Evaluating Factors That Influence Influenza Vaccination Uptake among Pregnant People in a Medically Underserved Area in Washington State
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study and Research Tool Design
2.2. Participants and Data Collection
2.3. Data Analysis
2.4. Ethical Considerations
3. Results
3.1. Demographics
3.2. Evaluating the Relationship between Vaccination and Pregnancy
3.3. Evaluating the Relationship between Pregnancy, Vaccination, and Trust in Medical Care
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Centers for Disease Control and Prevention. 2023–2024 U.S. Flu Season: Preliminary In-Season Burden Estimates. Available online: https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm (accessed on 17 April 2024).
- Gidengil, C.; Goetz, M.B.; Newberry, S.; Maglione, M.; Hall, O.; Larkin, J.; Motala, A.; Hempel, S. Safety of vaccines used for routine immunization in the United States: An updated systematic review and meta-analysis. Vaccine 2021, 39, 3696–3716. [Google Scholar] [CrossRef] [PubMed]
- Centers for Disease Control and Prevention. Weekly Flu Vaccination Dashboard. Available online: https://www.cdc.gov/flu/fluvaxview/dashboard/vaccination-dashboard.html (accessed on 17 April 2024).
- Centers for Disease Control and Prevention. Flu Vaccination Coverage, United States, 2022–2023 Influenza Season. Available online: https://www.cdc.gov/flu/fluvaxview/coverage-2223estimates.htm (accessed on 2 July 2024).
- Grohskopf, L.A.; Blanton, L.H.; Ferdinands, J.M.; Chung, J.R.; Broder, K.R.; Talbot, H.K. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023–2024 Influenza Season. MMWR Recomm. Rep. 2023, 72, 1–25. [Google Scholar] [CrossRef]
- Dawood, F.S.; Kittikraisak, W.; Patel, A.; Rentz Hunt, D.; Suntarattiwong, P.; Wesley, M.G.; Thompson, M.G.; Soto, G.; Mundhada, S.; Arriola, C.S.; et al. Incidence of influenza during pregnancy and association with pregnancy and perinatal outcomes in three middle-income countries: A multisite prospective longitudinal cohort study. Lancet Infect. Dis. 2021, 21, 97–106. [Google Scholar] [CrossRef] [PubMed]
- Dorélien, A. The Effects of In Utero Exposure to Influenza on Birth and Infant Outcomes in the US. Popul. Dev. Rev. 2019, 45, 489–523. [Google Scholar] [CrossRef] [PubMed]
- Centers for Disease Control and Prevention. Flu & Pregnancy. Available online: https://www.cdc.gov/flu/highrisk/pregnant.htm (accessed on 17 April 2024).
- Centers for Disease Control and Prevention. Pregnant People Hit Hard by Flu but Many Remain Unvaccinated. Available online: https://www.cdc.gov/flu/spotlights/2022-2023/pregnant-people-flu-vaccine.htm#:~:text=December%209%2C%202022%E2%80%94Flu%20season,in%20women%20who%20are%20pregnant (accessed on 17 April 2024).
- Callahan, A.G.; Coleman-Cowger, V.H.; Schulkin, J.; Power, M.L. Racial disparities in influenza immunization during pregnancy in the United States: A narrative review of the evidence for disparities and potential interventions. Vaccine 2021, 39, 4938–4948. [Google Scholar] [CrossRef]
- Carson, S.L.; Casillas, A.; Castellon-Lopez, Y.; Mansfield, L.N.; Morris, D.; Barron, J.; Ntekume, E.; Landovitz, R.; Vassar, S.D.; Norris, K.C.; et al. COVID-19 Vaccine Decision-making Factors in Racial and Ethnic Minority Communities in Los Angeles, California. JAMA Netw. Open 2021, 4, e2127582. [Google Scholar] [CrossRef] [PubMed]
- Shearn, C.; Krockow, E.M. Reasons for COVID-19 vaccine hesitancy in ethnic minority groups: A systematic review and thematic synthesis of initial attitudes in qualitative research. SSM Qual. Res. Health 2023, 3, 100210. [Google Scholar] [CrossRef] [PubMed]
- Kaur, R.; Callaghan, T.; Regan, A.K. Disparities in maternal influenza immunization among women in rural and urban areas of the United States. Prev. Med. 2021, 147, 106531. [Google Scholar] [CrossRef] [PubMed]
- O’Halloran, A.C.; Holstein, R.; Cummings, C.; Daily Kirley, P.; Alden, N.B.; Yousey-Hindes, K.; Anderson, E.J.; Ryan, P.; Kim, S.; Lynfield, R.; et al. Rates of Influenza-Associated Hospitalization, Intensive Care Unit Admission, and In-Hospital Death by Race and Ethnicity in the United States From 2009 to 2019. JAMA Netw. Open 2021, 2, e2121880. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- US Census Bureau. QuickFacts Yakima County, Washington. Available online: https://www.census.gov/quickfacts/yakimacountywashington (accessed on 17 April 2024).
