A Cross-Sectional Study of Maternity Care Providers' and Women's Knowledge, Attitudes, and Behaviours Towards Influenza Vaccination During Pregnancy

Background: Pregnant women are at increased risk of influenza-related complications, but research to examine barriers to maternal influenza vaccination has been limited and no studies have assessed the barriers to vaccinating pregnant women in Canada. Objectives: The objectives of the study were to assess (1) how the knowledge, attitudes, and beliefs of Canadian maternity care providers influence their discussion and recommendation patterns, and (2) how the knowledge, attitudes, and beliefs of Canadian women, along with care providers' recommendations, influence their acceptance of influenza vaccine during pregnancy. Methods: Two cross-sectional surveys, one of maternity care providers and one of postpartum women, were carried out between December 1, 2003, and March 31, 2004. Results: Multivariate logistic analysis demonstrated that high levels of provider knowledge about maternal vaccination (OR = 2.64; 95% CI 1.56-4.46), positive attitudes towards influenza vaccination (OR = 2.29; 95% CI 1.43-3.68), and increased age (OR = 1.03; 95% CI 1.02-1.06) were associated with recommending influenza vaccine to pregnant women. Similarly, women who had higher levels of knowledge about maternal vaccination (OR = 3.46; 95% CI 1.31-9.17), positive attitudes towards influenza vaccination (OR = 4.69; 95% CI 1.63-13.5), and a recommendation from their maternity care provider (OR = 32.3; 95% CI 10.4-100) were more likely to be vaccinated during pregnancy. One of the most striking provider barriers identified was uncertainty about who bears responsibility for discussion, recommendation, and vaccination. Conclusion: Maternity care provider recommendation was found to be an important element in increasing influenza vaccination rates during pregnancy. Clarity about responsibility for providing vaccine is needed.