A socio-ecological exploration to identify factors influencing the COVID-19 vaccine decision-making process among pregnant and lactating women: Findings from Kenya

  • Vaccine, Volume 40, No. 50, Year 2022

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Study Justification:
– The decision-making process for COVID-19 vaccines among pregnant and lactating women is complex.
– Pregnant women are at increased risk for severe disease and poor health outcomes from COVID-19.
– Available evidence suggests that COVID-19 vaccines are safe and protective during pregnancy.
– This study aims to explore factors influencing the vaccine decision-making process in order to inform demand generation strategies.
Study Highlights:
– Conducted 84 in-depth interviews with various stakeholders, including pregnant and lactating women, healthcare workers, male family members, and community gatekeepers.
– Used a socio-ecological approach to identify emerging themes related to vaccine acceptance.
– Organized emerging themes using the SAGE Vaccine Hesitancy model, including contextual influences, individual and group influences, and vaccine and vaccination specific issues.
– Themes related to contextual influences included myths, interpersonal norms, and religion.
– Themes related to individual and group influences included safety, risk perception, and the role of healthcare workers.
– Themes related to vaccine and vaccination specific issues included availability, accessibility, and eligibility.
Recommendations:
– Tailor communication efforts to increase vaccine demand among pregnant and lactating women.
– Address myths, interpersonal norms, and religious beliefs related to vaccine acceptance.
– Enhance safety messaging, address risk perception, and emphasize the role of healthcare workers.
– Improve vaccine availability, accessibility, and eligibility for pregnant and lactating women.
Key Role Players:
– Researchers and study team members
– Healthcare workers (nurses, midwives, doctors, frontline workers)
– Community leaders and faith-based leaders
– Policy makers and government officials
– Non-governmental organizations (NGOs) and community-based organizations (CBOs)
Cost Items for Planning Recommendations:
– Communication and awareness campaigns targeting pregnant and lactating women
– Training and capacity building for healthcare workers
– Infrastructure and logistics for vaccine distribution and accessibility
– Research and monitoring activities to assess vaccine demand and acceptance
– Collaboration and coordination efforts among stakeholders
– Evaluation and impact assessment of demand generation strategies

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a qualitative study that conducted in-depth interviews with a diverse set of participants. The study used a grounded theory approach to identify emerging themes related to factors influencing the COVID-19 vaccine decision-making process among pregnant and lactating women in Kenya. The study provides information on the recruitment process, data collection methods, and data analysis procedures, which adds to the credibility of the findings. However, the abstract does not mention the sample size or provide specific details about the findings and their implications. To improve the strength of the evidence, the abstract could include more specific information about the sample size, key findings, and recommendations based on the study’s results.

The vaccine decision-making process of pregnant and lactating women is complex. Regarding COVID-19, pregnant women are at increased risk for severe disease and poor health outcomes. While pregnant and lactating women were excluded from COVID-19 vaccine trials, available evidence suggests that COVID-19 vaccines are safe and protective during pregnancy. In this study, we used a socio-ecological approach to explore factors influencing the decision-making process for COVID-19 vaccines in pregnant and lactating women in Kenya, for the purpose of informing demand generation strategies. As pregnant and lactating women are influenced by many factors, we conducted 84 in-depth interviews with a variety of stakeholders, including 31 pregnant or lactating women, 20 healthcare workers such as nurses, midwives, doctors, and frontline workers, 25 male family members of pregnant or lactating women, and 8 gatekeepers such as community leaders and faith-based leaders. These individuals were recruited from six communities in Kenya: three urban, and three rural. We applied a grounded theory approach to identify emerging themes and organized emerging themes using the SAGE Vaccine Hesitancy model, which includes three categories of determinants of vaccine acceptance, including contextual influences, individual and group influences, and vaccine and vaccination specific issues. Myths, interpersonal norms, and religion emerged as themes related to contextual influences. Safety, risk perception, and the role of the healthcare worker emerged as themes related to individual and group influences. For vaccine and vaccination specific issues, emerging themes included availability, accessibility, and eligibility. While maternal immunization can substantially reduce the effect of infectious diseases in mothers and infants, vaccine acceptance is critical. However, vaccines do not save lives; vaccination does. We hope the results of this study can be used to tailor communication efforts to increase vaccine demand among pregnant and lactating women.

This qualitative study conducted in-depth interviews with a diverse set of audiences that may influence the vaccine decision-making process of pregnant or lactating women. Interviews were conducted with pregnant women, lactating women, male family members of pregnant or lactating women, community gatekeepers, and healthcare workers. Participants were recruited from three counties, with two communities in each county: Garissa (rural), Kakamega (rural and urban), and Nairobi (urban). Data were collected in August-September 2021. Interview instruments were pre-tested with pregnant women living in Kenya. Interview guides included questions related to the COVID-19 vaccine decision-making process for pregnant and lactating women. Data collectors participated in a three-day training exercise, after completing an online human ethics training. Participants were recruited at various health clinics across the six communities. If a participant met the inclusion criteria and agreed to participate, oral consent was obtained. Interviews were conducted in either English, Swahili, or other local languages as necessary in a semi-private setting or via Zoom. All interviews were audio recorded. Members of the study team transcribed and translated the transcripts into English. All data were stored on encrypted servers, and only members of the study team had access to the data. Study activities involving in-person interaction including training and data collection were conducted following COVID-19 safety protocols per the Ministry of Health in Kenya. A team of seven analyzed the data through a grounded theory approach. The team conducted three rounds of open coding to develop, refine, and finalize a code list. After open coding and agreement of a code list, team members coded 24 transcripts and discussed emerging themes. The team then coded the remaining transcripts. Two members of the team conducted inter-rater reliability with ∼ 10 % of the transcripts that neither of them had coded (10 transcripts). Reliability was > 90 %. The team then identified themes and sub-themes. Data were managed using Atlas.ti. This study received ethical approval from Johns Hopkins Bloomberg School of Public Health and Kenya Medical Research Institute.