- Pew Research Center. Who is Hispanic? Available online: https://www.pewresearch.org/short-reads/2023/09/05/who-is-hispanic/ (accessed on 2 July 2024).
- Health Resources & Services Administration. MUA Find. Available online: https://data.hrsa.gov/tools/shortage-area/mua-find (accessed on 17 April 2024).
- Health Resources & Services Administration. What is Shortage Designation. Available online: https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation#mups (accessed on 17 April 2024).
- Washington State Department of Health. Influenzas Vaccination Data. Available online: https://doh.wa.gov/data-statistical-reports/health-behaviors/immunization/influenza-vaccination-data (accessed on 17 April 2024).
- Health Care Authority (HCA). First Steps Enhanced Services. Available online: https://www.hca.wa.gov/free-or-low-cost-health-care/i-need-medical-dental-or-vision-care/first-steps-enhanced-services#what-is-fs (accessed on 17 April 2024).
- Washington State Department of Health. Yakima Valley Memorial CHNA. Available online: https://doh.wa.gov/sites/default/files/2022-12/CHNA-058-2022.pdf?uid=64699125ea626 (accessed on 17 April 2024).
- Yasmin, F.; Najeeb, H.; Moeed, A.; Naeem, U.; Asghar, M.S.; Chughtai, N.U.; Yousaf, Z.; Seboka, B.T.; Ullah, I.; Lin, C.Y.; et al. COVID-19 Vaccine Hesitancy in the United States: A Systematic Review. Front. Public Health 2021, 23, 770985. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- 2023 National Survey: Attitudes about Influenza, COVID-19, Respiratory Syncytial Virus, and Pneumococcal Disease. Available online: https://www.nfid.org/resource/2023-national-survey-attitudes-about-influenza-covid-19-respiratory-syncytial-virus-and-pneumococcal-disease/ (accessed on 17 April 2024).
- Way, N.; Martin, A.; Wallick, C.; Neuberger, E.; Corral, M. Patient Perspectives and Journey with Influenza and Seeking Care from US National Survey. Open Forum Infect. Dis. 2021, 4, S759–S760. [Google Scholar] [CrossRef] [PubMed Central]
- Domnich, A.; Cambiaggi, M.; Vasco, A.; Maraniello, L.; Ansaldi, F.; Baldo, V.; Bonanni, P.; Calabrò, G.E.; Costantino, C.; de Waure, C.; et al. Attitudes and Beliefs on Influenza Vaccination during the COVID-19 Pandemic: Results from a Representative Italian Survey. Vaccines 2020, 30, 711. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Valerio, V.; Rampakakis, E.; Zanos, T.P.; Levy, T.J.; Shen, H.C.; McDonald, E.G.; Frenette, C.; Bernatsky, S.; Hudson, M.; Ward, B.J.; et al. High Frequency of COVID-19 Vaccine Hesitancy among Canadians Immunized for Influenza: A Cross-Sectional Survey. Vaccines 2022, 10, 1514. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Guillari, A.; Polito, F.; Pucciarelli, G.; Serra, N.; Gargiulo, G.; Esposito, M.R.; Botti, S.; Rea, T.; Simeone, S. Influenza vaccination and healthcare workers: Barriers and predisposing factors. Acta Biomed. 2021, 25, e2021004. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- American Association for Public Opinion Research. Best Practices for Survey Research. Available online: https://aapor.org/standards-and-ethics/best-practices/ (accessed on 17 April 2024).
