Abstract
BackgroundIn England, influenza and pertussis vaccination has been recommended for all pregnant women since 2010 and 2012 respectively. However, in some areas, vaccination uptake rates have been low. A qualitative study was conducted to gain a contextualised understanding of factors influencing vaccination acceptance during pregnancy in Hackney, a borough in north-east London, UK. This paper draws on in-depth insights gained from the above study, to provide recommendations for increasing long-term maternal vaccination acceptance.MethodsHackney was chosen as the study site because it has one of the lowest vaccination coverage rates in pregnancy in the UK. A maximum variation sampling method was used to recruit 47 pregnant and recently pregnant women from a wide range of backgrounds, as well as ten healthcare professionals from three general practices; two community antenatal clinics; nine parent-toddler groups; and four community centres. In-depth interviews and a video-recording of a pregnant patient’s consultation, explored experiences of care within the National Health Service during pregnancy, and women’s views about maternal vaccination. In-depth interviews with healthcare professionals explored their views towards, and how they discuss and provide maternal vaccination. Study data were analysed both deductively, through drawing on insights from anthropological works that address diverse conceptualisations and practices around vaccination; and inductively, with a thematic analysis approach.ResultsThe findings of this study and the recommendations based on them were divided into five broad themes: access to maternal vaccination; healthcare institution rhetoric and its effect on maternal vaccination acceptance; community and family influences on maternal vaccination decisions; healthcare professionals’ views towards maternal vaccination; and the influence of patient-healthcare professional relationships on maternal vaccination acceptance.ConclusionsThe strategies to improve maternal vaccination acceptance recommended in this paper would engender a more open and democratised healthcare system.
Highlights
In England, influenza and pertussis vaccination has been recommended for all pregnant women since 2010 and 2012 respectively
Study site The London borough of Hackney was chosen as the study site as it has one of the lowest vaccination coverage rates in England [17], including for maternal vaccination
Recruitment Twelve parent-toddler groups; 11 community centres and migrant support groups; and four general practitioner (GP) practices were selected as individual participant recruitment sites as - according to 2012–2014 Hackney General practitioner (GP) practice data provided by The Blizard Institute, Barts and The London School of Medicine and Dentistry (J Robson 2015, personal communication, 13 June) - they had median maternal vaccination uptake rates and a diverse patient population
Summary
In England, influenza and pertussis vaccination has been recommended for all pregnant women since 2010 and 2012 respectively. In some areas, vaccination uptake rates have been low. In England, influenza vaccination was first recommended to all pregnant women, irrespective of gestational age in November 2010 after the 2009 influenza A(H1N1) virus outbreak [1]. The vaccine is recommended for all pregnant women from the 16th week of pregnancy [2]. Despite assurances of the efficacy and safety of the maternal dTaP/IPV and influenza [3], there are many challenges to obtaining optimum vaccination rates during pregnancy. In England, the influenza vaccine uptake rate in pregnancy is 45% [4] and for the dTaP/IPV vaccine it is 74% [5]
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