Sociodemographic and Psychological Differences Between Levels of Vaccination Intention Among Pregnant Mothers
Main Article Content
Abstract
Introduction: Vaccination intention is a prospective variable to screen for potential vaccine refusal. Improving the level of vaccination intention requires tailoring the approach of intervention according to the sociodemographic and psychological characteristics of the parents. Health literacy, health self-efficacy, and health assertiveness were proposed as relevant psychological characteristics for consideration in health educational intervention. This study aimed to identify significant differences in health self-efficacy, health assertiveness, and health literacy between vaccination intention levels among pregnant mothers. Materials and methods: A cross-sectional survey was done multi-stage random sampling involving pregnant mothers from maternity and child health clinic in district of Petaling, Klang, Gombak, and Hulu Langat. A random subset of 172 respondents were chosen from the larger study sample to address the objective to be consistent with sample size calculated. Data was analysed using SPSS version 27 for descriptive statistics and chi-squared, independent t-tests, and two-way ANOVA for inferential statistics. Results: Education level (p = 0.022), household income level (p = 0.004), health assertiveness (p < 0.001), and health literacy (p = 0.003) showed significantly higher value in high vaccination intention groups. Health self-efficacy showed no significant differences between the two groups. Multivariate analysis reported no interaction effects between the groups. Conclusion: Each of the characteristics warrant a tailored approach to intervention for improving or maintaining the levels of vaccination intention. Both significant characteristics were conceptually related to vaccination knowledge, hence supporting the importance of tailored health education to pregnant mothers.
Downloads
Article Details
References
World Health Organisation. Report of the SAGE working group on vaccine hesitancy. World Health Organisation; 2014. Report No.: 0022-538X (Print)r0022-538X (Linking). Available from: https://www.asset-scienceinsociety.eu/sites/default/files/sage_working_group_revised_report_vaccine_hesitancy.pdf
Danchin MH, Costa-Pinto J, Attwell K, Willaby H, Wiley K, Hoq M, et al. Vaccine decision-making begins in pregnancy: Correlation between vaccine concerns, intentions and maternal vaccination with subsequent childhood vaccine uptake. Vaccine. 2018;36(44):6473-9. doi: 10.1016/j.vaccine.2017.08.003.
Knijff M, van Lier A, Boer M, de Vries M, Hament JM, de Melker HE. Parental intention, attitudes, beliefs, trust and deliberation towards childhood vaccination in the Netherlands in 2022: Indications of change compared to 2013. Vaccine. 2024;42(4):801-11. doi: 10.1016/j.vaccine.2023.12.080.
Wu AMS, Lau JTF, Ma YL, Cheng KM, Lau MMC. A longitudinal study using parental cognitions based on the theory of planned behavior to predict childhood influenza vaccination. J Infect Public Health. 2020;13(7):970-9. doi: 10.1016/j.jiph.2020.04.009.
Mastura MS, Juwita S, Siti Suhaila MY, Wan Mohamad WMZ. Knowledge, decision-making and acceptance of human papilloma virus vaccination among parents of primary school students in Kota Bharu, Kelantan, Malaysia. Asian Pac J Cancer Prev. 2018;19(6):1509-14. doi: 10.22034/APJCP.2018.19.6.1509.
Hough-Telford C, Kimberlin DW, Aban I, Hitchcock WP, Almquist J, Kratz R, O’Connor KG. Vaccine Delays, Refusals, and Patient Dismissals: A Survey of Pediatricians. Pediatrics. 2016;138(3):e20162127. doi: 10.1542/peds.2016-2127.
Wiley KE, Leask J, Attwell K, Helps C, Degeling C, Ward P, Carter SM. Parenting and the vaccine refusal process: A new explanation of the relationship between lifestyle and vaccination trajectories. Soc Sci Med. 2020;263:113259. doi: 10.1016/j.socscimed.2020.113259.
Vrdelja M, Učakar V, Kraigher A. From mandatory to voluntary vaccination: Intention to vaccinate in the case of policy changes. Public Health. 2020;180:57-63. doi: 10.1016/j.puhe.2019.10.026.
Musa AF, Soni T, Cheong XP, Nordin RB. Vaccine hesitancy among parents in Kuala Lumpur: a single center study. F1000Research. 2019;8. Available from: https://f1000research.com/articles/8-1653.
Siddiqui M, Salmon DA, Omer SB. Epidemiology of vaccine hesitancy in the United States. Hum Vaccin Immunother. 2013;9(12):2643-8. doi: 10.4161/hv.27243.