- Ulin, P.R.; Robinson, E.T.; Tolley, E.E. Qualitative Methods in Public Health: A Field Guide for Applied Research; Jossey-Bass: San Francisco, CA, USA, 2005. [Google Scholar]
- Bradley, E.H.; Curry, L.A.; Devers, K.J. Qualitative data analysis for health services research: Developing taxonomy, themes, and theory. Health Serv. Res. 2007, 42, 1758–1772. [Google Scholar] [CrossRef] [PubMed]
- Thompson, M.G.; Li, D.K.; Shifflett, P.; Sokolow, L.Z.; Ferber, J.R.; Kurosky, S.; Bozeman, S.; Reynolds, S.B.; Odouli, R.; Henninger, M.L.; et al. Effectiveness of seasonal trivalent influenza vaccine for preventing influenza virus illness among pregnant women: A population-based case-control study during the 2010-2011 and 2011-2012 influenza seasons. Clin. Infect. Dis. 2014, 58, 449–457. [Google Scholar] [CrossRef] [PubMed]
- Mackin, D.W.; Walker, S.P. The historical aspects of vaccination in pregnancy. Best Pract. Res. Clin. Obstet. Gynaecol. 2021, 76, 13–22. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- American College of Obstetricians and Gynecologists. Influenza in Pregnancy: Prevention and Treatment. Available online: https://www.acog.org/clinical/clinical-guidance/committee-statement/articles/2024/02/influenza-in-pregnancy-prevention-and-treatment#:~:text=The%20inactivated%20influenza%20vaccine%20can,vaccine%20during%20a%20previous%20pregnancy (accessed on 17 April 2024).
- Thompson, M.G.; Kwong, J.C.; Regan, A.K.; Katz, M.A.; Drews, S.J.; Azziz-Baumgartner, E.; Klein, N.P.; Chung, H.; Effler, P.V.; Feldman, B.S.; et al. Influenza Vaccine Effectiveness in Preventing Influenza-associated Hospitalizations During Pregnancy: A Multi-country Retrospective Test Negative Design Study, 2010–2016. Clin. Infect. Dis. 2019, 68, 1444–1453. [Google Scholar] [CrossRef] [PubMed]
Survey Question Number | Survey Question | Topic Domain |
---|---|---|
1 | Have you lived in Yakima County for the past 12 months or longer? | Inclusion criteria |
2 | Are you age 18 or older? | Inclusion criteria |
3 | Have you ever been pregnant? | Inclusion criteria |
4 | Please indicate your ethnicity: Latino/Latina//Hispanic; Non-Hispanic. | Demographics |
5 | Please indicate your race: white or Caucasian; Black or African American; Asian; Native Hawaiian or Other Pacific Islander; American Indian/Alaska Native/Tribal; Other, please specify. | Demographics |
6 | What is the highest level of education you have completed: less than high school; high school or GED; some college/AA degree/technical certificate; bachelors degree; advanced degree (PhD, Masters, MD, etc.); other, please specify. | Demographics |
7 | Which of the following categories best describes your current employment status? | Demographics |
8 | Which of the following categories best describes who you work for? | Demographics |
9 | Which of the following is your age group? | Demographics |
10 | Have you ever served in any branch of the United States military? | Demographics |
11 | Which one of the following best describes your current marital status? | Demographics |
12 | Which gender do you identify as? | Demographics |
13 | Did you get the flu vaccine during your pregnancy or when you were trying to become pregnant? | Pregnancy and vaccination |
14A | If you answered “yes” to the previous question, how important were each of the following reasons for you to get vaccinated against the flu: protect yourself from the flu, protect your family/friends from the flu; protect your community from the flu; your employer encouraged you to get vaccinated; your employer mandated that you get vaccinated; your family/friend encouraged you to get vaccinated; a healthcare provider encouraged you to get vaccinated; it was convenient; it was available for free or low cost; or other (please describe). | Pregnancy and vaccination |
14B | If you answered “no” to the previous question, how important were each of the following reasons for you to choose not to get vaccinated against the flu in the past 5 years: Getting the vaccine is inconvenient; I do not believe the vaccine works; I am allergic to the vaccine; Religious reasons; I was worried about the side effects; or other (please describe) | Pregnancy and vaccination |
