title: 'Out of two bad choices, I took the slightly better one': vaccination dilemmas for Scottish and Polish migrant women during the H1N1 influenza pandemic.
abstract: OBJECTIVE
  Pregnancy has been identified as a risk factor for complications from pandemic H1N1 influenza, and pregnant women were identified as a target group for vaccination in the UK in the 2009 pandemic. Poland took a more conservative approach, and did not offer vaccination to pregnant women. Poland accounts for the largest wave of recent migrants to the UK, many of whom are in their reproductive years and continue to participate actively in Polish healthcare systems after migration. The authors speculated that different national responses may shape differences in approaches to the vaccine between Scottish and Polish women. This study therefore aimed to assess how pregnant Polish migrants to Scotland weighed up the risks and benefits of the vaccine for pandemic H1N1 influenza in comparison with their Scottish counterparts.
  
  
  METHODS
  A qualitative interview-based study comparing the views of Scottish and Polish pregnant women on H1N1 vaccination was carried out in 'real time' during the first 2 weeks of the vaccination programme in November 2009.
  
  
  METHODS
  One-to-one interviews were conducted with 10 women (five Polish and five Scottish) in their native language. Interviews were transcribed, translated, coded and analysed for differences and similarities in decision-making processes between the two groups.
  
  
  RESULTS
  Contrary to expectations, Scottish and Polish women drew on a strikingly similar set of considerations in deciding whether or not to accept the vaccine, with individual women reaching different conclusions. Almost all of the women adopted a critical stance towards the vaccine. While most women understood that pregnancy was a risk factor for complications from influenza, their primary concern was protecting family health overall and their fetus in particular. Deciding whether or not to accept the vaccine was difficult for women. Some identified a contradiction between the culture of caution which characterizes pregnancy-related advice, and the fact that they were being urged to accept what was perceived as a relatively untested vaccine. Their health histories, individual constitutions, and whether their everyday routines exposed them to sources of infection combined to establish their perceived 'candidacy' for contracting infection. Neither Scottish nor Polish women felt that 'official' information addressed their concerns in sufficient detail, and almost all of the women sought information from a variety of sources. Polish women found it more difficult to access information and advice from the National Health Service than their Scottish counterparts. For most respondents, deciding whether or not to accept the vaccine was an attenuated process, culminating for many in choosing the 'least worst' option in the context of competing risks.
  
  
  CONCLUSIONS
  To the authors' knowledge, this is the first study to assess perceptions of H1N1 immunization risk in pregnant women in 'real time'. It highlights the important unmet needs for information that women need to be able to make informed vaccination choices, and the challenges of producing such information in a context of uncertainty. This is of particular relevance as many countries, including the UK, are actively reviewing their plans for vaccination programmes during pregnancy.
authors.affiliation: Directorate of Public Health and Health Policy, NHS Lothian Waverley Gate, 2-4 Waterloo Place, Edinburgh EH13EG, UK. Judith.sim@nhslothian.scot.nhs.uk
authors.forename: J A
authors.initials: JA
authors.lastname: Sim
authors.forename: A A
authors.initials: AA
authors.lastname: Ulanika
authors.forename: S V
authors.initials: SV
authors.lastname: Katikireddi
authors.forename: D
authors.initials: D
authors.lastname: Gorman
mesh_terms: D000328:Adult; D002755:Choice Behavior; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology*; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000009:adverse effects; D007251:Influenza, Human / Q000208:ethnology / Q000517:prevention & control*; D007407:Interviews as Topic; D058873:Pandemics; D010342:Patient Acceptance of Health Care; D011044:Poland / Q000208:ethnology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000208:ethnology / Q000517:prevention & control*; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D014171:Transients and Migrants; D014611:Vaccination / Q000523:psychology*; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines