University of Oulu

Nichol B, McCready JL, Steen M, Unsworth J, Simonetti V, Tomietto M (2023) Barriers and facilitators of vaccine hesitancy for COVID-19, influenza, and pertussis during pregnancy and in mothers of infants under two years: An umbrella review. PLoS ONE 18(3): e0282525.

Barriers and facilitators of vaccine hesitancy for COVID-19, influenza, and pertussis during pregnancy and in mothers of infants under two years : an umbrella review

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Author: Nichol, Bethany1; McCready, Jemma Louise2; Steen, Mary2;
Organizations: 1Department of Social Work, Education and Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
2Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
3Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
4Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
5Visiting Professor, University of Bari “Aldo Moro”, Bari, Italy
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.9 MB)
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Language: English
Published: Public Library of Science, 2023
Publish Date: 2023-08-21


Background: Vaccination during pregnancy has been repeatedly demonstrated to be safe and effective in protecting against infection and associated harms for the mother, developing baby, and subsequent infant. However, maternal vaccination uptake remains low compared to the general population.

Objectives: An umbrella review to explore the barriers and facilitators to Influenza, Pertussis and COVID-19 vaccination during pregnancy and within 2 years after childbirth, and to inform interventions to encourage uptake (PROSPERO registration number: CRD42022327624).

Methods: Ten databases were searched for systematic reviews published between 2009 and April 2022 exploring the predictors of vaccination or effectiveness of interventions to improve vaccination for Pertussis, Influenza, or COVD-19. Both pregnant women and mothers of infants under two years were included. Barriers and facilitators were organised using the WHO model of determinants of vaccine hesitancy through narrative synthesis, the Joanna Briggs Institute checklist assessed review quality, and the degree of overlap of primary studies was calculated.

Results: 19 reviews were included. Considerable overlap was found especially for intervention reviews, and the quality of the included reviews and their primary studies varied. Sociodemographic factors were specifically researched in the context of COVID-19, exerting a small but consistent effect on vaccination. Concerns around the safety of vaccination particularly for the developing baby were a main barrier. While key facilitators included recommendation from a healthcare professional, previous vaccination, knowledge around vaccination, and communication with and support from social groups. Intervention reviews indicated multi-component interventions involving human interaction to be most effective.

Conclusion: The main barriers and facilitators for Influenza, Pertussis and COVID-19 vaccination have been identified and constitute the foundation for policy development at the international level. Ethnicity, socioeconomic status, concerns about vaccine safety and side effects, and lack of healthcare professionals’ recommendations, are the most relevant factors of vaccine hesitancy. Adapting educational interventions to specific populations, person-to-person interaction, healthcare professionals’ involvement, and interpersonal support are important strategies to improve uptake.

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Series: PLoS one
ISSN: 1932-6203
ISSN-E: 1932-6203
ISSN-L: 1932-6203
Volume: 18
Issue: 3
Article number: e0282525
DOI: 10.1371/journal.pone.0282525
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3142 Public health care science, environmental and occupational health
Funding: This study has been supported by an internal funding provided by Northumbria University at Newcastle Upon Tyne (UK) ( MT and JU received the funding. Bethany Nichol is the recipient. The funder had and will not have a role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Our study has been internally supported by the University of Northumbria (Newcastle). Due to this, we don’t have a formal letter from the funder, as usually required according to the PLOS One guidelines for the external funders.
Copyright information: © 2023 Nichol et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.