Patient and provider perspectives on how patient trust within the patient-provider relationship influences maternal vaccine acceptance among pregnant women in Kenya Open Access

Nganga, Stacy (Spring 2018)

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Background: altered immune systems during pregnancy and the inability to vaccinate newborns until they are at least 6 weeks old puts both mother and child at high risk of infections.  Maternal immunization is therefore critical for the safety of pregnant women and newborns everywhere. This study aimed to find out how the patient-provider relationships impacts maternal vaccine uptake, particularly in the context of developing countries where limited literature exists.

Methods: In-country research team conducted semi-structured, in-depth narrative interviews. Both providers and pregnant women were interviewed from four different sites in Kenya: Kisumu, Nairobi, Mombasa and Marsabit. Interviews were conducted in either English or, when needed, in one of the local regional languages and translated to English.

Results: we found that patient trust in health care providers (HCPs) is integral to vaccine acceptance among pregnant women in Kenya. Theirs is a fiduciary relationship whereby the patients’ trusts is primarily rooted in the provider’s social position as a person who is highly educated in matters of health. Furthermore, patient health education and provider attitudes are crucial for reinstating and fostering that trust, especially in cases where trust is impeded by rumors and religious / cultural factors.  

Conclusion: Patient trust in providers is a strong facilitator for vaccine acceptance among pregnant women in Kenya. To maintain / increase this trust, providers must foster a positive environment that allows for positive interactions and patient health education. This includes improving provider attitudes towards patients and learning effective risk communication.


Table of Contents


Chapter 1: Introduction 1

Objectives and Aims 2

Research Problem 3

Chapter 2: Literature Review 5

Maternal Vaccines 6

Need for maternal vaccines 6

Available maternal vaccines 7

Current maternal vaccine coverage 7

Major factors influencing vaccine uptake/ acceptance 8

    Patient- Provider Relationship 9

Types of patient- provider relationships 9

Physician- centered models 9

     Patient- centered models 11

Mutual Models 12

       Effects of the Patient- Provider Relationship on vaccine acceptance 14

            Patient trust in providers as a facilitator for acceptance 14

                Provider Attitudes/ patient voice as a function of patient trust 15

    References 17

Chapter 3: Manuscript 18

Cover Page 19

Abstract 20

Introduction 21

Methods 22

Results 25

Discussion 29

References 33

Tables 34

Chapter 4: Public Health Implications 46

Recommendations 47

Appendices   48



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