Introduction
Methods
Qualitative approach and theory
Study population and setting
Data collection and analysis
Results
Characteristic | Pregnant /Post-partum womena | Service providers | |
---|---|---|---|
Interviewees, n (N = 31) | FGD particip., n (N = 7) | Interviewees, n (N = 20) | |
Ageb | |||
< 30 years | 5 | 0 | 7 |
30 – 40 years | 24 | 6 | 4 |
> 40 years | 2 | 1 | 9 |
Genderc | |||
Female | 31 | 7 | 18 |
Male | 0 | 0 | 2 |
Ethnic group | |||
Asian/Asian British | 2 | 0 | 2 |
Black/Black British—Afr./ Carib | 15 | 0 | 4 |
White British | 2 | 4 | 8 |
Other white | 5 | 2 | 4 |
Mixed/Multiple/Other | 7 | 1 | 2 |
IMD decile | |||
1–2 (most deprived) | 7 | 1 | - |
3–4 | 12 | 1 | - |
5–6 | 1 | 1 | - |
7–8 | 1 | 0 | - |
9–10 (least deprived) | 0 | 0 | - |
No data/ no full post code given | 10 | 4 | - |
Borough in South London | |||
Southwark | 14 | 5 | - |
Lambeth | 8 | 2 | - |
Lewisham | 4 | 0 | |
Otherd | 5 | 0 | - |
Religion | |||
Christian | 17 | - | 7 |
Muslim | 6 | - | 0 |
None/ Agnostic/ Atheist | 7 | - | 10 |
Other | 1 | - | 3 |
Marital status | |||
Married/ in partnership | 22 | - | - |
Not married/ in partnership | 9 | - | - |
Highest level of education | |||
Primary or secondary school | 5 | - | 0 |
College | 4 | - | 1 |
Undergraduate degree (e.g. BA) | 11 | - | 12 |
Postgraduate (e.g. MSc, Dipl.) | 11 | - | 7 |
Employment | |||
Yes, full-time | 17 | - | 16 |
Yes, part-time | 4 | - | 4 |
No | 10 | - | 0 |
Profession | |||
Midwife | - | - | 12 |
GPe | - | - | 2 |
Pharmacist/Pharmacy manager | - | - | 3 |
Otherf | - | - | 4 |
Delivery/Due dateg | |||
Spring/Summer 21 (May-Aug21) | 7 | 0 | - |
Autumn 21 ( Sep-Nov21) | 4 | 1 | - |
Winter 21/22 (Dec21-Feb22) | 6 | 3 | - |
Spring 22 (Mar-May22) | 8 | 1 | - |
Summer 22 (Jun-Aug22) | 5 | 2 | - |
Autumn 22 (Sep-Nov22) | 2 | 0 | - |
Older child/ previous life birth(s) | |||
Yes | 12 | 2 | - |
Vaccination in pregnancy | |||
Took/ plans to take all vaccines | 9 | 5 | - |
Took/ plans to take some vaccines | 14 | 2 | - |
Took/ plans to take no vaccines | 8 | 0 | - |
Maternal vaccine uptake | Pertussis vaccine | Influenza vaccine | Covid-19 vaccine |
---|---|---|---|
Yes | 27 | 19 | 9 |
Yes, but with delay | 2 | 2 | 4 |
No, but offered | 3 | 5 | 19 |
No, not offered (despite indicated/ in season) | 1 | 1 | 1 |
No (unsure if offered/ other) | 4 | 7 | 1 |
No, not required, as already taken before pregnancy | n/a | 3 | 2 |
No, not yet available (for season or age group) | n/a | 0 | 2 |
Unsure | 1 | 1 | 0 |
Overarching Categories | Categories | (Sub-)Themesa |
---|---|---|
Structural and organisational factors | Organisation of and access to ANC | Limited GP involvement due to new midwife-led ANC services and access via new online self-referral system (and related confusion); delayed access/ disrupted ANC; organisational challenges and changes due to the Covid-19 pandemic (including remote ANC visits and suspension of continuity of care system) |
ANC booking visit | Lack of time and limited vaccination-related information | |
Subsequent ANC visits | Lack of time and lack of vaccination-related information and reminders | |
Access to influenza and pertussis vaccines within maternity and at GP clinics | Access to influenza and pertussis vaccines within maternity; access to influenza and pertussis vaccines via GP versus maternity and recent changes; opportunistic vaccination | |
Access to Covid vaccines within maternity and via vaccination centres | Temporary access to Covid vaccines in maternity in hospital; Access to Covid-vaccines at vaccination centres (including lack of special arrangement for pregnant women and reduced trust/confusion about change of guidance) | |
Access to maternal vaccines via pharmacies | Access to maternal vaccines via pharmacies (including advantages and barriers) | |
Resources, roles and responsibilities | Resource challenges in maternity services (including lack of staffing, space and supply) and in pharmacies; vaccination-related roles and responsibilities of different providers | |
Health information system and Apps | Insufficient information transfer between providers and shortcomings of electronic health records, referral systems and documentation; lack of user-friendliness of apps and not used to access vaccine information; information for participants via app versus hardcopy material (including digital exclusion and language barriers) | |
Behavioural factors | Passive versus active decision-making process | Passive decision-making; active decision-making (with own research) |
Interaction with HCP/ Provider recommendations | Recommendation against Covid-19 vaccines or no clear recommendation or information; no clear recommendation/ no information/dialogue regarding pertussis and influenza vaccines; importance of not putting pressure on women, and vaccination as personal decision; unambiguous recommendation as facilitator of vaccine uptake | |
Engagement with information material and social media | Hardcopy or electronic leaflets; Searching online/ via social media (including to fill information gaps and to search for personal stories from others) | |
Interaction with family, friends and others | Interaction with and influence of mothers, partners and others (including personal stories); interest in decisions of other pregnant women (including in waiting rooms) | |
Individual characteristics and influences on vaccination decisions: | ||
Risk–benefit perceptions | Risk benefit evaluation and motivation to accept/recommend vaccines (including based on own/ others previous experience of vaccine/vaccine-preventable disease); perceived risk and benefit of vaccine/vaccine-preventable disease on baby and/or/versus mother; perception of pregnancy as vulnerability; perceived susceptibility/ risks in case of underlying health conditions or complications; perceived risk and individual biological differences; risk evaluation based on exposure; alternative risk-mitigating behaviour | |
