促进孕期破伤风类毒素、白喉和无细胞百日咳（Tdap）疫苗接种：母亲认知与接种率之间的关联
Promoting Tdap immunization in pregnancy: Associations between maternal perceptions and vaccination rates.
作者信息
Payakachat Nalin, Hadden Kristie B, Ragland Denise
机构信息
Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Center for Health Literacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
出版信息
Vaccine. 2016 Jan 2;34(1):179-86. doi: 10.1016/j.vaccine.2015.09.062. Epub 2015 Oct 1.
OBJECTIVE
Tdap vaccine uptake among US pregnant women is low despite current recommendations. This study evaluated if a Tdap vaccine information statement (VIS) affected overall perception, vaccination intention, and components of a health behavior model associated with Tdap vaccination rates.
METHODS
A randomized, prospective study was conducted among pregnant women receiving care at two women's clinics in May-August 2014. Verbally consented participants were randomized to receive either the standard CDC Tdap VIS (sVIS) or a modified version (mVIS) before completing the first multi-part survey (T1). After T1, participants read their assigned VIS then completed the second part (T2). A 2015 chart review identified vaccinated participants. A health behavior model was hypothesized using the Reasoned Action Approach and Health Belief Model. Logistic regression, path analysis, and chi-square tests were used in the analysis.
RESULTS
279 surveys were analyzed. Average age of the participants was 26.4 years (SD=5.7) with average gestational age of 25.9 weeks (SD=9.2). 13% self-reported receiving Tdap vaccine prior to the survey. Overall perception scores significantly increased (3.1-3.4, p<0.001) after VIS review. A chart review showed that 131 (47%) received the vaccine post study. There was no significant difference in vaccination rates between the sVIS and mVIS groups (45% vs. 49%). Perceived benefits (B=0.315) and self-efficacy (B=0.197) were positively associated with the overall perception (T1), while perceived barriers (B=-0.191) were negatively associated with the overall perception (T1). Social norms (B=0.230), self-efficacy (B=0.213), and perceived benefits (B=0.117) were positively associated with vaccination intention (T1). The vaccination intention (T2) was positively associated with participants' decision to receive Tdap vaccine (B=0.223).
CONCLUSION
A VIS improved overall perception of the Tdap vaccine. Vaccination intention was a predictor of Tdap vaccination. It is crucial to provide information about immunization benefits to promote maternal Tdap vaccination.
目的
尽管有当前的推荐建议，但美国孕妇中破伤风类毒素、白喉类毒素和无细胞百日咳疫苗（Tdap）的接种率较低。本研究评估了一份Tdap疫苗信息声明（VIS）是否会影响总体认知、接种意愿以及与Tdap疫苗接种率相关的健康行为模型的组成部分。
方法
2014年5月至8月间，在两家妇女诊所接受护理的孕妇中进行了一项随机前瞻性研究。在完成第一份多部分调查问卷（T1）之前，口头同意参与的参与者被随机分配接受标准的美国疾病控制与预防中心（CDC）Tdap VIS（sVIS）或修改版（mVIS）。在T1之后，参与者阅读他们被分配的VIS，然后完成第二部分（T2）。2015年的图表审查确定了已接种疫苗的参与者。使用理性行动方法和健康信念模型假设了一个健康行为模型。分析中使用了逻辑回归、路径分析和卡方检验。
结果
分析了279份调查问卷。参与者的平均年龄为26.4岁（标准差=5.7），平均孕周为25.9周（标准差=9.2）。13%的人在调查前自我报告接种了Tdap疫苗。在查看VIS后，总体认知得分显著提高（3.1 - 3.4，p<0.001）。图表审查显示，131人（47%）在研究后接种了疫苗。sVIS组和mVIS组的接种率没有显著差异（45%对49%）。感知到的益处（B = 0.315）和自我效能感（B = 0.197）与总体认知（T1）呈正相关，而感知到的障碍（B = -0.191）与总体认知（T1）呈负相关。社会规范（B = 0.230）、自我效能感（B = 0.213）和感知到的益处（B = 0.117）与接种意愿（T1）呈正相关。接种意愿（T2）与参与者接受Tdap疫苗的决定呈正相关（B = 0.223）。
结论
一份VIS改善了对Tdap疫苗的总体认知。接种意愿是Tdap疫苗接种的一个预测因素。提供有关免疫益处的信息对于促进孕妇接种Tdap疫苗至关重要。
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