Improving rates of maternal immunization: Challenges and opportunities

Figures & data

Table 1. Factors affecting vaccine uptake in pregnant women.

Categories	Barriers	Facilitators	Interventions
Women(receiving vaccines)	Concern about vaccine safety.(general, self, baby, side effects).^22,25,29,30-32,34-39,42-46,48,51,52	Vaccine was recommended and offered by HCP.^21-23,25,28,29,31,33,34,37-40,42,45,46,50,54-60	Patient-centered pamphlet.^78,79
	Vaccine effectiveness and efficacy.^22,25,32,34,35	Protect baby and self from disease.^22,23,29,34,42,46,55,56	Text messaging with general pregnancy health and vaccination information, and appointment reminders.^81,82
	Lack of vaccine knowledge.^28,29,34-41	Have the flu shot in a previous year/or last 2 y.^25,28,34,45,46,53,60	Text4baby mobile health program.^83
	Perceived disease severity.^28	High level of vaccine knowledge.^28,49,53,54	Teach-back method.^80
	Lack of recommendation to receive vaccine.^28,32-34,41,42,46,51,52,59	Anticipated inaction regret.^47,50
	Perceived risk of disease.^22,29-34	Perceived vaccine effectiveness.^50
	Lack of trust in the vaccine.^29,30,37,49	Existing comorbidities.^24
	Social norms and family influence.^33,50	Having a family physician.^24
	Fear of the vaccine/needles.^33,34,37	Felt susceptible to infection.^42,45,47,50
	Religion.^33	Perceived infection severity.^39,45
	Previous adverse reaction.^46,47	Working in a high-risk environment.^34,46
	Time.^34	Partner recently vaccinated.^59
	Will give me the flu.^25	Perceived vaccine benefits.^41
		Information from the family.^34
		Trust recommended guidelines.^47
Healthcare providers(recommending vaccines)	Lack of knowledge/education.^29,32,37,60-65	National recommendation provided.^30	Chart reminders and physician education.^74
	Vaccine safety.^61,63,66	Increased age of provider.^54	Physician education program and distributed posters.^78
	Perceived risk of disease.^61	Belief in the safety and efficacy of the vaccines.^70	Best practice alert.^75
	Lack of vaccine testing.^61	If immunized themselves.^43,70	Physician opt-in orders and standing orders.^77
	Tracking patient vaccination status.^69	Providing primary care.^63	Computer decision support.^76
	Uncertainty about who bears the responsibility for vaccinationdiscussions/vaccine governance.^54,65,68	Engagement with the flu program.^71
	Physician in solo practice.^68	Practising in a multispecialty group.^68
	Misperceptions about what the patient wants.^37	Positive attitudes about vaccination.^54
	Not usual practice to vaccinate.^63	Belief primary care and preventative medicine are a very important part of practice.^68
	Patient refusal.^66	Observing serious conditions attributed to influenza-like illness (ILI).^68
	Ambiguous guidelines.^66
	Vaccine efficacy.^66
	Lack of time.^66
	Risk of blame if adverse event occurs.^65
	Unconvinced of need.^65
Vaccine	Before a vaccine exists, knowledge likely very unimportant; if it exists, hesitancy issues enter.^49
Systems	Reimbursement.^62-64,66,68	Incorporation of maternal immunization into standard care through a structured process.^73
	Liability.^64,66	IT involvement with timely monitoring of program.^71
	Compliance with reporting.^64	Access to a clinic-based setting.^57
	Access to care.^37,39,41,59	Single dose preferred.^49
	Vaccine tracking.^64	Timing of vaccine delivery (not in first trimester).^49
	Ineffective dissemination of information from clinics to patients.^28
	Cost of vaccine to patients.^59,62
	Cost of ordering vaccine and maintaining supply, and storage.^32,63,66,68
	Lack of staff.^66
	Workload.^65
	Work setting unsuitable.^65

Figure 1. Supports required for the establishment of a “maternal immunization platform.” HIC: High-income countries; LMIC: Low- and middle-income countries; RSV: Respiratory Syncytial Virus; Tdap: Tetanus, diphtheria, and acellular pertussis vaccine

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