Using Mixed Method Research to Inform and Refine a Maternal Immunization Campaign for Pregnant Women and Prenatal Care Providers

Background: Routine prenatal care in the United States includes recommendations for pregnant women to receive two vaccines during every pregnancy: tetanus, diphtheria, and acellular pertussis (Tdap) vaccine during the third trimester, and inactivated influenza (flu) vaccine anytime during flu season. Despite the importance of preventing flu and pertussis morbidity and mortality in pregnant women and their newborns, uptake of both vaccines remains suboptimal among pregnant women.

Program background: The Health Communication Science Office at CDC’s National Center for Immunization and Respiratory Diseases conducts ongoing research to understand the vaccine-related knowledge and attitudes of pregnant women and prenatal healthcare professionals (PHCPs), inform the development and distribution of educational materials and messages, and evaluate campaign process and outcome measures with these target audiences. Recent efforts build on research conducted in 2014, which highlighted the central importance of PHCP recommendation in pregnant women’s vaccination decisions, as well as the logistical barriers to vaccination encountered by many PHCPs.

Evaluation Methods and Results: In 2016, in-depth interviews were conducted with 24 PHCPs, followed by an online survey with 251 pregnant women, to test and refine messages and educational materials regarding the importance of Tdap and flu vaccination during pregnancy. While PHCPs interviewed had low awareness of CDC online resources for maternal vaccination, most reported that the information would be useful in their practice, and were supportive of the website’s content for both PHCPs and patients. Pregnant women surveyed considered messages about disease severity and messages designed to be delivered by PHCPs directly to them most helpful in accepting vaccines during pregnancy. Educational materials were well received by pregnant women with 55%, 52%, and 44%, reporting that the fact sheet, online quiz, and animated video, respectively, would influence their decision regarding vaccination during pregnancy.

Conclusions: Iterative target audience research has helped the National Center for Immunization and Respiratory Diseases develop and refine educational materials for PHCPs and pregnant women regarding vaccines recommended during pregnancy. Findings from research have guided the development of PHCP-directed materials and messages to support conversations with pregnant patients, as well as educational materials (animated video, online quiz, and listicles) intended to support healthy pregnancy messaging for pregnant women.

Implications for research and/or practice: Because most pregnant women trust their prenatal providers to recommend vaccines essential to their health and many are likely to get vaccinated if recommended and offered the vaccine in the provider’s office, CDC can assist PHCPs by providing support for patient education as well as tools to improve referral and documentation.  In addition, pregnant women are high information seeking and motivated to protect their babies. They use health information websites (50%) and social media sites like Facebook, YouTube, and Pinterest. We can use owned, earned, and paid media to reach this audience with engaging and relevant information to encourage vaccination.