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Factors Influencing Maternal Immunization Among Pregnant Immigrant and Refugee Women

Fox, Elizabeth Kathleen (2015)
Master's Thesis (58 pages)
Committee Chair / Thesis Adviser: Frew, Paula
Committee Members: Bednarczyk, Robert A
Research Fields: Health Sciences, Public Health; Health Sciences, Obstetrics and Gynecology
Partnering Agencies: Emory University schools, faculty or affiliated programs ; Georgia state or local health department ; Community-based non-profit organization (e.g., AID Atlanta)
Keywords: Maternal Immunization; Immigrant Women; Refugee Women; Influenza Vaccination; Tdap Vaccination; Group B Streptococcus; Vaccine Barriers and Facilitators; Vaccine Acceptance
Program: Rollins School of Public Health, Hubert Department of Global Health
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Background: During pregnancy women become more susceptible to disease due to suppression of cell-mediated immunity. Immigrant and refugee pregnant women are uniquely vulnerable because they face additional barriers to healthcare. Multiple advisory and professional groups recommend that pregnant women receive the influenza and the tetanus, diphtheria, and acellular pertussis (Tdap) vaccines to protect themselves and their infants from disease. However, vaccination rates remain low. Further, a Group B Streptococcus (GBS) vaccine is currently undergoing clinical trials and may soon be available to pregnant women to prevent colonization and intrapartum transmission of GBS to infants. The purpose of this study was to understand factors related to influenza, pertussis, and potential GBS immunization among pregnant refugee and immigrant women to have a better understanding of how to improve health outcomes, increase healthcare access, and reduce influenza, pertussis, and GBS-related morbidity and mortality.

Methods: In-depth interviews were conducted with sixteen pregnant women in metro Atlanta. Interviews were recorded and transcribed. Transcripts were then coded and analyzed using a grounded theory approach. Emergent themes and patterns were constructed into a conceptual framework.

Results: The most prevalent facilitators to vaccination include a provider recommendation, comorbidities, desire to keep baby healthy, and being offered the vaccine during a healthcare visit. Prevalent barriers include not being offered the vaccine, no knowledge of the disease (pertussis and GBS), and a lack of awareness that the vaccine is available for pregnant women.

Conclusions: The strongest theme to emerge was the influence a provider's recommendation has on vaccination status. A provider recommendation had the ability to overcome other barriers. These results suggest that providers can strongly impact vaccination rates in this population. Further research on providers' knowledge and attitudes towards maternal vaccination would be useful in determining why women are not being offered the vaccines and how to implement change. Although a provider recommendation alone has such a strong influence, education and engagement are still crucial components to health education and interventions targeted at this population. A three-pronged approach is recommended 1) Educate women 2) Engage women in adopting vaccination as a staying health strategy 3) Promotion by healthcare providers.

Table of Contents


Chapter 1: Introduction 1

Definition of Terms 7

Chapter 2: Literature Review 8

Chapter 3: Project Content

Methods 21

Results 24

Chapter 4: Discussion and Recommendations 39

References 48


application/pdf Factors Influencing Maternal Immunization Among Pregnant Immigrant and Refugee Women 58 pages (842.2 KB) [Access copy of Master's Thesis]
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