Pregnant Women's Opinions and Acceptance of Influenza and Tdap Vaccines.

Background: Influenza and tetanus, diphtheria, and pertussis (Tdap) vaccinations during pregnancy protect mother and infant. However, acceptance of these vaccines during pregnancy is suboptimal, especially among Black women in the United States. We characterize vaccine intentions and opinions of pregnant patients at two prenatal care clinics before and after reading informational text. Methods: A survey was distributed to pregnant patients at prenatal clinics in Winchester, Virginia, and Jacksonville, Florida. The survey assessed patient demographics and vaccine opinions and acceptance before and after patients read informational text about the vaccines. Associations between demographics and vaccine opinions and acceptance were assessed using Chi-square; Principal Component Analysis was used to produce an influenza vaccine opinion score. Differences in the opinion score between groups were assessed by ANOVA and ANCOVA. Results: Respondents (n = 654) who identified as Black and with lower educational attainment reported lower receipt of the influenza vaccine outside of pregnancy and receipt of or plans to receive the influenza and Tdap vaccines during pregnancy (p < 0.001). Respondents' influenza vaccine practices outside of pregnancy were associated with their likelihood of getting the vaccine while pregnant. Most respondents found the informational text useful; among women not yet vaccinated, 26% reported they were more likely to receive the influenza vaccine and 49.9% more likely to receive the Tdap vaccine after reading the text. Conclusions: Women have varying opinions and make different decisions about immunization, with race and educational level being significant correlates. Participants generally welcomed information about vaccines, and many were influenced positively, especially for Tdap.

Comparison of different methods of patient education on preeclampsia: a randomized controlled trial.

BACKGROUND: Preeclampsia is a life-threatening condition unique to pregnancy that contributes to maternal mortality worldwide. Delays in diagnosis and treatment are contributing factors for most maternal deaths from preeclampsia. Patients who are educated and knowledgeable regarding this disease process may present earlier for care. OBJECTIVE: To assess whether two different visual aids are effective methods to educate patients about preeclampsia, and to evaluate the potential impact of these visual aids on patient anxiety. STUDY DESIGN: Primigravid participants at a tertiary care center were given a survey regarding preeclampsia knowledge 18-25 weeks gestation. Participants were then randomized to preeclampsia education with a graphic card, an educational video, or through routine prenatal care. Participants completed the survey again at 32-37 weeks gestation. We compared the follow-up preeclampsia knowledge score for each type of education as well as the level of anxiety after viewing the video or graphic card. RESULTS: Recruitment began 9 May 2016 and ceased 18 January 2017. A total of 179 patients were randomized and 150 participants completed the study, with 56 shown the graphic card, 45 shown the educational video, and 49 who had only routine prenatal counseling. The remaining 28 patients were lost to follow up and 1 was withdrawn. There was no significant difference in preeclampsia knowledge score at follow-up. There was no significant difference in anxiety score before and after viewing either educational tool for those randomized to either the graphic card (p = .64) or the video (p = .63). CONCLUSIONS: There is no additional improvement of patient knowledge retention when patients receive education with a graphic card versus an educational video over routine prenatal counseling. Patient anxiety does not appear to be impacted by preeclampsia education with a graphic card or an educational video.

Patient attitudes toward influenza and tetanus, diphtheria and acellular pertussis vaccination in pregnancy.

BACKGROUND: Routine influenza and tetanus, diphtheria and acellular pertussis (Tdap) vaccination of pregnant women to prevent poor maternal, fetal and neonatal outcomes is recommended practice; however, actual rates of influenza vaccine acceptance are typically well below the (Healthy People 2020, 2015) goal of 80%. OBJECTIVE: We sought to identify barriers to accepting either vaccination. MATERIALS AND METHODS: From December 2014 to April 2015 women were given a questionnaire eliciting their experiences, attitudes and history of influenza and Tdap vaccination in pregnancy during their routine prenatal care appointments at a tertiary care center. Patient demographics were included in the questionnaire. A similar questionnaire was administered to prenatal care providers. Patient influenza and Tdap vaccination acceptance rates were compared and predictors of vaccine acceptance were analyzed with bivariate logistic regression. RESULTS: Out of the 400 patient questionnaires distributed, 338 (84.5%) were completed and returned; 24 of 45 (53.3%) provider questionnaires were returned. Vaccination acceptance rates were 70.7% for the influenza vaccine and 76.3% for the Tdap vaccine. The logistic regression model indicated that predictors of acceptance for either vaccine in pregnancy are patient attitude and previous vaccination history. Patient attitudes were more favorable towards Tdap than influenza vaccination. The combination of healthcare provider recommendation and educational materials was significantly predictive of both Tdap and influenza vaccine acceptance. The most common reasons given for declining the influenza vaccine were safety concerns; the most common reasons given for declining the Tdap vaccine were that patients did not think it was required again when they received the vaccine before pregnancy. CONCLUSIONS: Our study suggests that providers can improve Tdap and influenza vaccination acceptance in pregnancy by recommending the vaccination in combination with provision of educational materials on the vaccines.

Influenza Vaccination among Pregnant Women: Patient Beliefs and Medical Provider Practices.

ACOG's research department recruited four medical centers to participate in a study on the attitudes and practices of medical providers and pregnant patients regarding influenza vaccination. Medical providers and patients were given voluntary surveys and medical record data was collected over two flu seasons, from 2013 to 2015. Discrepancies between self-reports of medical providers and patients and medical records were observed. Nearly 80% of patients self-reported accepting the influenza vaccine, but medical record data only reported 36% of patients accepting the vaccine. Similarly, all medical providers reported giving recommendations for the vaccine, but only 85% of patients reported receiving a recommendation. Age, education, a medical provider's recommendation, and educational materials were found to positively influence patient beliefs about the influenza vaccine. Accepting the vaccine was influenced by a patient's previous actions, beliefs, and a medical provider's recommendation. Patients who reported previously not accepting the vaccine and had negative feelings towards the vaccine but accepted it while pregnant reported concern for the health and safety of their baby. Future research should focus on groups that may be less likely to accept the vaccine and ways to dispel negative myths. Medical provider should continue to strongly recommend the vaccine and provide educational materials.