“Me figuring stuff out myself” – maternal vaccination uptake in socially and ethnically diverse areas in London in the Covid-19 context: a qualitative study

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

2E.1

Presenter:

Sima Berendes

Twitter:

@BerendesSima

Co-authors:

Sima Berendes (1), Sandra Mounier-Jack (1), Oyinkansola Ojo-Aromokudu (1), Alice Ivory (1), Joseph D Tucker (1, 2), Heidi J. Larson (1, 3, 4), Caroline Free (1)

Author institutions:

(1)- London School of Hygiene and Tropical Medicine, London, UK, (2) - University of North Carolina, Chapel Hill, NC, USA, (3) - University of Washington, Seattle, WA, USA, (4) - University of Antwerp, Antwerp, Belgium

Problem

Maternal vaccinations against influenza, pertussis and Covid-19 have been recommended in the UK since 2010, 2012 and 2021 respectively, with others likely to follow. Uptake, however, has been far below national targets, especially in socially and ethnically diverse areas. Qualitative studies on the reasons and possible responses are scarce, focus mostly on behavioural factors, were conducted before Covid-19 vaccinations became available to pregnant women and/or did not include in-depth accounts from minority ethnic groups and from both service providers and users. Our study therefore aimed to understand the complex interplay between structural and behavioural factors contributing to low maternal vaccine uptake in socially and ethnically diverse areas in England in the Covid-19 context.

Approach

We conducted semi-structured interviews and a focus group discussion (FGD) among a purposive sample of participants recruited via clinics and from the community, with support from the NIHR Clinical Research Network. We included health service providers and pregnant/post-partum women receiving health care in socially and ethnically diverse areas in South London. The FGD with pregnant/post-pregnant women was held via video-call and interviews were conducted face-to-face or remotely. We followed a critical realist paradigm and analysed data using a thematic analysis approach.

Findings

Between April and September 2022, a total of 38 pregnant/postpartum women and 20 health service providers including 12 midwives participated in the study. The sample purposively included those living in more socio-economically deprived areas and those describing themselves as from black/ black British, non-British white, mixed and other ethnic groups. Pregnant/post-partum women took all, some or none of the maternal vaccines, with some participants unsure whether they had taken/been offered the vaccines. Decision-making was passive or active, with a common expectation for pregnant women to do their 'own research'. Participants described various individual and social factors that influenced their decision-making as they navigated the antenatal care system and interacted with different providers. Missing or conflicting information from providers, especially regarding Covid-19 vaccines, meant knowledge gaps were sometimes filled with (mis-) information from unreliable sources that increased (pre-existing) 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 electronic healthcare record systems and apps.

Consequences

Our study showed how structural factors and informational processes 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 and alternative modes of education and communication provided that consider individual (language/digital) skills and needs for information and reassurance. Further research should aim to co-produce solutions with service users and providers.

Submitted by:

Sima Berendes

Funding acknowledgement:

The study has been funded by an LSHTM ISSF Pump Priming Grant with funding from the Wellcome Trust (ref: 204928/Z/16/Z). SMJ and OOA are supported by the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation. The NIHR Clinical Research Network (CRN) helped with the recruitment of study participants. The views expressed are those of the authors and not necessarily those of the funders, who did not have any role in the design of the study, the data collection, analysis, interpretation, and writing of the report.