Socioecological and message framing factors influencing maternal influenza immunization among minority women.
OBJECTIVE
A suboptimal level of seasonal influenza vaccination among pregnant minority women is an intractable public health problem, requiring effective message resonance with this population. We evaluated the effects of randomized exposure to messages which emphasize positive outcomes of vaccination ("gain-frame"), or messages which emphasize negative outcomes of forgoing vaccination ("loss-frame"). We also assessed multilevel social and community factors that influence maternal immunization among racially and ethnically diverse populations.


METHODS
Minority pregnant women in metropolitan Atlanta were enrolled in the longitudinal study and randomized to receive intervention or control messages. A postpartum questionnaire administered 30 days postpartum evaluated immunization outcomes following baseline message exposure among the study population. We evaluated key outcomes using bivariate and multivariate analyses.


RESULTS
Neither gain- [OR=0.5176, (95% CI: 0.203,1.322)] nor loss-framed [OR=0.5000, 95% CI: (0.192,1.304)] messages were significantly associated with increased likelihood of immunization during pregnancy. Significant correlates of seasonal influenza immunization during pregnancy included healthcare provider recommendation [OR=3.934, 95% CI: (1.331,11.627)], use of hospital-based practices as primary source of prenatal care [OR=2.584, 95% CI: (1.091,6.122)], and perceived interpersonal support for influenza immunization [OR=3.405, 95% CI: (1.412,8.212)].


CONCLUSIONS
Dissemination of vaccine education messages via healthcare providers, and cultivating support from social networks, will improve seasonal influenza immunization among pregnant minority women.
Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Decatur, GA, United States; Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Atlanta, GA, United States. Electronic address: pfrew@emory.edu.
Paula M
PM
Frew
Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Decatur, GA, United States; Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, United States.
Diane S
DS
Saint-Victor
Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Decatur, GA, United States; Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA, United States.
Lauren E
LE
Owens
Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA, United States.
Saad B
SB
Omer
D000293:Adolescent; D000328:Adult; D005260:Female; D005845:Georgia; D058015:Health Communication / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control; D033181:Information Dissemination; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D011247:Pregnancy; D037841:Pregnant People; D012959:Socioeconomic Factors; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
D007252:Influenza Vaccines
Immunization coverage; Influenza vaccination; Message framing; Pregnant women; Prospect theory; Racial/ethnic minorities; Socioecological model