Vaccine discussions in pregnancy: interviews with midwives to inform design of an intervention to promote uptake of maternal and childhood vaccines

ABSTRACT

Presumptive and Motivational Interviewing communication styles have successfully promoted childhood and adolescent vaccination to parents, but less is known about effective communication approaches during pregnancy to promote maternal vaccination and childhood vaccines. In Australian public antenatal settings, midwives provide a substantial proportion of care and are highly accessed and trusted sources of vaccine information for expectant parents. However, there are no evidence-based interventions incorporating communication strategies and resources for midwives to optimize discussions and promote acceptance of maternal and childhood vaccines. This study aimed to gather qualitative data from midwives to inform the design of a feasible and acceptable vaccine communication intervention package building on an evidence-based model utilized with US obstetricians. We explored midwives’ attitudes and values regarding maternal and childhood vaccination, their perceived role in vaccine advocacy and delivery, and barriers and enablers to implementation of a potential communication intervention. We recruited 12 midwives for semi-structured interviews at two Australian tertiary public hospitals (one with antenatal vaccines onsite, one without). Interviews were analyzed using thematic template analysis. Midwives supported vaccination but expressed varied views regarding its centrality to their role. Most reported receiving minimal or no training on vaccine communication. Their communication practices focused primarily on vaccine information provision rather than persuasion, although some midwives shared personal views and actively encouraged vaccination. More vaccine and communication training and resources were requested. Findings highlight the need for communication tools that align with midwifery standards for practice to support midwives to address parents’ questions and concerns about maternal and childhood vaccines.

KEYWORDS:

• Pregnancy
• midwifery
• vaccination
• attitudes
• health services
• communication

Acknowledgments

The authors are grateful to the midwives interviewed at both hospitals, and to clinic managers Barb Lourey and Trish Ryan who facilitated our access. We acknowledge and thank our wider team who consulted on study design: Helen Marshall, Julie Leask, Kerrie Wiley, Tom Snelling, and Penny Haora. Penny provided valuable context and understanding on the regulation and recommendation protocol for Australian midwives. We thank our research assistants Annette Alafaci and Shevaun Drislane, who provided valuable support at different stages of the project. We also thank Anne O’Leary at Women and Newborn Ethics Committee for helping us to navigate the ethics for KEMH.

Disclosure of potential conflicts of interest

Katie Attwell has previously been employed by the Immunisation Alliance of Western Australia to conduct social research using an unrestricted grant from Sanofi Pasteur. She has also received travel, accommodation and conference registration support from GSK, and travel, accommodation and speakers fees from Merck. The other authors have no conflicts to declare.

Ethics, consent, and permissions

Ethics approval was obtained in WA (RGS00000000736) and VIC (HREC 37338A). Consent for Publication is not applicable to the current research study.

Availability of data and materials

Supporting data are available from the lead authors upon written request.

Supplemental data

Supplemental data for this article can be accessed here.

Additional information

Funding

This research was funded by the Communicable Disease Control Directorate, Department of Health, Government of Western Australia. MD is funded by the University of Melbourne Bickart Clinician Research Fellowship; University of Melbourne [Bickart Clinical Research Fellowship].