COVID-19 is associated with poor maternal and pregnancy outcomes. COVID-19 vaccination is recommended in Spain, yet vaccination rates in pregnancy are suboptimal. This study investigates the perceptions of pregnant women and healthcare workers (HCW) regarding COVID-19 vaccination. A web-based cross-sectional quantitative study was conducted in 2021–2022 among 302 pregnant women and 309 HCWs in the Catalan public health system. Most pregnant women (83%) and HCWs (86%) were aware of COVID-19 maternal vaccines. The recommendation of the COVID-19 vaccination by an HCW was identified as the greatest facilitator for maternal vaccine uptake, while the fear of harming the foetus was the most significant barrier reported for rejecting vaccination. HCWs recognised they received limited information and training about COVID-19 vaccination in pregnancy, which hindered them from providing informed recommendations. This study highlights that information and education on COVID-19 vaccines to pregnant women and health professionals are pivotal to ensuring informed decision-making and increasing vaccine uptake.
The data presented here are part of a larger cross-sectional study aimed at understanding the barriers and facilitators to maternal vaccine acceptance among pregnant women and HCWs. This study consisted of a quantitative online survey conducted among pregnant women and HCWs at the Hospital Clínic of Barcelona and Primary Healthcare Centres providing antenatal care (ANC) services in Barcelona, Spain. Pregnant women aged between 18 and 55 years, of any gestational age, attending ANC services at Hospital Clínic Barcelona (a tertiary health facility) or Sexual and Reproductive Health Services (Primary Healthcare) in the Barcelona metropolitan area, who are fluent in Spanish or English, were invited to participate in the study. For HCWs, the inclusion criteria included being an HCW providing clinical and/or preventive services to pregnant women in the public health system and being fluent in Catalan or Spanish. Online informed consent was obtained prior to enrolment after the participants were provided with the relevant information about the study purpose in antenatal care visits by an HCW. Data collection was obtained through two different questionnaires; one designed specifically for pregnant women and another for HCW. It was conducted anonymously, and a unique identification number was automatically assigned to every participant by the survey platform. The survey covered individual, social, and structural factors that drive vaccine decisions and included constructs related to knowledge, attitudes, beliefs, and practices concerning maternal vaccinations, including COVID-19. The WHO SAGE on Immunization Working Group “Model of determinants of vaccine hesitancy” [25] was used to guide the survey’s development. The survey questions were closed-ended, allowing the participants to choose from a list of predetermined options or to rate their perceptions on a scale. Some questions included the option of “Other”, allowing participants to provide an open answer different from the ones predefined. The surveys were administered online through the LimeSurvey data entry system (Version 5.3.6) on the interface of the Hospital Clínic of Barcelona survey platform, Sistema Enquestes. Two data collection tools were used, a 42-item questionnaire for pregnant women, which took approximately 10–15 min to complete, and a 21-item questionnaire for HCWs, which could be completed in 5 min. The survey for HCWs (Supplementary Material Survey S2) was available in Catalan and Spanish, while the survey for pregnant women (Supplementary Materials Survey S1) was available in Spanish and English. The mode of recruitment was both active and passive. For pregnant women, the active recruitment aspect involved HCWs enrolling participants during ANC visits and researchers recruiting participants in waiting rooms. The data collection was then performed either digitally or in paper form. The paper copies were later entered into the survey platform by the study researchers. Regarding the passive recruitment of pregnant women, participants could access the survey via a QR code displayed on posters throughout the health facilities or through fliers provided by HCWs during ANC visits. For HCWs, active recruitment involved recruiting study participants through emails containing a survey link, while passive recruitment entailed accessing the survey via a QR code displayed on posters throughout the health facilities. The sample size included in the larger study was 611 participants (302 pregnant women and 309 health professionals). These enrolment targets were computed to identify the most conservative response proportion, 50%, using PASS VI 1 (NCSS, LLC; Kaysville, UT, USA). To estimate a response proportion of 50% with a 95% confidence interval of +/− 5% with 80% power, a total of 300 completed surveys were required for each population group. Data collection, cleaning, and management were performed using the LimeSurvey open source tool through the Hospital Clínic platform. Only fully completed surveys were used for data analysis. For analysis of maternal vaccination coverage, only data from participants eligible for maternal vaccinations at the time of the survey (e.g., week of gestation, season, and COVID-19 recommendations) was included. Categorical data were summarised by frequencies and percentages. Continuous variables were presented as mean and ranges (minimum and maximum values). Missing values were not considered in the description of the data. Data from free-text responses were thematically analysed and manually coded into themes and subthemes to identify the barriers and facilitators for maternal vaccination. Responses provided in Spanish or Catalan were translated into English. For data analysis, all responses were transcribed into the active voice. The resulting responses were organised into codes and sub-codes and displayed in tables (Appendix A and Appendix B). Ethical approval for this study was granted by the Ethics Review Committees of the Hospital Clínic Barcelona (CEIm) [Reg. No. HCB/2021/0352] and of the Primary Health Care Network Ethics Committee (CEI) IDIAP Jordi Gol [Reg. No. CEI 21/149-P]. The study was conducted in accordance with the Good Clinical Practice Guidelines and under the provisions of the Declaration of Helsinki and national and regional rules and regulations.