Comparison of Factors Influencing Maternal Vaccine Hesitancy among Pregnant Women Living in Atlanta and Denver Open Access

Mohamed Musa (Spring 2018)

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Comparison of Factors Influencing Maternal Vaccine Hesitancy among Pregnant Women Living in Atlanta and Denver



Mohamed Musa


Background: Influenza and pertussis are respiratory diseases that are endemic in the United States. Pregnant women and infants are even more vulnerable to these diseases, with the potential of adverse health outcomes leading to hospitalization and death. Studies have shown that immunization is the most effective strategy in the prevention of these diseases. Despite efforts to increase uptake of influenza and pertussis vaccination, national vaccination coverage of these vaccines remained low. The states of Georgia and Colorado are among the states with the highest burden of these diseases, with vaccination coverage below national coverage rates.

Goal: This research aimed to identify primary hesitancy factors, compare them between states, and translate the findings into programmatic interventions to improve vaccine coverage not only for these diseases but also other vaccine preventable diseases.

Methods: Eligible study participants were pregnant women age 18 to 50 years between 20-27 weeks of gestation or first pregnancy at any gestation. Data was collected from a convenience sample size of a total of 45 participants who were classified into three groups: vaccine acceptors, vaccine-hesitant, and vaccine refusers. Interviews were transcribed, analyzed and coded using NVivo 11.0. The nodal correlation assessment for validation of coding and thematic convergence using Pearson’s R measurement across major codes was conducted, with codes that met high correlation coefficient standards (e.g., R ≥ 0.80) validating the identified code relationships. Thematic findings were then summarized.

Results: Some complex social-economic factors (hesitant factors) such as social networks, unsubstantiated vaccines myths, vaccine safety, communication with providers, and beliefs and attitudes were identified as the primary causes of influenza and pertussis vaccines hesitancy. Some similarities on these factors affect vaccine hesitancy were observed among these states. However, there was some striking difference as well such as knowledge on child and pregnant women vaccination, safety and efficaciousness of vaccines.

Conclusion: Many women of childbearing age (18-50 years) are unaware on the importance of and recommendations for vaccines during pregnancy and childhood. Women rely on unsubstantiated information obtained through word of mouth, friends, the internet, and family members. Public health interventions should be geared to improving access to information about recommended vaccines, collaborating with all stakeholders involved in vaccination to increase not only influenza and pertussis vaccine uptake but other vaccines for vaccine preventable diseases.

Table of Contents

Table of Contents

Chapter 1             1

Introduction and Rationale          1

Problem Statement        3

Significance Statement  4

Definition of Terms         5

Chapter 2             6

Literature Review            6

Introduction       6

Influenza Epidemiology in Colorado         9

Pertussis Epidemiology in Colorado          10

Influenza Epidemiology in Georgia            11

Pertussis Epidemiology in Georgia            12

ACIP Recommendations on Vaccination 13

Influenza             13

Pertussis              14

Facilitators of Maternal Immunization    15

Chapter 3             18

Materials and Methods 18

Population and Sample  18

Research Design               18

Study Instruments           19

Procedures         19

Ethical Considerations   20

Data Analysis     20

Chapter 4             22

Results 22

Findings               22

Beliefs and Values:          22

Sources of Information and Influence     28

Elaboration Likelihood Model (ELM)        32

Limitations          34

Chapter 5             36

Discussion           36

References         42

Appendices        46

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