Effect of stepwise perinatal immunization education: A cluster-randomized controlled trial
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
References (35)
- et al.
Parent attitudes toward immunizations and healthcare providers: the role of information
Am J Prev Med
(2005) - et al.
Current issues with the immunization program in Japan: can we fill the “vaccine gap”?
Vaccine
(2012) - et al.
Disseminating Japan's immunisation policy to the world
The Lancet
(2011) - et al.
Recent progress and concerns regarding the Japanese immunization program: addressing the “vaccine gap”
Vaccine
(2014) - et al.
A mixed methods study of parental vaccine decision making and parent–provider trust
Acad Pediat
(2013) - et al.
Prenatal immunization education: the pediatric prenatal visit and routine obstetric care
Am J Prev Med
(2007) - et al.
Perinatal immunization education improves immunization rates and knowledge: a randomized controlled trial
Prev Med
(2013) - et al.
Teachable moments for health behavior change: a concept analysis
Patient Educ Couns
(2009) - et al.
Current practices and needs regarding perinatal childhood immunization education for Japanese mothers
Vaccine
(2015) - et al.
Early continuity of care and immunization coverage
Ambul Pediatr
(2004)
Primary care strategies to improve childhood immunisation uptake in developed countries: systematic review
JRSM Short Rep
Childhood vaccine risk/benefit communication among public health clinics: a time-motion study
Public Health Nurs
Childhood vaccine risk/benefit communication in private practice office settings: a national survey
Pediatrics
Developing tailored immunization materials for concerned mothers
Health Educ Res
The Changing vaccination rates by education and introduction of public medical expenses assistance of 6 voluntary vaccines in Hokaidou
Jpn J Prim Care
Qualitative analysis of mothers' decision-making about vaccines for infants: the importance of trust
Pediatrics
Cited by (16)
The Resurgence of Measles, Mumps, and Pertussis
2019, Journal for Nurse PractitionersCitation Excerpt :The prenatal education took place between 34 and 36 weeks of gestation and centered on the necessity of vaccines, VPDs, types of vaccines, and how to search the Internet for reliable vaccine information.33 The postnatal education occurred 3 to 6 days after delivery and focused on the vaccine schedule, vaccines under the Japan system, detailed VPD risk, and first vaccination date.33 The last period of interaction happened at the 1 month well-baby visit and addressed how to vaccinate and adverse reactions versus serious reactions.33
Factors that influence parents' and informal caregivers' views and practices regarding routine childhood vaccination: a qualitative evidence synthesis
2021, Cochrane Database of Systematic ReviewsInfant vaccination education preferences among low-income pregnant women
2021, Human Vaccines and Immunotherapeutics