Knowledge and skills | Conflicting information; misconceptions and general health knowledge; lack of awareness or information about vaccines; ability/ opportunity to ask HCPs questions; lack of HCP training, knowledge or specific information to pass on to clients; commitment of some HCP to relay information and have honest dialogue; lack of research evidence; language and digital skills | |
Emotions and trust | Fear of vaccine and/or vaccine-preventable disease; trust in healthcare system and HCP; reduced trust and/or confusion due to change of guidance; lack of trust and historical events; lack of trust and ethnicity; lack of trust and conspiracy theories/ misinformation; emotions and trust linked to pressure and mandatory vaccines | |
Cultural norms, philosophy and beliefs | Social and cultural norms, including in country of origin/ abroad; religion and Covid-19 vaccination; other beliefs and philosophy (including letting nature take its course, preference for natural products and homeopathy); attitudes regarding altruistic reasons for vaccination | |
Attitude towards mandatory Covid-19 vaccines | Vaccination needed for travel or work; planned mandatory vaccines for HCP; perceived pressure/ no pressure to get vaccinated | |
Participant recommendations | (Relating to various categories above) | Clearer provider recommendation, vaccination dialogue and more information; vaccination programmes and messages more targeted to pregnant women, and more personalised; provider training; organisational changes (including opt-out versus opt-in approach); increased accessibility; improved health information systems and apps; Provision of hardcopy information material to avoid digital exclusion; addressing language barriers |
Structural and organisational factors
Organisation of and access to ANC
ANC booking visit
“I felt like it had to be a very proactive experience of me figuring stuff out myself. There was no like, here’s an information pack, at your first midwife appointment…” (W).
Subsequent ANC visits
“almost at the end of the pregnancy they were asking me, oh have you had your whooping cough vaccine? I was like, I don’t, I didn’t remember, I didn’t know I was meant to have it, you didn’t tell me when and where to have it, you know, yeah so I didn’t have that vaccine.” (W).
Access to influenza and pertussis vaccines within maternity and at GP clinics
“And whoever’s doing the Vaccine Clinic[…] I always come out like “anyone here waiting for vaccine”, so I just sell it like tomatoes but… some midwives are more shy and they just wait in the room.” (M).
Access to Covid vaccines within maternity services and via vaccination centres
Access to maternal vaccines via pharmacies
Resources, roles & responsibilities
“I got told by my midwife it’s a walk-in service, so I went […], they said, oh, no, we’ve run out of the vaccine, you’ll have to come back another time.” (W).
“I think it is like the hot potato and they’re all passing it to each other, no one wants to take it, it’s like “you do it”, “no you do it” because again it’s not maternity. We are doing it out of our good hearts for our women because we love our women, we want to give a good service but it’s not maternity, it’s not our training, it’s not our profession, it’s not a part of what we do or what we are.” (M).
“I still do think that midwives play a big role because that is who you mostly spend your time with in pregnancy… I know they’ve got a lot to get through, but it definitely doesn’t seem like vaccines is a priority on the list.” (W).
Health information system and apps
“They use different services and different types of documentation for each vaccine, so it was a nightmare for the midwife having to document every single vaccine on three different systems.” (M)
Behavioural factors
Passive versus active decision-making process
“vaccination is kind of like what information can I give you to be empowered to make your own choice rather than I think you should have this so I’m going to convince you […]. Because a lot of midwifery is about empowering people, you know, because they’re not unwell, they’re not poorly […] this is your body and your baby and your choice, so I think maybe we were slightly different from nursing in that sense.” (M).
“I hadn’t really had a conversation with anybody about what the benefits of them, taking them were, what the possible side-effects were, what the impacts were, and so all that meant is then I had to turn around and go on Google and do my research. The worst thing to do was go on Google because you’re going to get a whole lot of horror stories…” (W).
Individual characteristics and influences on vaccination decisions
“There was also a lot of conflicting information from the authorities so a lot of women were quite nervous about it and we could see why…” (O).
“So either you have fear of the disease or you have fear of the vaccine, and whatever fear you have, that's what you go with.“ (M)
Participant recommendations
“it should be an opt-out rather than an opt-in. […] Meaning that it’s standardised, it’s in the calendar and you just need to decline it, if you don’t want it, but that if not you just go ahead with it. Rather than actually having to proactively go and get it, and discuss it.”
“I think we definitely need to be more proactive in trying to offer vaccine information in as many languages accessible as possible […] it may need to go as far as even educating interpreters about how to deliver information about vaccines because we have many that don’t actually can interpret what the vaccines are.” (M).