot of midwives is that you don’t know and… you don’t want to talk about things when you don’t know…”M3
“… even midwives don’t understand [how bad influenza in pregnancy can be] because we don’t see it.”M11
“[Women] have this misconception of when I get the flu vaccine I get the flu... I don’t really know how to kind of demystify that…”M2
“I told my midwife [I’d had the vaccination]… she had heard about it but doesn’t actually know much about it…”W4 (pertussis only)
3.2.4. Opportunity for Women and for Health Professionals
“… because we’ve got the vaccines on site it’s just so much easier and the women go ‘yup, let’s do it.’ I do it at the beginning of our appointment so by the time we’ve finished… they’ve had their observations and they like it like that.”M1
“… more pressing issues like, I don’t know, the grocery shopping or getting all my five kids ready for school and you know it’s things that are like more in the forefront of their mind rather than this vaccination that they should probably think about getting.”M3
“I complain sometimes about my ladies not coming here but sometimes the pregnancy is the smallest issue in their life… Some of it is drugs and alcohol and priorities being askew.”M5
3.2.5. Motivation for Women and for Health Professionals
“… at first [on administering MVs] it was like I did sort of hesitate a little bit… It’s actually knowing that these women are being vaccinated on time and helping to protect the babies, that’s made me realise now that it’s actually an important part of the role.”M1
“I still feel that females were made to do it [carry a baby] I suppose.”W1 (received neither MV)
“I’ve turned so many around when I’ve said, “oh actually it’s recommended” and I show them the posters… and they go ‘oh okay that’s fine because my midwife has suggested it but I’m still a bit…”P10
“I quite like being vaccinated, especially during pregnancy and for baby after baby’s born. I find it most important that my babies are vaccinated when they should be.”W12 (planning to have both MVs)
“I got little text reminders on my phone from the doctors to remind me when my appointment was due to go and get them [MVs] done too, [handy] [e]specially when you’ve got so many children and after one you start losing track.”W12 (planning to have both MVs)
“I usually say Ministry of Health recommends because I don’t want it to be like I’m pushing this on you because I’m not, it’s up to you to make that choice.”M3
“… we’re really passionate about giving choices and options so on some topics that’s really hard… you want to give them the information, but you can’t be too directive.”M6
“… the chance is we might forget about the immunisation because there’s a lot to discuss on the [antenatal appointment] with the excitement and we have 15 min.”D2
“… when you start giving 14 vaccines a day you… get confidence in it and you begin to realise that it is safe.”M4
4. Discussion
4.1. Summary of Findings
4.2. Comparison with Other Literature and Implications
4.3. Strengths and Weaknesses
4.4. Future Research
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Māori or Pacific Women n = 10 | Women Who Identified with Neither Māori nor Pacific Ethnicity n = 8 |
---|---|---|
Identified ethnicity | 9 Māori and 1 Cook Island Māori. | 4 NZ European; 3 South African European; 1 Chinese (born in China). |
Rural/urban | 6/4. | 2/6. |
Age | 18–31 years. | 23–37 years. |
Number ≤ 25 years | 5 | 1 |
Number of weeks’ gestation or age of infant when interviewed | 1 was 22 weeks’ gestation and 4 were 31–39 weeks’ gestation. 5 had infants aged 5 weeks to 4 months old. | 3 women were 34–36 weeks’ gestation. 4 had infants 1 week to 4.5 months old; 1 had a 12-month-old infant. |
