Title: MAternal Vaccination In the NHS (MAVIS) Study: A mixed methods approach to improving antenatal immunisation rates, focusing on pertussis
Funder: Department of Health and Social Care

Abstract: Pertussis vaccination is recommended for pregnant women to give neonates passive immunity from birth when they are highly vulnerable to this prevalent infection. 30% pregnant women in the UK do not receive the vaccine. Despite shifts to NHS maternity-service vaccine delivery to reduce barriers to uptake, coverage is declining, as it is for all child vaccinations. Maternal immunisation against multiple infant infections is developing rapidly nationally and globally. Understanding how to maximise effective delivery of such programmes is important. This research aims to identify how NHS maternity services can be supported to improve vaccination coverage, aiming to reduce inequities between demographic groups and NHS areas, with the following research objectives (ROs): RO1:Describe common characteristics of women who did/did not receive maternal pertussis vaccinationRO2:Analyse the relationship between maternal and infant vaccine uptakeRO3:Explore the views of maternity service healthcare professionals (HCPs) involved in delivering the maternal pertussis programme, comparing NHS areas with high and low vaccination rates to identify intervention targets to improve uptakeRO4:Explore women's views and experiences of maternal vaccination, focusing on those who missed their vaccine(s) to identify intervention targets to improve uptakeRO5:Produce intervention recommendations to improve maternity-service delivery of the pertussis vaccine Methods: Project 1 (RO1, RO2): Statistical analyses of national primary care record data using logistic regression modelling to ascertain; (i)whether there are predictors of/risk factors for low uptake and (ii)associations between maternal and infant vaccination uptake (completion 01/2022). Project 2 (RO3): (i)Development of a mixed-methods cross-sectional survey to identify barriers/facilitators to maternity-service delivery of pertussis vaccines and acceptable intervention targets, utilising theoretical frameworks of behavioural determinants, stakeholder consultation and Think-aloud user-testing; (ii)Administering national survey with HCPs at maternity services in NHS clinical commissioning group areas with the 10% highest and 10% lowest maternal pertussis vaccination coverage, with quantitative (logistic regression) and qualitative (thematic) analysis of responses; (iii)Qualitative semi-structured (thematically analysed) interviews with HCPs will supplement survey data (completion 03/2023). Project 3 (RO4): (i)Development of a mixed-methods cross-sectional patient survey (using PPI support and methodology used in project 2) to identify barriers/facilitators to pregnant women's uptake of pertussis vaccination and acceptable intervention targets; (ii)Administering national survey to recently pregnant women via GP mailout, oversampling those who did not receive maternal pertussis vaccination (iii)Qualitative patient interviews (completion 01/2024). Project 4 (RO5): Triangulation of findings to produce intervention recommendations to improve pertussis vaccination delivery across maternity services and to demographic groups, drawing on stakeholder and PPI consultation (completion 05/2024). NHS Impact: This research will produce evidence-based intervention recommendations for improving maternity-service delivery of pertussis immunisation, which can immediately feed into policy and guidelines, while offering potential to inform efficient delivery of existing (influenza) and future (e.g. RSV) maternal vaccination programmes. Dissemination: Research summaries will be shared with participating patients and HCPs. Results will be presented to the Joint Committee on Vaccination and Immunisation, WHO Euro Technical Advisory Group of Experts (ETAGE), NHS maternity services and policymakers, published in peer-reviewed journals and conferences and disseminated via video, blogs and social media.

Lay abstract: Whooping cough is widespread, highly contagious and serious for new-born babies. Pregnant women are vaccinated against whooping cough to protect babies from birth until they are old enough for their own vaccination. The pregnancy vaccine is safe and effective, estimated to prevent around 6 deaths, 165 babies needing hospital treatment, and 2050 mothers becoming ill with whooping cough every year. Thirty percent of pregnant women in the UK do not receive the vaccine, leading to avoidable illness and death. Women from ethnic minority backgrounds are less likely to be vaccinated but we do not know why. The vaccine is now offered at the same time as the 20-week ultrasound scan to make it more accessible for women. Unfortunately, vaccination rates have recently been falling and are highly variable across the country. The reasons are unknown. According to the World Health Organisation, vaccine hesitancy is a top ten global health threat. We do not know if mothers who are not vaccinated in pregnancy are less likely to vaccinate their children. Improving pregnancy vaccination rates may increase child vaccine rates. Aim: This research aims to identify why pregnant women are not being vaccinated against whooping cough and how to maximise delivery by maternity services and mothers' acceptance of vaccines. Design/methods: 1) I will study national GP records to see what characteristics (e.g. ethnicity, age, first child, location) may predict whether a pregnant woman is vaccinated. I will then link mothers' and children's records to investigate the relationship between rates of vaccination in mothers and their children. 2) I will use a mixed methods approach to identify barriers and facilitators to delivery of whooping cough vaccination, recruiting maternity services from the highest and lowest vaccinating NHS areas. I will work with a healthcare professional (HCP) stakeholder group to design a questionnaire to explore practical barriers and HCP attitudes to vaccine delivery, drawing on well-established theories about what influences behaviour. HCPs from the highest and lowest vaccinating areas will complete the questionnaire online and take part in additional interviews. I will analysis the data to identify reasons for differences between high and low vaccinating areas in the UK to identify mechanisms for change. 3) I will use a mixed methods approach to identify barriers and facilitators to vaccine acceptance in women, interviewing women who have recently had a baby to identify the range of issues. I will design a questionnaire using similar methods as for project 2. Using GP records, women who did and did not receive whooping cough vaccination will be invited to complete the online questionnaire by their GP surgery. Data analysis will identify the relative importance of vaccine hesitancy, practical and communication barriers and identify mechanisms for change. 4) Using well-established methods for designing interventions and working with stakeholder and patient groups, I will produce intervention recommendations to increase the number of pregnant women receiving the whooping cough vaccine and to inform other mother and child vaccine programmes. Patient and public involvement (PPI): Discussions with eight women (currently or recently pregnant) identified appropriate methods for recruiting women. PPI consultation will be ongoing during the project to help design the research and interpret findings. I am leading an initiative to coordinate support across child health projects and increase the diversity of PPI representation and will draw on this wider panel for support. Dissemination: I will publish results in peer-reviewed journals and use a range of dissemination channels and accessible materials including lay summaries, videos, blogs and social media for patient and public presentation. I will present results to national and international organisations involved in vaccine delivery programmes to ensure maximum clinical impact.

Research activity codes: 3.4 VACCINES
Health categories: INFECTION;REPRODUCTIVE HEALTH AND CHILDBIRTH