Table 3.
Overview of categories and (sub-)themes, VIP-IDEAL study, 2022
| Overarching Categories | Categories | (Sub-)Themesa |
|---|---|---|
| Structural and organisational factors | Organisation of and access to ANC | Limited GP involvement due to new midwife-led ANC services and access via new online self-referral system (and related confusion); delayed access/ disrupted ANC; organisational challenges and changes due to the Covid-19 pandemic (including remote ANC visits and suspension of continuity of care system) |
| ANC booking visit | Lack of time and limited vaccination-related information | |
| Subsequent ANC visits | Lack of time and lack of vaccination-related information and reminders | |
| Access to influenza and pertussis vaccines within maternity and at GP clinics | Access to influenza and pertussis vaccines within maternity; access to influenza and pertussis vaccines via GP versus maternity and recent changes; opportunistic vaccination | |
| Access to Covid vaccines within maternity and via vaccination centres | Temporary access to Covid vaccines in maternity in hospital; Access to Covid-vaccines at vaccination centres (including lack of special arrangement for pregnant women and reduced trust/confusion about change of guidance) | |
| Access to maternal vaccines via pharmacies | Access to maternal vaccines via pharmacies (including advantages and barriers) | |
| Resources, roles and responsibilities | Resource challenges in maternity services (including lack of staffing, space and supply) and in pharmacies; vaccination-related roles and responsibilities of different providers | |
| Health information system and Apps | Insufficient information transfer between providers and shortcomings of electronic health records, referral systems and documentation; lack of user-friendliness of apps and not used to access vaccine information; information for participants via app versus hardcopy material (including digital exclusion and language barriers) | |
| Behavioural factors | Passive versus active decision-making process | Passive decision-making; active decision-making (with own research) |
| Interaction with HCP/ Provider recommendations |
Recommendation against Covid-19 vaccines or no clear recommendation or information; no clear recommendation/ no information/dialogue regarding pertussis and influenza vaccines; importance of not putting pressure on women, and vaccination as personal decision; unambiguous recommendation as facilitator of vaccine uptake |
|
| Engagement with information material and social media | Hardcopy or electronic leaflets; Searching online/ via social media (including to fill information gaps and to search for personal stories from others) | |
| Interaction with family, friends and others | Interaction with and influence of mothers, partners and others (including personal stories); interest in decisions of other pregnant women (including in waiting rooms) | |
| Individual characteristics and influences on vaccination decisions: | ||
| Risk–benefit perceptions | Risk benefit evaluation and motivation to accept/recommend vaccines (including based on own/ others previous experience of vaccine/vaccine-preventable disease); perceived risk and benefit of vaccine/vaccine-preventable disease on baby and/or/versus mother; perception of pregnancy as vulnerability; perceived susceptibility/ risks in case of underlying health conditions or complications; perceived risk and individual biological differences; risk evaluation based on exposure; alternative risk-mitigating behaviour | |
| Knowledge and skills | Conflicting information; misconceptions and general health knowledge; lack of awareness or information about vaccines; ability/ opportunity to ask HCPs questions; lack of HCP training, knowledge or specific information to pass on to clients; commitment of some HCP to relay information and have honest dialogue; lack of research evidence; language and digital skills | |
| Emotions and trust | Fear of vaccine and/or vaccine-preventable disease; trust in healthcare system and HCP; reduced trust and/or confusion due to change of guidance; lack of trust and historical events; lack of trust and ethnicity; lack of trust and conspiracy theories/ misinformation; emotions and trust linked to pressure and mandatory vaccines | |
| Cultural norms, philosophy and beliefs | Social and cultural norms, including in country of origin/ abroad; religion and Covid-19 vaccination; other beliefs and philosophy (including letting nature take its course, preference for natural products and homeopathy); attitudes regarding altruistic reasons for vaccination | |
| Attitude towards mandatory Covid-19 vaccines | Vaccination needed for travel or work; planned mandatory vaccines for HCP; perceived pressure/ no pressure to get vaccinated | |
| Participant recommendations | (Relating to various categories above) | Clearer provider recommendation, vaccination dialogue and more information; vaccination programmes and messages more targeted to pregnant women, and more personalised; provider training; organisational changes (including opt-out versus opt-in approach); increased accessibility; improved health information systems and apps; Provision of hardcopy information material to avoid digital exclusion; addressing language barriers |
aOverarching categories and categories correlate with headings and sub-headings in the results section; The (sub-)themes or explanations that are placed in the third column are described/referred to in the text with additional anonymised exemplary quotes in supplementary file 4; ANC Antenatal care, HCP Health care professional