Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA; International Vaccine Access Center, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA; Department of Health, Behavior & Society, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
International Vaccine Access Center, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA.
Vaccine. 2022 Nov 28;40(50):7305-7311. doi: 10.1016/j.vaccine.2022.10.068. Epub 2022 Oct 31.
The vaccine decision-making process of pregnant and lactating women is complex. Regarding COVID-19, pregnant women are at increased risk for severe disease and poor health outcomes. While pregnant and lactating women were excluded from COVID-19 vaccine trials, available evidence suggests that COVID-19 vaccines are safe and protective during pregnancy. In this study, we used a socio-ecological approach to explore factors influencing the decision-making process for COVID-19 vaccines in pregnant and lactating women in Kenya, for the purpose of informing demand generation strategies. As pregnant and lactating women are influenced by many factors, we conducted 84 in-depth interviews with a variety of stakeholders, including 31 pregnant or lactating women, 20 healthcare workers such as nurses, midwives, doctors, and frontline workers, 25 male family members of pregnant or lactating women, and 8 gatekeepers such as community leaders and faith-based leaders. These individuals were recruited from six communities in Kenya: three urban, and three rural. We applied a grounded theory approach to identify emerging themes and organized emerging themes using the SAGE Vaccine Hesitancy model, which includes three categories of determinants of vaccine acceptance, including contextual influences, individual and group influences, and vaccine and vaccination specific issues. Myths, interpersonal norms, and religion emerged as themes related to contextual influences. Safety, risk perception, and the role of the healthcare worker emerged as themes related to individual and group influences. For vaccine and vaccination specific issues, emerging themes included availability, accessibility, and eligibility. While maternal immunization can substantially reduce the effect of infectious diseases in mothers and infants, vaccine acceptance is critical. However, vaccines do not save lives; vaccination does. We hope the results of this study can be used to tailor communication efforts to increase vaccine demand among pregnant and lactating women.
疫苗接种决策过程对于孕妇和哺乳期妇女来说较为复杂。在新冠疫情中，孕妇患重病和出现不良健康结局的风险增加。尽管孕妇和哺乳期妇女未被纳入新冠疫苗试验，但现有证据表明，新冠疫苗在妊娠期是安全且具有保护作用的。在本研究中，我们采用社会生态学方法，探讨了肯尼亚孕妇和哺乳期妇女对新冠疫苗接种决策的影响因素，旨在为制定需求产生策略提供信息。由于孕妇和哺乳期妇女受到多种因素的影响，我们对包括 31 名孕妇或哺乳期妇女、20 名医护人员（如护士、助产士、医生和一线工作者）、25 名孕妇或哺乳期妇女的男性家庭成员以及 8 名社区领袖和宗教领袖等各类利益相关者进行了 84 次深入访谈。这些人员是从肯尼亚的六个社区招募的：三个城市社区和三个农村社区。我们应用扎根理论方法识别了新出现的主题，并使用 SAGE 疫苗犹豫模型对这些主题进行了组织，该模型包括疫苗接受的三个决定因素类别，包括背景影响、个人和群体影响以及疫苗和接种具体问题。与背景影响相关的主题包括神话、人际规范和宗教；与个人和群体影响相关的主题包括安全性、风险感知和医护人员的作用；与疫苗和接种具体问题相关的主题包括可及性、可及性和资格。虽然母婴免疫可以大大降低母亲和婴儿感染性疾病的影响，但疫苗接种的接受度至关重要。然而，疫苗不能拯救生命，只有接种疫苗才能拯救生命。我们希望本研究的结果可以用于调整沟通工作，以增加孕妇和哺乳期妇女对疫苗的需求。
