title: Skewed risk perceptions in pregnant women: the case of influenza vaccination.
abstract: BACKGROUND
  Pregnant women and their newborns have an increased risk of developing severe influenza and influenza-related complications. In Germany, seasonal influenza vaccination is recommended for pregnant women since 2010. However, little is known about pregnant women's vaccination-related knowledge and attitudes, as well as their risk perceptions. This study therefore assessed pregnant women's vaccination-related knowledge, risk perceptions related to influenza disease and influenza vaccination during pregnancy, and aimed to identify determinants of influenza vaccination uptake during pregnancy in Germany.
  
  
  METHODS
  Between 2012 and 2014, a nationwide web-based prospective cohort study with follow-up interviews was conducted in initially pregnant women who gave birth over the study period. Control groups were set up in a cross-sectional fashion during the follow-up interviews. Women who participated in both, the baseline interview before giving birth and in the 1st interview after giving birth were included in the analysis. Univariate and multiple logistic regression were used to identify associations between influenza vaccination uptake and sociodemographic characteristics as well as items assessing attitude and knowledge.
  
  
  RESULTS
  In total, 838 women were included in the analyses. Pregnant women had a positive attitude towards vaccination in general, but only modest vaccination knowledge. Overall, 10.9 % of women were vaccinated against seasonal influenza during pregnancy. While pregnant women perceived classical childhood diseases to be more risky than the respective vaccinations, this relation reversed for influenza: The risk of vaccination was perceived higher than the risk of the disease. These two types of risk perceptions independently determined influenza vaccination uptake-higher perception of disease risk and lower perceptions of vaccination-related risks increased uptake. Additionally, knowledge about the vaccination recommendation for pregnant women and a positive gynaecologist's attitude towards vaccination during pregnancy influenced the uptake significantly.
  
  
  CONCLUSIONS
  Influenza vaccination uptake in pregnant women is low in Germany. Tailored communication strategies for pregnant women should focus especially on changing the perceptions of personal risks regarding influenza and influenza vaccination during pregnancy. Gynaecologists should be made aware about their crucial role in supporting vaccination decision-making of pregnant women and the need to provide relevant information to counteract misconceptions.
authors.affiliation: Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany. BoedekerB@rki.de.|Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. BoedekerB@rki.de.
authors.forename: Birte
authors.initials: B
authors.lastname: Bödeker
authors.affiliation: Department of Psychology, Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Nordhäuserstraße 63, 99089, Erfurt, Germany.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Betsch
authors.affiliation: Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany.
authors.forename: Ole
authors.initials: O
authors.lastname: Wichmann
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage; D007251:Influenza, Human / Q000517:prevention & control*; D008875:Middle Aged; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011446:Prospective Studies; D036301:Qualitative Research; D018570:Risk Assessment; D014611:Vaccination / Q000523:psychology*; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines
keywords: Attitudes; Germany; Influenza; Pregnancy; Risk perception; Vaccination