PREGNANT WOMEN'S DECISION-MAKING REGARDING INFLUENZA VACCINATION IN BRITISH COLUMBIA

Purpose: Despite increased risks for influenza morbidity and mortality, influenza vaccination rates among pregnant Canadian women are consistently low. This mixed-methods study investigated the attitudes and immunization decisions of pregnant women regarding seasonal and pandemic influenza vaccination.

Method: We conducted a baseline quantitative survey and eight semi-structured focus group interviews with 34 women (26 pregnant and eight mothers of newborns) from July-December. Near the end of influenza season (April-June), an online follow-up survey was sent to all participants to determine whether their vaccination intentions at intake predicted their behavior, and to elicit additional information on their influenza vaccination information sources and the factors which encouraged or discouraged them from being immunized. Data analysis included descriptive statistics of pre and post survey responses and directed content analysis focus group transcripts based on the health belief model.

Result: Intentions accurately predicted behavior for the minority of women who did not intend to be immunized at baseline, none of whom reported obtaining the vaccine. Intentions moderately predicted behavior for those who hadintended to be immunized, as 64% were. Of those who were undecided at intake, outcomes were split nearly evenly. Most women did not consider influenza vaccination an important preventative measure to take while pregnant, although some were more willing to consider vaccination during a pandemic. Omission bias played a substantial role as justification for not vaccinating. Participants expressed confusion about vaccination recommendations during pregnancy and frustration with inconsistent messages from health care providers, particularly around pandemic vaccines. Women were vaccinated when they perceived themselves and/or their babies to be at increased risk for influenza. Vaccinated women had strong normative influences (usually a health care provider or a family member) that influenced their decision.

Conclusion: Many pregnant women may struggle with weighing the risks and benefits of influenza vaccination. Improving clarity and strength of communications about influenza severity and susceptibility for pregnant women and newborns and about the risks and benefits of vaccination could lead to increased uptake of vaccination among this at-risk population. Because maternity care providers were identified as highly trusted by pregnant women, we recommend they take a more active role in discussing and recommending influenza vaccination among pregnant women and families with newborns.