Perceptions of COVID-19 Maternal Vaccination among Pregnant Women and Healthcare Workers and Factors That Influence Vaccine Acceptance: A Cross-Sectional Study in Barcelona, Spain

Vaccines, Volume 10, No. 11, Year 2022

Interpretation

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.

AI Digest

Study Justification:

– COVID-19 is associated with poor maternal and pregnancy outcomes.
– COVID-19 vaccination is recommended in Spain, but vaccination rates in pregnancy are suboptimal.
– This study aims to investigate the perceptions of pregnant women and healthcare workers (HCWs) regarding COVID-19 vaccination.

Highlights:

– 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.
– The fear of harming the fetus was the most significant barrier reported for rejecting vaccination.
– HCWs recognized they received limited information and training about COVID-19 vaccination in pregnancy, hindering them from providing informed recommendations.
– Information and education on COVID-19 vaccines to pregnant women and health professionals are pivotal to ensuring informed decision-making and increasing vaccine uptake.

Recommendations:

– Increase information and education on COVID-19 vaccines to pregnant women and healthcare professionals.
– Provide comprehensive training to healthcare workers regarding COVID-19 vaccination in pregnancy.
– Address the fear of harming the fetus by providing accurate and evidence-based information on the safety of COVID-19 vaccines during pregnancy.
– Strengthen communication channels between healthcare providers and pregnant women to address concerns and provide support.

Key Role Players:

– Healthcare professionals (doctors, nurses, midwives) involved in antenatal care services.
– Public health officials and policymakers responsible for vaccine communication and education.
– Researchers and scientists studying COVID-19 vaccines and maternal health.

Cost Items for Planning Recommendations:

– Development and implementation of educational materials and resources.
– Training programs for healthcare professionals.
– Communication campaigns targeting pregnant women.
– Research and data collection on vaccine acceptance and barriers.
– Monitoring and evaluation of vaccine uptake and impact.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a cross-sectional quantitative study conducted among 302 pregnant women and 309 healthcare workers in Barcelona, Spain. The study investigates the perceptions of pregnant women and healthcare workers regarding COVID-19 vaccination. The study provides information on the awareness of COVID-19 maternal vaccines, the factors influencing vaccine acceptance, and the barriers and facilitators for maternal vaccination. The study also highlights the need for information and education on COVID-19 vaccines for pregnant women and healthcare professionals. The evidence is based on a relatively large sample size and provides valuable insights into the topic. However, it is important to note that the study is limited to a specific geographic location and may not be generalizable to other populations. To improve the strength of the evidence, future studies could consider including a more diverse sample and conducting a longitudinal study to assess changes in vaccine acceptance over time.

Abstract

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.

Materials

https://efashare.b-cdn.net/materials/7367f499f12b55a22e0b465ea4e532d4cc6fb6ca8d265d30bf62350120d5903c/vaccines-10-01930-s001.zip

Innovations

Based on the provided description, here are some potential innovations that could improve access to maternal health:

1. Telemedicine: Implementing telemedicine services can provide pregnant women with remote access to healthcare professionals, allowing them to receive prenatal care and consultations without having to travel to healthcare facilities.

2. Mobile health applications: Developing mobile applications that provide pregnant women with information, reminders, and tools for monitoring their health during pregnancy can improve access to maternal health resources and support.

3. Community health workers: Training and deploying community health workers who can provide education, support, and basic healthcare services to pregnant women in underserved areas can help improve access to maternal health services.

4. Online educational resources: Creating online platforms or websites that offer comprehensive and easily accessible educational resources on maternal health, including information on vaccinations, can empower pregnant women to make informed decisions about their health.

5. Collaborative care models: Implementing collaborative care models that involve multidisciplinary teams, including obstetricians, midwives, nurses, and social workers, can ensure comprehensive and coordinated care for pregnant women, improving access to a range of services.

6. Mobile clinics: Establishing mobile clinics that travel to remote or underserved areas can provide prenatal care, vaccinations, and other essential maternal health services to women who may have limited access to healthcare facilities.

7. Public awareness campaigns: Conducting targeted public awareness campaigns to educate pregnant women and healthcare workers about the importance of maternal vaccinations and address any concerns or misconceptions can help increase vaccine acceptance and uptake.

8. Training programs for healthcare professionals: Developing training programs for healthcare professionals that specifically focus on maternal vaccinations and provide up-to-date information and guidance can ensure that they are well-informed and able to provide accurate recommendations to pregnant women.

These innovations have the potential to improve access to maternal health by addressing barriers such as geographical distance, lack of information, and limited healthcare resources. However, it is important to consider the specific context and needs of the target population when implementing these innovations.

AI Innovations Description

The study titled “Perceptions of COVID-19 Maternal Vaccination among Pregnant Women and Healthcare Workers and Factors That Influence Vaccine Acceptance: A Cross-Sectional Study in Barcelona, Spain” provides valuable insights into the barriers and facilitators for maternal vaccine acceptance and the factors that influence vaccine uptake among pregnant women and healthcare workers (HCWs). The study highlights the importance of information and education on COVID-19 vaccines for pregnant women and HCWs to ensure informed decision-making and increase vaccine uptake.