15 | How often in the past five years have you been vaccinated for the flu? | Influenza vaccination status |
16 | Are you up to date on all your routine vaccinations? Routine vaccinations include vaccines like pneumonia, hepatitis, measles, and tetanus, but does not include COVID-19 or flu vaccine. | Routine vaccination status |
17 | Will you continue to be vaccinated with routine vaccines? | Routine vaccination status |
18 | If you answered “no” to the previous question, why not? (open ended response field) | Routine vaccination status |
19 | Do you have an egg allergy? | Routine vaccination status |
20 | If you are up to date on all your routine vaccinations but answered “no” to “Will you continued to be vaccinated with routine vaccines”, please explain why not. | Routine vaccination status |
21 | How much do you trust the advice of each of the following healthcare providers: primary care provider, specialty care provider, pharmacist, nurse, other (please list). | Healthcare provider trust and advice |
22 | Was getting the flu vaccine during pregnancy recommended by your healthcare provider? | Healthcare provider trust and advice |
23 | How confident are you that you have received good information about the flu vaccine? | Vaccination confidence |
24 | How confident are you that the flu vaccine is safe? | Vaccination confidence |
25 | How confident are you in your knowledge of how the flu vaccine works? | Vaccination confidence |
Demographic | Number | Percentage |
---|---|---|
Age (n = 244) | ||
18–24 years | 2 | 0.6% |
25–34 years | 24 | 9.9% |
35–44 years | 45 | 18.6% |
45–54 years | 61 | 24.9% |
55–64 years | 64 | 26.1% |
65–79 years | 34 | 14.1% |
80 years or older | 14 | 5.7% |
Race (n = 244, multiple response possible) | ||
White or Caucasian | 204 | 83.6% |
American Indian/Alaska Native/Tribal | 11 | 4.5% |
Asian | 5 | 2.0% |
Black or African American | 5 | 2.0% |
Native Hawaiian or Other Pacific Islander | 2 | 0.8% |
Other (Mexican, Hispanic) | 14 | 5.7% |
Ethnicity (n = 228) | ||
Latino/Latina/Hispanic | 54 | 23.8% |
Non-Hispanic | 174 | 76.2% |
Highest level of education completed (n = 239) | ||
Less than high school | 12 | 5.1% |
High school or GED | 45 | 19.0% |
Some college/AA degree/technical certificate | 83 | 34.6% |
Bachelor’s degree | 60 | 25.0% |
Advanced degree (Masters, PhD, MD, etc.) | 37 | 15.3% |
Other (multiple degrees) | 2 | 1.0% |
Current marital status (n = 245) | ||
Married | 150 | 61.4% |
Living with a partner | 14 | 5.6% |
Never married | 13 | 5.1% |
Divorced or separated | 42 | 17.4% |
Widowed | 23 | 9.3% |
Other (single, living alone, married but living separately) | 3 | 1.1% |
Employment status (n = 241) | ||
Employed full-time | 136 | 56.8% |
Employed part-time | 19 | 7.9% |
Not employed, looking for employment | 2 | 0.6% |
Not employed, not looking for employment | 26 | 10.7% |
Retired | 58 | 24.0% |
Employment Category for those employed (n = 155) | ||
Private, for-profit company or business, or for an individual | 61 | 39.6% |
Private not-for-profit, tax-exempt, or charitable organization | 13 | 8.1% |
Local government (city, county, etc.) | 15 | 9.8% |
State government | 33 | 21.2% |
Federal government | 0 | 0.3% |
Self-employed in my own NOT incorporated business, professional practice, or farm | 14 | 8.9% |
Self-employed in my own incorporated business, professional practice, or farm | 8 | 5.2% |
Working without pay in family business or farm | 2 | 1.0% |
Other (healthcare, higher education, school district) | 9 | 5.9% |
Ever served in the United States military (n = 243) | ||
Yes, now on active duty | 0 | 0.0% |
Yes, on active duty in the p0.0ast, but not in last 12 months | 6 | 2.6% |
No, training for Reserves or National Guard only | 0 | 0.0% |
No, never served in the military | 237 | 97.4% |
Theme | Illustrative Quote |
---|---|
Belief that vaccination was not needed. | “I was young and never really got sick that much”. “The flu vaccine was not important to me at that time”. “I don’t need a flu vaccine, we get the flu every test whether we are vaccinated for the flu or not”. “I didn’t feel I was at risk”. |