Fefferman NH, Naumova EN. Dangers of vaccine refusal near the herd immunity threshold: a modelling study. Lancet Infect Dis. 2015;15(8):922-6. doi: 10.1016/S1473-3099(15)00053-5.
Gowda C, Schaffer SE, Kopec K, Markel A, Dempsey AF. A pilot study on the effects of individually tailored education for MMR vaccine-hesitant parents on MMR vaccination intention. Hum Vaccin Immunother. 2013;9(2):437-45. doi: 10.4161/hv.22821.
Yang TU, Cheong HJ, Song JY, Noh JY, Kim WJ. Survey on public awareness, attitudes, and barriers for herpes zoster vaccination in South Korea. Hum Vaccin Immunother. 2015;11(3):719-26. doi: 10.1080/21645515.2015.1008885.
Repalust A, Šević S, Rihtar S, Štulhofer A. Childhood vaccine refusal and hesitancy intentions in Croatia: insights from a population-based study. Psychol Health Med. 2017;22(9):1045-55. doi: 10.1080/13548506.2016.1263756.
Bocquier A, Ward J, Raude J, Peretti-Watel P, Verger P. Socioeconomic differences in childhood vaccination in developed countries: a systematic review of quantitative studies. Expert Rev Vaccines. 2017;16(11):1107-18. doi: 10.1080/14760584.2017.1381020.
Zychlinsky Scharff A, Paulsen M, Schaefer P, Tanisik F, Sugianto RI, Stanislawski N, et al. Students' age and parental level of education influence COVID-19 vaccination hesitancy. Eur J Pediatr. 2022;181(4):1757-62. doi: 10.1007/s00431-021-04343-1.
Wong LP. Knowledge and attitudes about HPV infection, HPV vaccination, and cervical cancer among rural southeast Asian women. Int J Behav Med. 2011;18(2):105-11. doi: 10.1007/s12529-010-9104-y.
Kalok A, Loh SYE, Chew KT, Abdul Aziz NH, Shah SA, Ahmad S, et al. Vaccine hesitancy towards childhood immunisation amongst urban pregnant mothers in Malaysia. Vaccine. 2020;38(9):2183-9. doi: 10.1016/j.vaccine.2020.01.043.
Zou X, Chen Q, Zhang Y, Evans R. Predicting COVID-19 vaccination intentions: the roles of threat appraisal, coping appraisal, subjective norms, and negative affect. BMC Public Health. 2023;23(1):230. doi: 10.1186/s12889-023-15169-x.
Wang Y, Zhang X. Influence of Parental Psychological Flexibility on Pediatric COVID-19 Vaccine Hesitancy: Mediating Role of Self-Efficacy and Coping Style. Front Psychol. 2021;12:783401. doi: 10.3389/fpsyg.2021.783401.
Gavaruzzi T, Caserotti M, Leo I, Tasso A, Speri L, Ferro A, et al. The Role of Emotional Competences in Parents' Vaccine Hesitancy. Vaccines (Basel). 2021;9(3). doi: 10.3390/vaccines9030298.
Lorini C, Santomauro F, Donzellini M, Capecchi L, Bechini A, Boccalini S, et al. Health literacy and vaccination: A systematic review. Hum Vaccin Immunother. 2018;14(2):478-88. doi: 10.1080/21645515.2017.1392423.
Ames HMR, Glenton C, Lewin S. Parents' and informal caregivers' views and experiences of communication about routine childhood vaccination: a synthesis of qualitative evidence. CDSR. 2017(2). doi: 10.1002/14651858.CD011787.pub2.
Rosso A, Massimi A, De Vito C, Adamo G, Baccolini V, Marzuillo C, et al. Knowledge and attitudes on pediatric vaccinations and intention to vaccinate in a sample of pregnant women from the City of Rome. Vaccine. 2019;37(14):1954-63. doi: 10.1016/j.vaccine.2019.02.049.
Wong LP, Wong PF, AbuBakar S. Vaccine hesitancy and the resurgence of vaccine preventable diseases: the way forward for Malaysia, a Southeast Asian country. Hum Vaccin Immunother. 2020;16(7):1511-20. doi: 10.1080/21645515.2019.1706935
Pugliese-Garcia M, Heyerdahl LW, Mwamba C, Nkwemu S, Chilengi R, Demolis R, et al. Factors influencing vaccine acceptance and hesitancy in three informal settlements in Lusaka, Zambia. Vaccine. 2018;36(37):5617-24. doi: 10.1016/j.vaccine.2018.07.042.
