COVID19 vaccine hesitancy among perinatal women at risk for health disparities

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， 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的妇女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 了解导致疫苗不情愿和拒绝的因素。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。

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.