Protecting pregnant people & infants against influenza: A landscape review of influenza vaccine hesitancy during pregnancy and strategies for vaccine promotion

Figures & data

Figure 1. Direct and indirect health impacts of influenza on infants <6 months of age.

*Predominantly documented during the 2009 influenza A/H1N1 pandemic.

Figure 2. Health belief model outlining individual factors influencing influenza vaccine behavior.

Figure 3. Social-ecological model as a framework for influenza vaccine promotion during pregnancy.

Table 1. Summary of strategies for increasing influenza vaccine acceptance during pregnancy^40,83.

Intervention Target	Example Interventions	Amount of Evidence	Effectiveness
Individual	Patient education^Citation84–94	+++	Modest inconsistent increase
	Message framing^Citation95,Citation96	+	No effect
	Motivational Interviewing	-	Effects not currently known in pregnancy*
Relationships	Peer support interventions (i.e., group prenatal care)^Citation97	+	Increase
	Community organization-led interventions	-	Effects not currently known in pregnancy*
Institutional	Staff education and training^Citation85–88–Citation93	++	Modest inconsistent increase
	Provider education^Citation85,Citation86	++	Increase
	Patient immunization reminders (“nudges”)^Citation87–89–Citation98–100	++	Modest inconsistent effect
	Provider alerts to discuss vaccination^Citation87–93–Citation101–104	++	Increase
	Standing orders/midwifery-led vaccination program^Citation103,Citation105,Citation106	++	Increase
	Opt-out vs. opt-in vaccination policies^Citation107	+	No effect
	Institutional vaccine “champion”^Citation85,Citation86,Citation106	+	No effect
	Interventions to increase access to vaccines at clinic/health service^Citation87,Citation88	+	Increase
	Workplace vaccination policies	-	Effects not currently known in pregnancy*
Community	Provision of low-cost or free vaccines to pregnant persons^Citation108	+	Increase
	Health policies encouraging vaccination during pregnancy^Citation108	+	Increase
	Health plan incentives	-	Effects not currently known in pregnancy*
Society	Mass media campaigns	-	Effects not currently known in pregnancy*
	Social marketing	-	Effects not currently known in pregnancy*

*Effects have been documented in general population, but to our knowledge, have not been evaluated among pregnant persons specifically.

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