title: A qualitative study of vaccine acceptability and decision making among pregnant women in Morocco during the A (H1N1) pdm09 pandemic.
abstract: Vaccination uptake of pregnant women in Morocco during the A (H1N1) pdm09 pandemic was lower than expected. A qualitative study using open-ended questions was developed to explore the main determinants of acceptance and non-acceptance of the monovalent A (H1N1) pdm09 vaccine among pregnant women in Morocco and to identify information sources that influenced their decision-making process. The study sample included 123 vaccinated and unvaccinated pregnant women who were in their second or third trimester between December 2009 and March 2010. They took part in 14 focus group discussions and eight in-depth interviews in the districts of Casablanca and Kenitra. Thematic qualitative analysis identified reasons for vaccine non-acceptance: (1) fear of the monovalent A (H1N1) pdm09 vaccine, (2) belief in an A (H1N1) pdm09 pandemic conspiracy, (3) belief in the inapplicability of the monovalent A (H1N1) pdm09 vaccine to Moroccans, (4) lack of knowledge of the monovalent A (H1N1) pdm09 vaccine, and (5) challenges of vaccination services/logistics. Reasons for vaccine acceptance included: (1) perceived benefits and (2) modeling. Decision-making was strongly influenced by family, community, mass media, religious leaders and health providers suggesting that broad communication efforts should also be used to advocate for vaccination. Meaningful communication for future vaccine campaigns must consider these context-specific findings. As cultural and religious values are shared across many Arab countries, these findings may also provide valuable insights for seasonal influenza vaccine planning in the Middle East and North Africa region at large.
authors.affiliation: Global Disease Detection Center-Egypt, US Naval Medical Research Unit no. 3, Cairo, Egypt.
authors.forename: Anna-Leena
authors.initials: AL
authors.lastname: Lohiniva
authors.affiliation: Centre National de réfèrence Grippe-Institut National d'Hygiène-Ministry of Health, Rabat, Morocco.
authors.forename: Amal
authors.initials: A
authors.lastname: Barakat
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America; and Global Disease Detection Center-Egypt, US Naval Medical Research Unit no. 3, Cairo, Egypt.
authors.forename: Erica
authors.initials: E
authors.lastname: Dueger
authors.affiliation: Global Disease Detection Center-Egypt, US Naval Medical Research Unit no. 3, Cairo, Egypt.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Restrepo
authors.affiliation: Centre National de réfèrence Grippe-Institut National d'Hygiène-Ministry of Health, Rabat, Morocco.
authors.forename: Rajae
authors.initials: R
authors.lastname: El Aouad
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology*; D007252:Influenza Vaccines / Q000276:immunology*; D007251:Influenza, Human / Q000453:epidemiology* / Q000517:prevention & control*; D009018:Morocco; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000517:prevention & control; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D014611:Vaccination
chemical_list: D007252:Influenza Vaccines