Elsevier

Vaccine

Volume 35, Issue 12, 14 March 2017, Pages 1645-1651
Vaccine

Effect of stepwise perinatal immunization education: A cluster-randomized controlled trial

https://doi.org/10.1016/j.vaccine.2017.01.069Get rights and content

Abstract

Background

Perinatal immunization education is important for improving the immunization outcomes of infants; however, the content of educational materials used at each perinatal period has not been carefully evaluated. We hypothesized that stepwise education offered at different perinatal periods would improve infant immunization status and enhance maternal immunization knowledge.

Methods

In this cluster-randomized controlled trial, pregnant women were recruited from nine obstetric sites in Niigata, Japan. The intervention group received a stepwise, interactive education intervention (prenatally, postnatally, and 1 month after birth). The control group received a leaflet containing general information on immunization. Infant immunization status was evaluated at 6 months of age, and maternal immunization knowledge was evaluated by a written survey after each intervention.

Results

Among 188 study participants, 151 (80.3%) replied to the final post-intervention survey. At 6 months of age, the percentage of children who completed three doses of inactivated polio, diphtheria, tetanus toxoid, and acellular pertussis (DTaP-IPV) vaccine was higher in the intervention group than in the control (p = 0.04); however, no differences between groups were observed for the Haemophilus influenzae type b (Hib) (p = 0.67) or 13-valent pneumococcal conjugate (PCV13) vaccines (p = 0.20). The duration to the completion of the third dose of the DTaP-IPV, Hib, and PCV13 vaccines was shorter in the intervention group than in the control (p = 0.03, p < 0.01, and p < 0.01, respectively). Furthermore, maternal knowledge scores exhibited significantly greater improvement in the intervention group over time compared with those of the control group (p = 0.02).

Conclusions

Stepwise perinatal immunization education improved immunization schedule adherence for required vaccines and improved maternal immunization knowledge.

Introduction

Some educational interventions improve immunization coverage or intention to vaccinate. The success of immunization programs depends on parents having sufficient information [1], [2]. Many high-income countries provide standardized immunization education. In the United States, instruction regarding infant immunization is routinely provided, with healthcare providers (HCPs) being legally required to communicate the risks/benefits of vaccines such as necessity of immunization, side effects, and contraindicates; however, information is often insufficient and depends on HCP initiative [3], [4], [5], [6].

In Japan, approximately one-third of vaccines are voluntary [7]. Information is particularly limited for these vaccines and accordingly they are perceived as less important than required vaccines [8]. Furthermore, out-of-pocket fees for vaccines limit vaccination rates. The estimated vaccination rates for voluntary vaccines, such as mumps, rotavirus, and influenza vaccines, are 30%, 45%, and 40%, respectively [9]. In addition, with a limited use of combination vaccines, simultaneous vaccination is not widely accepted owing to questions regarding its safety [7], [10].

Effective educational interventions should be provided early [11], [12], [13], [14], [15]. A delay in the first vaccination may impact adherence to the immunization schedule and increase the risk of vaccine-preventable diseases (VPDs). Perinatal educational interventions are effective [12], [15], [16], [17]; they increase knowledge and improve immunization status [14], [18]. However, the effect of stepwise education at different perinatal periods on infant immunization status and maternal knowledge is unknown.

Information preferences differ before and after childbirth. Prior to giving birth, women desire general information, such as definitions of immunization, VPD characteristics, and vaccine types. After giving birth, women want detailed information regarding the timing and method of vaccine administration. The theory of the teachable moment [19], [20], in which natural health events motivate individuals to adopt risk-reducing behaviors, suggests that interest in immunization information changes over time [19], [20]. Therefore, educational interventions must target the needs of pre- and postnatal populations [19], [21], and this may improve adherence to immunization schedules [21].

This study investigated the impact of a stepwise immunization education intervention on infant immunization status and maternal knowledge compared to a control group.

Section snippets

Study design and setting

This was a pair-matched, cluster-randomized, controlled trial conducted in obstetric hospitals and clinics in Niigata, Japan. Participating institutions were Niigata University Hospital, four affiliated hospitals, and four private obstetric clinics. The annual number of deliveries at these sites ranged from 100 to 800.

Eligibility and enrollment

Pregnant women aged ≥18 years and able to communicate in Japanese were recruited by a midwife or physician during gestational weeks 24–30 at antenatal classes or prenatal checkups

Study participants

Participant entry and flow through the study is summarized in Fig. 1. Of 490 pregnant women approached at nine sites, 188 (38.3%) agreed to participate in the study, 81 (43.1%) from the five hospitals and 107 (56.9%) from the four clinics. The intervention group had 100 participants (53.2%) and the control group had 88 (46.8%) participants (Table 2). There were no statistically significant demographic differences between the two groups. Overall, 160 questionnaires were returned (response rate,

Discussion

Stepwise maternal immunization education improved immunization schedule adherence for required vaccines and increased maternal knowledge of infant immunization practice. All required vaccines were administered earlier in the intervention group than in the control group. These findings differ from those of previous studies in which participants received only a single perinatal education session, which improves immunization knowledge, but not the timing of immunization [17], [18]. In terms of

Conclusion

Our results indicate that stepwise perinatal immunization education improved maternal knowledge and immunization schedule adherence for required vaccines. Future efforts should focus on the development of a standardized perinatal immunization education program to improve infant immunization outcomes.

Conflict of interest

None of the authors has any conflict of interest to declare.

Funding source

This work was supported by a grant from St. Luke’s Life Science Institute.

Financial disclosure

All authors have indicated they have no financial relationships relevant to this article to disclose.

Acknowledgments

This study was supported by a grant from St. Luke’s Life Science Institute. We would like to thank all the study participants. We are also grateful to Toshio Yagimoto at Yagimoto Pediatric Clinic, Takeshi Hirohashi at Hirohashi Obstetric Clinic, Akiteru Tokunaga at Tokunaga Jyo-sei Clinic, Masato Arakawa at Arakawa Ladies’ clinic, Akira Honda at Honda Ladies’ clinic, Isao Takeyama at Takeyama Hospital, Takumi Kurabayashi and Yoshihisa Nagayama at Niigata City Hospital, Isao Hasegawa at

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