The study was conducted through a quantitative online survey among 302 pregnant women and 309 HCWs in the Catalan public health system. The participants were recruited from the Hospital Clínic of Barcelona and Primary Healthcare Centres providing antenatal care services in Barcelona, Spain. The survey included closed-ended questions and rating scales to assess knowledge, attitudes, beliefs, and practices related to maternal vaccinations, including COVID-19.

The findings of the study revealed that 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. However, the fear of harming the fetus was reported as the most significant barrier for rejecting vaccination. HCWs also recognized that they received limited information and training about COVID-19 vaccination in pregnancy, which hindered them from providing informed recommendations.

To improve access to maternal health, based on the study findings, the following recommendations can be developed into innovations:

1. Enhance education and information dissemination: Develop comprehensive educational materials and training programs for pregnant women and HCWs about the safety and benefits of COVID-19 vaccination during pregnancy. This can include online resources, informational videos, and targeted campaigns to address common concerns and misconceptions.

2. Strengthen communication between HCWs and pregnant women: Implement strategies to improve communication between HCWs and pregnant women, such as regular discussions during antenatal care visits, where HCWs can provide accurate and up-to-date information about COVID-19 vaccination and address any concerns or questions.

3. Provide training for HCWs: Offer specialized training programs for HCWs on COVID-19 vaccination in pregnancy, including the latest research findings, safety data, and guidelines. This will enable HCWs to provide informed recommendations and address any doubts or fears expressed by pregnant women.

4. Collaborate with community organizations: Partner with community organizations and influencers to promote accurate information about COVID-19 vaccination during pregnancy. This can include hosting webinars, organizing community events, and leveraging social media platforms to reach a wider audience and address vaccine hesitancy.

5. Improve access to vaccination services: Ensure that COVID-19 vaccination services are easily accessible to pregnant women, including convenient appointment scheduling, dedicated vaccination clinics for pregnant women, and transportation support if needed.

By implementing these recommendations, healthcare systems can work towards improving access to maternal health and increasing vaccine acceptance among pregnant women, ultimately leading to better maternal and pregnancy outcomes.

AI Innovations Methodology

The study described is focused on understanding the barriers and facilitators to maternal vaccine acceptance among pregnant women and healthcare workers (HCWs) in Barcelona, Spain. The methodology used in the study includes the following steps:

1. Study Design: The study is a cross-sectional quantitative study conducted online using a web-based survey. It aims to collect data from pregnant women and HCWs in the Catalan public health system.

2. Participant Selection: Pregnant women aged between 18 and 55 years, attending antenatal care services at the Hospital Clínic of Barcelona and Primary Healthcare Centres in the Barcelona metropolitan area, were invited to participate. HCWs providing clinical and/or preventive services to pregnant women in the public health system were also included.

3. Informed Consent: Participants were provided with relevant information about the study purpose and gave online informed consent prior to enrollment. The consent process was conducted during antenatal care visits by an HCW.

4. Data Collection: Two different questionnaires were used, one for pregnant women and another for HCWs. The questionnaires covered individual, social, and structural factors related to vaccine decisions, including knowledge, attitudes, beliefs, and practices concerning maternal vaccinations, including COVID-19. The surveys were administered online through the LimeSurvey data entry system.

5. Survey Development: The survey questions were closed-ended, allowing participants to choose from a list of predetermined options or rate their perceptions on a scale. Some questions included an “Other” option for participants to provide open-ended answers. The survey development was guided by the WHO SAGE on Immunization Working Group’s “Model of determinants of vaccine hesitancy.”

6. Recruitment: Participants were recruited actively and passively. Active recruitment involved HCWs enrolling participants during antenatal care visits and researchers recruiting participants in waiting rooms. Passive recruitment methods included QR codes displayed on posters and fliers provided by HCWs.

7. Sample Size: The sample size for the larger study was 611 participants, including 302 pregnant women and 309 HCWs. The sample size was calculated to ensure a 95% confidence interval of +/- 5% with 80% power.

8. Data Analysis: Categorical data were summarized using frequencies and percentages, while continuous variables were presented as mean and ranges. Missing values were not considered in the data description. Free-text responses were thematically analyzed and manually coded into themes and subthemes.

9. Ethical Approval: The study received ethical approval from the Ethics Review Committees of the Hospital Clínic Barcelona and the Primary Health Care Network Ethics Committee. The study was conducted in accordance with Good Clinical Practice Guidelines and the Declaration of Helsinki.

In summary, the methodology used in this study involved online surveys administered to pregnant women and HCWs to collect data on their perceptions and factors influencing COVID-19 maternal vaccine acceptance. The data collected were analyzed using descriptive statistics and thematic analysis. The study aimed to identify barriers and facilitators to maternal vaccine acceptance and highlight the importance of information and education for informed decision-making and increased vaccine uptake.

Authors & Co-Authors

Statistics:

Citations: 2

Authors: 14

Identifiers:

DOI: 10.3390/vaccines10111930

Research Areas:

COVID, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants

Study Design:

Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Female