Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
BMC Public Health. 2023 Jul 21;23(1):1408. doi: 10.1186/s12889-023-16317-z.
Maternal vaccinations against Influenza, Pertussis, and Covid-19 are recommended in the UK, and vaccines against further infections may become available soon. However, many pregnant women, especially in socially and ethnically diverse areas, have low vaccine uptake. Qualitative studies on the reasons and possible solutions are needed that are inclusive of disadvantaged and minority ethnic groups. We therefore aimed to understand the complex interplay between structural and behavioural factors contributing to the low maternal vaccine uptake in socially and ethnically diverse areas in London in the Covid-19 context.
In 2022, we conducted semi-structured interviews and a focus group discussion among a purposive sample of 38 pregnant/recently pregnant women and 20 health service providers, including 12 midwives. Participants were recruited in ethnically diverse London boroughs. We followed a critical realist paradigm and used a thematic analysis approach.
The sample included participants who took all, some or none of the maternal vaccines, with some participants unsure whether they had taken or been offered the vaccines. Decision-making was passive or active, with the expectation for pregnant women to do their 'own research'. Participants described various individual, social and contextual influences on their decision-making as they navigated the antenatal care system. Missing or conflicting information from providers meant knowledge gaps were sometimes filled with misinformation from unreliable sources that increased uncertainties and mistrust. Both pregnant women and providers described structural and organisational factors that hindered access to information and vaccinations, including lack of training, time and resources, and shortcomings of health information systems and apps. Some participants described factors that facilitated vaccination uptake and many made recommendations for improvements.
Our study showed how structural and organisational factors can compound uncertainties around maternal vaccination among socially and ethnically diverse populations. Results highlight the need for more reliable resources, streamlined workflows, improved electronic information systems and training in their use. Roles and responsibilities should be clarified with potential greater involvement of nurses and pharmacists in vaccine provision. Education and communication should consider individual (language/digital) skills and needs for information and reassurance. Further research is needed to co-produce solutions with service users and providers.
在英国，建议孕妇接种流感、百日咳和新冠疫苗，并且针对其他感染的疫苗可能很快就会上市。然而，许多孕妇，尤其是在社会和种族多样化的地区，疫苗接种率较低。需要进行定性研究，以了解导致伦敦社会和种族多样化地区孕妇疫苗接种率低的结构和行为因素的复杂相互作用，同时包容弱势群体和少数族裔。因此，我们旨在了解在新冠疫情背景下，导致伦敦社会和种族多样化地区孕妇疫苗接种率低的结构和行为因素的复杂相互作用。
2022 年，我们对来自伦敦不同种族多样化地区的 38 名孕妇/最近分娩的妇女和 20 名卫生服务提供者（包括 12 名助产士）进行了半结构式访谈和焦点小组讨论。参与者是通过目的性抽样招募的。该研究遵循批判实在论范式，并采用主题分析方法。
样本包括所有、部分或全部接种了孕产妇疫苗的参与者，有些参与者不确定是否接种或被提供了疫苗。决策是被动或主动的，期望孕妇自己“做研究”。参与者描述了他们在产前保健系统中做出决策时，各种个人、社会和环境因素对他们决策的影响。提供者提供的信息缺失或相互矛盾，导致知识空白有时会被不可靠来源的错误信息填补，从而增加了不确定性和不信任。孕妇和提供者都描述了阻碍获取信息和疫苗接种的结构和组织因素，包括缺乏培训、时间和资源，以及健康信息系统和应用程序的缺陷。一些参与者描述了促进疫苗接种的因素，许多人提出了改进建议。
我们的研究表明，结构和组织因素如何在社会和种族多样化人群中增加对孕产妇疫苗接种的不确定性。结果强调需要更可靠的资源、简化工作流程、改进电子信息系统并培训其使用。应明确角色和责任，可能会增加护士和药剂师在疫苗接种方面的参与度。教育和沟通应考虑个人（语言/数字）技能以及对信息和保证的需求。需要与服务使用者和提供者共同开展进一步研究，以制定解决方案。
