Development work for an evaluation of a complex intervention to increase uptake of vaccinations in pregnancy among socio-economically and ethnically diverse populations

Development work questions: Can an intervention designed to address user, provider and systemic barriers to vaccination be co-developed with pregnant women/people, those planning a pregnancy, midwives and midwife assistants. Will our intervention be feasible to deliver and acceptable to users and providers. Will theory and evidence-based vaccine communication, co-developed with users and midwives, be feasible to deliver, actively offered by midwives (after training), and acceptable? Will videos with testimonies regarding maternal vaccine use be acceptable to pregnant women/people? Background: COVID-19, influenza, and pertussis vaccinations can protect pregnant women/people and their babies from mortality and serious illness. However, vaccine uptake remains low, especially in socio-economically deprived areas and among ethnic minorities. Our research with pregnant women/people and health care providers described the influences on vaccination and their recommendations to improve vaccine communication and uptake. Aims and objectives: Part 1: To develop a behavioural theory and evidence informed complex intervention designed to increase informed choice and uptake of maternal vaccinations in socio-economically and ethnically diverse populations by targeting user, provider and systemic barriers to vaccine uptake. Objectives: To Further examine systemic and provider barriers to vaccination in qualitative interviews with midwives, midwife assistants and senior midwives responsible for services. Co-develop with pregnant women/people, those intending to become pregnant and providers, vaccine communication and materials (printed/ digital formats) designed to increase informed choice about having vaccines in pregnancy. Co-develop video content of users and providers vaccine stories designed to increase women/people s confidence in maternal vaccines and alter social norms about vaccination. Co-develop intervention components with and for midwives targeting provider barriers to vaccination. This will include formalised midwife vaccine training targeting midwives misconceptions about vaccines and lack of confidence in talking with pregnant women about vaccines. Co-develop content targeting systemic barriers to vaccination identified in our previous and proposed research to make it easier to obtain vaccines. Part 2: To describe the acceptability, barriers to use and perceived impacts of our complex intervention from the perspectives of women/people who are pregnant or planning a pregnancy and midwives/ midwife assistants. Development work plan Setting: South London and Liverpool Methods: Working with potential users we will use established methods to co-develop vaccine communication and materials for delivery in ANCs, midwives training and videos of user s/provider s vaccination testimonies. Outcomes: We will conduct about 20 semi-structured interviews with pregnant women/people and 20 midwives to explore the acceptability, barriers to use and positive or negative impacts of the intervention. Timelines for delivery. 0-12 months – intervention development 10-14 months – writing-up Anticipated impacts and dissemination. Our work will result in an intervention to increase vaccination that is feasible to deliver and acceptable. We will apply for a programme grant to evaluate the effectiveness of the intervention in a randomised controlled trial. We will evaluate its efficiency and impact when implemented. We will gain understanding of how to increase people s opportunities to make informed choices about maternal vaccination across social and ethnic groups. We anticipate our intervention will increase maternal vaccination rates and improve maternal and newborn health.