Lack of awareness or recommendation. | “Was younger and I did not know much about flu vaccine”. “It was never offered to me by my doctors”. “Never heard of any flu vaccine given at that time of pregnancies”. |
Lack of access to the influenza vaccine. | “I don’t recall a flu vaccine being available when I was pregnant in the early 1980′s”. “Lived remote in Alaska”. “I don’t believe it was available” |
Did not want to be vaccinated against influenza. | “I’ve never gotten a flu shot! Never wanted to”. “Felt that it would be ok if I got [the flu], and my body would fight it”. “Never ever believed in the flu vaccine”. |
Concerned about safety of vaccination during pregnancy. | “I didn’t take any Rx then or want to jeopardize pregnancy viability”. “Was afraid of what it might do to my babies”. “I did not want to risk adverse side effects to the fetus”. “Too many side effects that could harm a baby”. “I wasn’t going to put foreign chemicals in my child”. |
How Much Do You Trust the Advice of Each of the following Healthcare Providers? (Question 21) | Not at All | Only a Little | Mostly | Strongly |
---|---|---|---|---|
Primary care provider (n = 241) | 3.8% | 10.3% | 46.5 | 39.9% |
Specialty care provider (cardiologist, pulmonologist, etc.) (n = 219) | 8.0% | 6.8% | 43.4% | 41.8% |
Pharmacist (n = 229) | 6.1% | 16.0% | 45.9% | 31.9% |
Nurse (n = 228) | 23.8% | 46.7% | 29.5% |
Survey Question | Not at All Confident | Only a Little Confident | Mostly Confident | Very Confident |
---|---|---|---|---|
How confident are you that you have received good information about flu vaccines? (Question 23, n = 241) | 8.9% | 13.5% | 47.7% | 30.0% |
How confident are you in your knowledge of how the flu vaccine works? (Question 24, n = 241) | 8.9% | 19.6% | 48.7% | 23.8% |
How confident are you that flu vaccine is safe? (Question 25, n = 242) | 15.4% | 14.1% | 40.9% | 29.6% |
Frequency of Being Vaccinated against Influenza in the Last 5 Years Question 15 (n = 238) | Number | Percentage |
---|---|---|
Not at all | 75 | 31.6% |
1–2 times | 34 | 14.4% |
3–4 times | 36 | 15.1% |
Every year | 93 | 38.9% |
Survey Item | Received Influenza Vaccine during Pregnancy or When Trying to Become Pregnant (Question 13) | Total | |||||
---|---|---|---|---|---|---|---|
Yes | No | ||||||
Number | Percentage | Number | Percentage | Number | Percentage | ||
Are you up to date on all your routine vaccinations? (Question 16) (n = 227) | Yes | 69 | 88.5% | 114 | 76.5% | 183 | 80.6% |
No | 9 | 11.5% | 35 | 23.5% | 44 | 19.4% | |
Will you continue to be vaccinated with routine vaccines? (Question 17) (n = 193) | Yes | 68 | 95.8% | 104 | 85.2% | 172 | 89.1% |
No | 3 | 4.2% | 18 | 14.8% | 21 | 10.9% |
Received Influenza Vaccine during Pregnancy or When Trying to Become Pregnant (Question 13) | Total | ||||||
---|---|---|---|---|---|---|---|
Yes | No | ||||||
Number | Percentage | Number | Percentage | Number | Percentage | ||
Frequency of getting flu vaccine within the past five years (Question 15) | Not at all | 13 | 16.7% | 60 | 40.0% | 73 | 32.0% |
1–2 times | 6 | 7.7% | 28 | 18.7% | 34 | 14.9% | |
3–4 time | 25 | 32.1% | 11 | 7.3% | 36 | 15.8% | |
Every time | 34 | 43.6% | 51 | 34.0% | 85 | 37.3% | |
Total | 78 | 100.0% | 150 | 100.0% | 228 | 100.0% |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
McKeirnan, K.; Brand, D.; Giruzzi, M.; Vaitla, K.; Giruzzi, N.; Krebill-Prather, R.; Dang, J. Evaluating Factors That Influence Influenza Vaccination Uptake among Pregnant People in a Medically Underserved Area in Washington State. Vaccines 2024, 12, 768. https://doi.org/10.3390/vaccines12070768
McKeirnan K, Brand D, Giruzzi M, Vaitla K, Giruzzi N, Krebill-Prather R, Dang J. Evaluating Factors That Influence Influenza Vaccination Uptake among Pregnant People in a Medically Underserved Area in Washington State. Vaccines. 2024; 12(7):768. https://doi.org/10.3390/vaccines12070768
Chicago/Turabian StyleMcKeirnan, Kimberly, Damianne Brand, Megan Giruzzi, Kavya Vaitla, Nick Giruzzi, Rose Krebill-Prather, and Juliet Dang. 2024. "Evaluating Factors That Influence Influenza Vaccination Uptake among Pregnant People in a Medically Underserved Area in Washington State" Vaccines 12, no. 7: 768. https://doi.org/10.3390/vaccines12070768