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COVID19 vaccine hesitancy among perinatal women at risk for health disparities

面临健康差异风险的围产期妇女对新冠病毒疫苗接种犹豫不决

基本信息

批准号：
10575972
负责人：
CYNTHIA L. BATTLE
金额：
$ 20.5万
依托单位：
BUTLER HOSPITAL (PROVIDENCE, RI)
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-01-01 至 2024-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10575972
关键词：
Address Admission activity Affective African American American College of Obstetricians and Gynecologists Area Attention Attitude Automobile Driving Behavior Black race COVID-19 COVID-19 pandemic COVID-19 risk COVID-19 vaccination COVID-19 vaccine Centers for Disease Control and Prevention (U.S.)Cessation of life Child Child Health Cognitive Communication Communities Counseling Data Decision Making Development Disadvantaged Discipline of obstetrics Education Enrollment Ethnic Population Family Practice Federally Qualified Health Center Health Health Personnel High Risk Woman Infant Infection Interview Investigation Knowledge Lactation Latina Light Linear Models Location Maternal Mortality Mechanical ventilation Medical Methods Midwife Modeling Mothers Nurses Outcome Patients Perinatal Phase Planning Theory Population Postpartum Period Postpartum Women Pregnancy Pregnant Women Premature Birth Prenatal care Primary Care Procedures Provider Public Health Recommendation Research Risk Role SARS-CoV-2 infection Safety Sampling Secondary Immunization Services Shapes Structure Suggestion Surveys United States Vaccinated Vaccination Vaccines Vulnerable Populations Woman Women&apos s Group Work adverse birth outcomes adverse outcome care providers design disadvantaged women effective intervention ethnic minority experience health care service health disparity health organization high risk improved infant outcome innovation maternal morbidity maternal vaccination mortality novel strategies offspring participant enrollment perinatal period perinatal women pregnant prenatal provider behavior psychological symptom racial minority racial population recruit therapy development unvaccinated uptake vaccination outcome vaccine acceptance vaccine hesitancy vaccine refusal women of color

项目摘要

Abstract Despite safety data supporting use of COVID-19 vaccines among pregnant and lactating women, COVID-19 vaccine coverage among perinatal women in the United States is very low, with uptake even lower among some racial and ethnic groups such as Black/African American and Latina women. Concerningly, pregnancy is associated with more severe outcomes associated with COVID-19 infection: pregnant women with COVID-19 have higher rates of ICU admission, mechanical ventilation, and mortality compared to women with COVID-19 who are not pregnant. Further, infants born to women with COVID-19 are more likely to be born preterm, potentially leading to numerous downstream negative consequences for the child’s health and development. In spite of the high stakes of infection for women and their offspring, little is known about factors contributing to COVID-19 vaccine hesitancy (VH) and refusal among perinatal women, particularly those at highest risk for health disparities. Identifying factors contributing to VH among this vulnerable group of women is crucial to the development of effective interventions to promote vaccine uptake. Further, little is known about factors relating to prenatal care provider behavior and recommendations regarding COVID-19 vaccination during pregnancy and postpartum. Our experienced, interdisciplinary team proposes a 2-year, mixed methods R21 investigation that includes both a patient component and a provider component in order to identify key factors contributing to COVID-19 vaccine uptake and refusal in the perinatal period. In the patient component, we will recruit 120 English and Spanish-speaking financially-disadvantaged pregnant and postpartum women, including half who were vaccinated in pregnancy and half who are unvaccinated. Guided by the Theory of Planned Behavior and the Five C’s model of Vaccine Hesitancy, and with input from a diverse group of community stakeholders, we will assess cognitive and affective factors, psychological symptoms, medical mistrust, and other contributors to vaccine decision-making. We will conduct qualitative interviews with a subset of women (n=30) to augment our understanding of factors driving vaccine reluctance and refusal. In the provider component, we will recruit 60 prenatal care providers who work with financially disadvantaged women (OBs, family medicine, midwives, nurses) to take part in an in-depth survey regarding factors contributing to VH, refusal and uptake during the perinatal period; a subset of 30 providers will take part in qualitative interviews to explore these issues further. Our analytic plan involves generalized linear models to examine predictors of patient vaccination outcomes, and qualitative thematic analysis to identify key themes women and providers endorse regarding COVID-19 vaccine hesitancy. Findings will inform provider education and services innovations, as well as intervention development to target increased vaccination uptake this vulnerable patient group.

摘要尽管安全数据支持在孕妇和哺乳期妇女中使用COVID-19疫苗，美国围产期妇女的疫苗覆盖率非常低，一些种族和族裔群体，如黑人/非裔美国人和拉丁美洲妇女。令人担忧的是，怀孕与COVID-19感染相关的更严重结局相关：COVID-19孕妇与COVID-19女性相比，ICU入院率、机械通气率和死亡率更高没有怀孕的人此外，患有COVID-19的女性所生的婴儿更有可能早产，这可能会对儿童的健康和发育造成许多下游负面后果。在尽管妇女及其后代感染的风险很高，但对导致感染的因素知之甚少。围产期妇女，特别是高危妇女对COVID-19疫苗的犹豫和拒绝健康差距。确定导致这一弱势妇女群体中的VH的因素，制定有效的干预措施，促进疫苗接种。此外，人们对有关因素知之甚少。产前护理提供者的行为和关于怀孕期间COVID-19疫苗接种的建议和产后。我们经验丰富的跨学科团队提出了一项为期2年的混合方法R21调查包括患者组件和提供者组件，以确定导致围产期COVID-19疫苗接种和拒绝。在患者部分，我们将招募120名讲英语和西班牙语的经济上处于不利地位的孕妇和产后妇女，其中一半人在怀孕期间接种了疫苗，一半人没有接种疫苗。以计划行为理论为指导，疫苗犹豫的五个C模型，以及来自不同社区利益相关者群体的投入，我们将评估认知和情感因素，心理症状，医疗不信任，以及其他因素，疫苗决策。我们将对一部分女性（n=30）进行定性访谈，以增强我们的了解导致不愿和拒绝接种疫苗的因素。在供应商部分，我们将招募60名为经济上处于不利地位的妇女工作的产前护理提供者（产科医生，家庭医学，助产士，护士）参加一项深入的调查，了解导致VH的因素，拒绝和吸收期间，围产期; 30名提供者将参加定性访谈，以进一步探讨这些问题。我们的分析计划涉及广义线性模型，以检查患者疫苗接种结果的预测因素，和定性专题分析，以确定妇女和提供者认可的有关COVID-19的关键主题疫苗犹豫调查结果将为提供者的教育和服务创新以及干预提供信息发展的目标是增加这一脆弱患者群体的疫苗接种率。