Number of children | 2 women had no other children, 3 had 1 other child, 1 had 2 other children, 1 had 3 other children, and 3 had 4 other children. | 3 women had no other children; 4 had 1 other child, and 1 had 2 other children. |
Lead maternity carer | All used a midwife. | All used a midwife. |
First presentation to their midwife | 5 women first saw their midwife at 4–7 weeks’ gestation; 2 at 12–15 weeks, and 3 at 25–27 weeks. | All women first presented to the midwife at 4–10 weeks’ gestation. |
Received no MVs | 2 | 1 |
Received both MVs (or planned to) | 4 * | 2 |
Received pertussis vaccine only | 4 | 4 |
Received influenza vaccine only | 0 | 1 |
Location of MVs | Pharmacy: 3. General Practice: 4 *. Hospital: 1. | Pharmacy: 6. General practice: 1. Hospital: 0 |
Variable | Community Pharmacists (n = 12) | Midwives (n = 11) | General Practice Staff (n = 12) |
---|---|---|---|
Staff mix | 10 (including 3 pharmacy owners) were trained vaccinators providing vaccinations. 2 were pharmacy owners in pharmacies that did not provide vaccinations, but 1 of these was a trained vaccinator and owned other pharmacies where vaccinations occurred. | 1 worked at a hospital, 10 worked as Lead Maternity Carers (LMCs), 3 of whom had recent or current hospital or district health board experience. | 4 general practitioners (2 practice owners), 7 practice nurses, 1 practice manager. |
Rural/urban | 7/5. | 7/4. | 8/4. |
Practice details | 6 worked in high needs areas, 2 were in higher socio-economic areas, the rest had a mixed socio-economic clientele. | 2 described their area served as high socio-economic, the rest were in low socioeconomic or mixed socio-economic areas. The Māori midwives tended to have mainly Māori clients. | All worked in practices with a large proportion of high deprivation, with mixed high and low deprivation, and/or high Māori patient load. 2 worked at a Māori healthcare provider. |
Work hours | 11 worked full time and 1 worked part-time. | All worked full-time or close to it. A total of 2 worked around 60 h per week or more. | 7 were full-time, 4 part-time and 1 unknown. |
Identified ethnicity | 6 NZ European, 3 Chinese/Asian), 1 Māori, 1 Fiji Indian, and 1 Middle Eastern. | 5 Māori or part Māori, 4 NZ European, 1 British, and 1 Asian. | 8 NZ European, 1 South Asian, 3 Māori or NZ European/Māori. |
Experience | 4 had 1–4 years’ experience, 5 had 9–18 years’ experience, and 3 had 30–40 years’ experience. | 3 had 1–5 years’ experience, 4 had 7–15 years and 4 had 20–30 years’ experience. | 2 had 2–5 years’ experience, 4 had 9–16 years’ experience, and 6 had 25–31 years’ experience. |
Gender | 8 female and 4 male. | All female. | All female. |
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Gauld, N.; Martin, S.; Sinclair, O.; Petousis-Harris, H.; Dumble, F.; Grant, C.C. Influences on Pregnant Women’s and Health Care Professionals’ Behaviour Regarding Maternal Vaccinations: A Qualitative Interview Study. Vaccines 2022, 10, 76. https://doi.org/10.3390/vaccines10010076
Gauld N, Martin S, Sinclair O, Petousis-Harris H, Dumble F, Grant CC. Influences on Pregnant Women’s and Health Care Professionals’ Behaviour Regarding Maternal Vaccinations: A Qualitative Interview Study. Vaccines. 2022; 10(1):76. https://doi.org/10.3390/vaccines10010076
Chicago/Turabian StyleGauld, Natalie, Samuel Martin, Owen Sinclair, Helen Petousis-Harris, Felicity Dumble, and Cameron C. Grant. 2022. "Influences on Pregnant Women’s and Health Care Professionals’ Behaviour Regarding Maternal Vaccinations: A Qualitative Interview Study" Vaccines 10, no. 1: 76. https://doi.org/10.3390/vaccines10010076
APA StyleGauld, N., Martin, S., Sinclair, O., Petousis-Harris, H., Dumble, F., & Grant, C. C. (2022). Influences on Pregnant Women’s and Health Care Professionals’ Behaviour Regarding Maternal Vaccinations: A Qualitative Interview Study. Vaccines, 10(1), 76. https://doi.org/10.3390/vaccines10010076