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Factors that influence vaccination decision-making among pregnant women: A systematic review and meta-analysis

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  • Eliz Kilich
  • Sara Dada
  • Mark R Francis
  • John Tazare
  • R Matthew Chico
  • Pauline Paterson
  • Heidi J Larson

Abstract

Background: The most important factor influencing maternal vaccination uptake is healthcare professional (HCP) recommendation. However, where data are available, one-third of pregnant women remain unvaccinated despite receiving a recommendation. Therefore, it is essential to understand the significance of other factors and distinguish between vaccines administered routinely and during outbreaks. This is the first systematic review and meta-analysis (PROSPERO: CRD 42019118299) to examine the strength of the relationships between identified factors and maternal vaccination uptake. Methods: We searched MEDLINE, Embase Classic & Embase, PsycINFO, CINAHL Plus, Web of Science, IBSS, LILACS, AfricaWideInfo, IMEMR, and Global Health databases for studies reporting factors that influence maternal vaccination. We used random-effects models to calculate pooled odds ratios (OR) of being vaccinated by vaccine type. Findings: We screened 17,236 articles and identified 120 studies from 30 countries for inclusion. Of these, 49 studies were eligible for meta-analysis. The odds of receiving a pertussis or influenza vaccination were ten to twelve-times higher among pregnant women who received a recommendation from HCPs. During the 2009 influenza pandemic an HCP recommendation increased the odds of antenatal H1N1 vaccine uptake six times (OR 6.76, 95% CI 3.12–14.64, I2 = 92.00%). Believing there was potential for vaccine-induced harm had a negative influence on seasonal (OR 0.22, 95% CI 0.11–0.44 I2 = 84.00%) and pandemic influenza vaccine uptake (OR 0.16, 95% CI 0.09–0.29, I2 = 89.48%), reducing the odds of being vaccinated five-fold. Combined with our qualitative analysis the relationship between the belief in substantial disease risk and maternal seasonal and pandemic influenza vaccination uptake was limited. Conclusions: The effect of an HCP recommendation during an outbreak, whilst still powerful, may be muted by other factors. This requires further research, particularly when vaccines are novel. Public health campaigns which centre on the protectiveness and safety of a maternal vaccine rather than disease threat alone may prove beneficial.

Suggested Citation

  • Eliz Kilich & Sara Dada & Mark R Francis & John Tazare & R Matthew Chico & Pauline Paterson & Heidi J Larson, 2020. "Factors that influence vaccination decision-making among pregnant women: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 15(7), pages 1-28, July.
    • Handle: RePEc:plo:pone00:0234827
    DOI: 10.1371/journal.pone.0234827
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    References listed on IDEAS

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    1. Aysegul Celikel & Ayfer Ustunsoz & Gulten Guvenc, 2014. "Determination of vaccination status of pregnant women during pregnancy and the affecting factors," Journal of Clinical Nursing, John Wiley & Sons, vol. 23(15-16), pages 2142-2150, August.
    2. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    3. Rajagopal, 2014. "The Human Factors," Palgrave Macmillan Books, in: Architecting Enterprise, chapter 9, pages 225-249, Palgrave Macmillan.
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