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The study conducted in-depth interviews with various stakeholders to explore factors influencing the COVID-19 vaccine decision-making process among pregnant and lactating women in Kenya. The study aimed to inform demand generation strategies for COVID-19 vaccines in this population. Some key innovations and recommendations that can improve access to maternal health based on the study findings include:

1. Tailored communication efforts: The study suggests that communication efforts should be tailored to address specific concerns and factors influencing vaccine acceptance among pregnant and lactating women. This can include addressing myths, providing accurate information on vaccine safety, and highlighting the role of healthcare workers in promoting vaccination.

2. Engaging male family members: The involvement of male family members in the decision-making process can play a crucial role in increasing vaccine acceptance among pregnant and lactating women. Engaging and educating male family members about the benefits and safety of COVID-19 vaccines can help in influencing positive decision-making.

3. Collaboration with community gatekeepers: Community gatekeepers, such as community leaders and faith-based leaders, can have a significant influence on vaccine acceptance within their communities. Collaborating with these gatekeepers and involving them in vaccine promotion efforts can help in addressing vaccine hesitancy and increasing access to maternal health.

4. Improving vaccine availability and accessibility: The study highlights the importance of ensuring that COVID-19 vaccines are readily available and easily accessible to pregnant and lactating women. This can be achieved through targeted vaccine distribution strategies, ensuring vaccine supply in healthcare facilities, and addressing logistical barriers that may hinder access.

5. Addressing eligibility concerns: The study identifies eligibility as an important factor influencing vaccine acceptance among pregnant and lactating women. Clear and accurate information on vaccine eligibility criteria for this population should be provided to address any misconceptions or concerns.

Overall, the study emphasizes the need for a comprehensive approach that considers the socio-ecological factors influencing vaccine decision-making among pregnant and lactating women. By implementing these recommendations, access to maternal health can be improved, and vaccine acceptance can be increased in this population.
AI Innovations Description
The study described aims to explore the factors influencing the decision-making process for COVID-19 vaccines among pregnant and lactating women in Kenya. The goal is to inform strategies to increase vaccine demand among this population. The study used a socio-ecological approach and conducted 84 in-depth interviews with various stakeholders, including pregnant and lactating women, healthcare workers, male family members, and community gatekeepers. The interviews were conducted in both urban and rural communities in Kenya.

The study employed a grounded theory approach to analyze the data and identified emerging themes based on the SAGE Vaccine Hesitancy model. The themes included contextual influences such as myths, interpersonal norms, and religion; individual and group influences such as safety, risk perception, and the role of healthcare workers; and vaccine and vaccination specific issues such as availability, accessibility, and eligibility.

The study followed ethical guidelines and obtained oral consent from participants. Interviews were conducted in multiple languages and either in-person or via Zoom. Data were securely stored and analyzed by a team of researchers using Atlas.ti software. The study received ethical approval from Johns Hopkins Bloomberg School of Public Health and Kenya Medical Research Institute.

The findings of this study can be used to tailor communication efforts and develop strategies to increase vaccine acceptance among pregnant and lactating women, ultimately improving access to maternal health.
AI Innovations Methodology
The study described above aimed to explore the factors influencing the decision-making process for COVID-19 vaccines among pregnant and lactating women in Kenya. The methodology used in the study involved conducting in-depth interviews with various stakeholders, including pregnant and lactating women, healthcare workers, male family members, and community gatekeepers. The interviews were conducted in three counties, with two communities in each county, and data were collected in August-September 2021.

To ensure the validity and reliability of the study, several steps were taken. The interview instruments were pre-tested with pregnant women in Kenya to ensure they were appropriate and relevant. Data collectors underwent a three-day training exercise and completed an online human ethics training. Participants were recruited from health clinics in the communities, and oral consent was obtained from those who met the inclusion criteria and agreed to participate. The interviews were conducted in a semi-private setting or via Zoom, in English, Swahili, or other local languages as necessary.

All interviews were audio recorded and transcribed into English by members of the study team. The data were stored on encrypted servers, and only the study team had access to the data. The team of seven analysts used a grounded theory approach to analyze the data. They conducted three rounds of open coding to develop a code list, which was then used to code the transcripts. Inter-rater reliability was assessed by two team members coding a subset of transcripts, and reliability was found to be above 90%. The team identified themes and sub-themes based on the coded data using Atlas.ti software.

The study followed COVID-19 safety protocols as per the Ministry of Health in Kenya, ensuring the safety of both participants and data collectors. Ethical approval was obtained from the Johns Hopkins Bloomberg School of Public Health and the Kenya Medical Research Institute.

Overall, this qualitative study employed a rigorous methodology to explore the factors influencing the COVID-19 vaccine decision-making process among pregnant and lactating women in Kenya. The findings from this study can be used to inform strategies to increase vaccine demand among this population and improve access to maternal health.

Statistics:
Authors: 15
Identifiers:
DOI: 10.1016/j.vaccine.2022.10.068
ISSN: 0264410X
Research Areas:
Community Interventions, COVID, Health System and Policy, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Workforce
Study Countries:
Kenya
Study Design:
Grounded Theory
Study Approach:
Qualitative
Participants Gender:
Male & Female
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