Farrukh MJ, Ming LC, Zaidi STR, Khan TM. Barriers and strategies to improve influenza vaccination in Pakistan. J Infect Public Heal. 2017;10(6):881-3. doi: 10.1016/j.jiph.2016.11.021.
Mohd Baharudin JA, Mohd Zain MR, Taib F, Abd Hamid IJ. Knowledge and practice of childhood immunisation among parents in Kelantan, Malaysia: A cross-sectional study. Malaysian Family Physician : the Official Journal of the Academy of Family Physicians of Malaysia. 2024;19:6 - doi:10.51866/oa.202.
Ahmad M, Majid U. The value of information: a qualitative analysis of how trust in information sources influences the decision to vaccinate in parents. J Risk Res. 2022;25(11-12):1444-57. doi: 10.1080/13669877.2022.2142949
Lasseter G, Al-Janabi H, Trotter CL, Carroll FE, Christensen H. Understanding the role of peace of mind in childhood vaccination: A qualitative study with members of the general public. Vaccine. 2020;38(10):2424-32. doi: 10.1016/j.vaccine.2019.12.009.
Rozbroj T, Lyons A, Lucke J. Psychosocial and demographic characteristics relating to vaccine attitudes in Australia. Patient Educ Couns. 2018;102(1):172-9. doi: 10.1016/j.pec.2018.08.027.
Lockhart S, Dempsey AF, Pyrzanowski J, O'Leary ST, Barnard JG. Provider and Parent Perspectives on Enhanced Communication Tools for Human Papillomavirus Vaccine-Hesitant Parents. Acad Pediatr. 2018;8(7):776-82. doi: 10.1016/j.acap.2018.05.012.
Nazori MNM, Ismail R, Rasudin NS, Mohamed R, Noor NM, Sulli Z, et al. Health Efficacy and Assertiveness Scale in Malay Language: a Validation Study. Malays J Public Health Med. 2022;22(1):227-35. https://doi.org/10.37268/mjphm/vol.22/no.1/art.1412
Cheong SM, Mohd Nor NS, Chan WL, Ambak R, Abdul Aziz NS, Mohd Zaki N, et al. Preliminary assessment of reliability and validation of the Newest Vital Sign questionnaire among obese housewives. Institute of Public Health; 2014. Available from: https://www.researchgate.net/publication/269818893_Preliminary_assessment_of_reliability_and_validation_of_the_Newest_Vital_Sign_questionnaire_among_obese_housewives.
Biasio LR. Vaccine hesitancy and health literacy. Hum Vaccin Immunother. 2017;13(3):701-2. doi: 10.1080/21645515.2016.1243633.
Veldwijk J, Van Der Heide I, Rademakers J, Schuit AJ, De Wit GA, Uiters E, Lambooij MS. Preferences for vaccination: Does health literacy make a difference? Med Decis Making. 2015;35(8):948-58. doi: 10.1177/0272989X15597225.
Aharony N, Goldman R. E-health literacy and the vaccination dilemma: An Israeli perspective. Inf Res. 2017;22(2):1-20. Available from: http://InformationR.net/ir/21-2/paper751.html
Amit Aharon A, Nehama H, Rishpon S, Baron-Epel O. Parents with high levels of communicative and critical health literacy are less likely to vaccinate their children. Patient Educ Couns. 2017;100(4):768-75. doi: 10.1016/j.pec.2016.11.016.
Meppelink CS, Smit EG, Fransen ML, Diviani N. “I was right about vaccination”: Confirmation bias and health literacy in online health information seeking. J Health Commun. 2019;24(2):129-40. doi: 10.1080/10810730.2019.1583701.
Fadda M, Galimberti E, Carraro V, Schulz PJ. What are parents' perspectives on psychological empowerment in the MMR vaccination decision? A focus group study. BMJ Open. 2016;6(4):1-9. doi: 10.1186/s12889-015-2200-9.
Orr D, Baram-Tsabari A, Landsman K. Social media as a platform for health-related public debates and discussions: the Polio vaccine on Facebook. Isr J Health Policy Res. 2016;5:34-. doi: 10.1186/s13584-016-0093-4.
Shay LA, Baldwin AS, Betts AC, Marks EG, Higashi RT, Street RL, et al. Parent-Provider Communication of HPV Vaccine Hesitancy. Pediatrics. 2018;141(6):e20172312-e. doi: 10.1542/peds.2017-2312.
Leask J, Kinnersley P, Jackson C, Cheater F, Bedford H, Rowles G. Communicating with parents about vaccination: A framework for health professionals. BMC Pediatrics. 2012;12(1):154-. doi: 10.1186/1471-2431-12-154.