Wilson R, Paterson P, Larson H J
LSHTM, Keppel Street, London, WC1E 7HT, UK.
BMC Public Health. 2019 Mar 25;19(1):342. doi: 10.1186/s12889-019-6655-y.
In 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.
Hackney 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.
The 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.
The strategies to improve maternal vaccination acceptance recommended in this paper would engender a more open and democratised healthcare system.
在英国，自2010年起建议所有孕妇接种流感疫苗，自2012年起建议接种百日咳疫苗。然而，在一些地区，疫苗接种率一直很低。在英国伦敦东北部的哈克尼区进行了一项定性研究，以深入了解影响孕期疫苗接种接受度的因素。本文借鉴上述研究获得的深入见解，为提高孕妇长期疫苗接种接受度提供建议。
选择哈克尼作为研究地点，因为它是英国孕期疫苗接种覆盖率最低的地区之一。采用最大差异抽样方法，从广泛的背景中招募了47名孕妇和刚分娩的妇女，以及来自三个全科诊所的十名医疗保健专业人员；两个社区产前诊所；九个亲子小组；以及四个社区中心。通过深入访谈和对一名孕妇咨询过程的录像，探讨了孕期在国民医疗服务体系中的护理经历以及女性对孕妇疫苗接种的看法。对医疗保健专业人员的深入访谈探讨了他们对孕妇疫苗接种的看法，以及他们如何讨论和提供孕妇疫苗接种服务。研究数据通过借鉴人类学著作中关于疫苗接种的不同概念化和实践的见解进行演绎分析，并采用主题分析方法进行归纳分析。
本研究的结果及其基于此的建议分为五个广泛的主题：孕妇疫苗接种的可及性；医疗机构的说辞及其对孕妇疫苗接种接受度的影响；社区和家庭对孕妇疫苗接种决策的影响；医疗保健专业人员对孕妇疫苗接种的看法；以及医患关系对孕妇疫苗接种接受度的影响。
本文推荐的提高孕妇疫苗接种接受度的策略将带来一个更加开放和民主的医疗体系。
