Impact of a multi-component antenatal vaccine promotion package on improving knowledge, attitudes and beliefs about influenza and Tdap vaccination during pregnancy

Figures & data

Table 3. Questions on MOMVAX study questionnaires assessing knowledge, attitudes and beliefs about influenza and pertussis infection and associated vaccinations.

Health Belief Domain	Question on baseline questionnaire	Question on postpartum follow-up questionnaire	Response options^a
Perceived susceptibility (to self)	(Please indicate level of agreement with this statement): The flu is a concern for pregnant women.	(Please indicate level of agreement with this statement): The flu is a concern for pregnant women.	Strongly agree (1)^bAgree (2^bNeutral/No opinion/Don't know (3) Disagree (4) Strongly disagree (5)
Perceived severity (to self)	How serious do you think it would be if you got influenza (the flu) while pregnant?	If you got pregnant again, how serious do you think it would be if you got influenza (the flu) while pregnant?	Not serious at all (1) Somewhat serious (2) Neutral/Don't know (3) Serious (4)^bVery serious (5)^b
	How serious do you think it would be if you got pertussis (whooping cough) while pregnant?	If you got pregnant again, how serious do you think it would be if you got pertussis (whooping cough) while pregnant?
Perceived severity (to infant)	After delivery, how serious do you think it would be if your newborn baby got influenza (the flu) within their first 6 months?	How serious do you think it would be if your newborn baby got influenza (the flu) within their first 6 months?
	After delivery, how serious do you think it would be if your newborn baby got pertussis (whooping cough) within their first 6 months?	How serious do you think it would be if your newborn baby got pertussis (whooping cough) within their first 6 months?
Perceived safety	(Please indicate level of agreement with this statement): Getting a flu vaccine while pregnant seems risky.	(Please indicate level of agreement with this statement): Getting a flu vaccine while pregnant seems risky.	Strongly agree (1) Agree (2) Neutral/No opinion/Don't know (3) Disagree (4)^bStrongly disagree (5)^b
Likelihood of vaccinating self	On a scale of 0 (definitely not) to 10 (definitely so), please rank your likelihood of getting a flu shot during this pregnancy.	On a scale of 0 (definitely not) to 10 (definitely so), please rank your likelihood of getting a flu shot during your next pregnancy.	0 (Definitely not) – 10 (Definitely so)^c
	On a scale of 0 (definitely not) to 10 (definitely so), please rank your likelihood of getting a Tdap shot during this pregnancy.	On a scale of 0 (definitely not) to 10 (definitely so), please rank your likelihood of getting a Tdap shot during your next pregnancy.
Likelihood of vaccinating infant	On a scale of 0 (definitely will not) to 10 (definitely will), please rank the likelihood you will get your baby vaccinated with all recommended childhood vaccines.	On a scale of 0 (definitely will not) to 10 (definitely will), please rank the likelihood you will get your baby vaccinated with all recommended childhood vaccines.	0 (Definitely will not) – 10 (Definitely will)^b
Intention to promote cocooning	Have you ever considered asking close family members to get a vaccine(s) (e.g., a flu shot or a Tdap shot) to help protect your newborn from infectious diseases?	During your most recent pregnancy, do you recall asking close family members to get a vaccine(s) (e.g. a flu shot or a Tdap shot) to help protect your newborn from infectious diseases?	Yes^bNo Don't know
Degree of vaccine hesitancy	On a scale of 0 (not hesitant) to 10 (very hesitant), how hesitant are you about getting shots your doctor recommends that you get during pregnancy?	On a scale of 0 (not hesitant) to 10 (very hesitant), how hesitant are you about getting shots your doctor recommends that you get during pregnancy?	0 (Not hesitant) – 10 (very hesitant)^d

^a Numeric values provided in parentheses after response options for susceptibility, severity and self-efficacy measures were added after questionnaire administration for analysis purposes.

^b Indicates favorable response options.

^c Responses of 9 – 10 considered favorable.

^d Responses of 0 – 1 considered favorable.

Table 1. Differences in proportions of women citing favorable responses to measures of knowledge, attitudes and beliefs about antenatal and childhood vaccination at baseline and follow-up, Emory MOMVAX Study.

	Intervention group		Control group			Intervention effect.
Measure of knowledge, attitude or belief	Baseline (n=161)	Follow-up (n=137)^a	Baseline (n=164)^a	Follow-up (n=140)^a	p-values for between-group differences at baseline^b	RR (95% CI) comparing intervention to control groups at follow-up^c
Dichotomized 5-point Likert scale measures
Perceives pertussis as serious or very serious for infant	93.2%	96.3%	92.0%	96.3%	0.63	1.00 (0.96, 1.04)
Perceives influenza as serious or very serious for infant	88.8%	92.6%	86.4%	94.1%	0.09	0.98 (0.93, 1.04)
Perceives pertussis as serious or very serious during pregnancy	82.3%	77.4%	80.1%	81.4%	0.64	0.95 (0.80, 1.12)
Agrees or strongly agrees that influenza is a concern for pregnant women	81.9%	83.9%	82.7%	85.0%	0.74	0.98 (0.90, 1.06)
Perceives influenza as serious or very serious during pregnancy	75.8%	73.0%	72.6%	70.0%	0.36	1.04 (0.88, 1.23)
Disagrees or strongly disagrees that antenatal vaccination seems risky	26.4%	29.9%	24.1%	30.2%	0.64	0.99 (0.64, 1.54)
Dichotomous measure
Asks family members to get vaccinated to protect newborn	41.0%	37.2%	34.4%	32.4%	0.06	1.21 (0.74, 1.96)
Dichotomized 11-point Likert scale measures
Indicates a strong willingness (scores of 9 – 10) to vaccinate their infant with recommended vaccines	80.1%	87.4%	78.8%	86.0%	0.78	1.01 (0.92, 1.11)
Indicates a strong willingness (scores of 9 – 10) to receive a Tdap vaccine during pregnancy	16.3%	53.3%	11.6%	45.0%	0.24	1.18 (0.81, 1.70)
Indicates a strong willingness (scores of 9 – 10) to receive an influenza vaccine during pregnancy	10.6%	39.4%	6.7%	32.1%	0.11	1.23 (0.78, 1.92)
Not hesitant (scores of 0 – 1) about getting recommended antenatal vaccines	36.9%	42.3%	34.6%	39.3%	0.65	1.05 (0.81, 1.37)

^a For some measures, group counts varied slightly from these overall totals.

^b As determined by score test comparing differences in PROC GENMOD accounting for clustering by practice.

^c All models adjusted for clustering by practice.

RR, risk ratio; CI, confidence interval; Tdap, tetanus, diphtheria, and acellular pertussis.

Table 2. Intervention effects (odds ratios and 95% confidence intervals) on knowledge, attitudes and beliefs about antenatal vaccination among pregnant women in Georgia, estimated by ordinal regression.

	Likelihood of getting an antenatal influenza vaccine	Likelihood of getting an antenatal Tdap vaccine	Likelihood of vaccinating infant	Hesitancy about getting vaccines during pregnancy
BASELINE
Unadjusted OR	1.24 (0.76, 2.01)	1.18 (0.84, 1.67)	1.07 (0.59, 1.93)	0.96 (0.60, 1.52)
FOLLOW-UP
Unadjusted OR	1.35 (0.76, 2.39)	1.17 (0.55, 2.49)	1.09 (0.55, 2.19)	1.01 (0.72, 1.40)
OR adjusted for baseline value of easure	1.27 (0.75, 2.15)	1.13 (0.55, 2.33)	—	—

Tdap, tetanus, diphtheria, and acellular pertussis; OR, odds ratio.