title: Intention to Accept Pertussis Vaccination for Cocooning: A Qualitative Study of the Determinants.
abstract: BACKGROUND
  Several countries have reported a resurgence of pertussis in the last decades. This puts infants (especially <6 months) at risk of severe complications, because they are too young to be fully protected by vaccination. The global pertussis initiative has proposed pertussis vaccination of young infants' close contacts, in order to reduce pertussis transmission and the burden of the disease on infants. Our aim is to explore the perceived determinants (barriers and facilitators) of intention to accept vaccination among the possible target groups of pertussis vaccination for cocooning. Consideration of these determinants is necessary to optimise the uptake of the vaccination.
  
  
  METHODS
  We conducted 13 focus groups and six individual semi-structured interviews with members of possible target groups for pertussis cocooning (i.e. parents, maternity assistants, midwives, and paediatric nurses) in the Netherlands. Here, both maternal pertussis vaccination as well as pertussis cocooning has not been implemented. The topic list was based on a literature review and a barrier framework. All interviews were transcribed verbatim and two researchers performed thematic content analysis.
  
  
  RESULTS
  The participants' risk perception, outcome expectations, general vaccination beliefs, moral norms, opinion of others, perceived autonomy, anticipated regret, decisional uncertainty, and perceived organisational barriers were all factors that influenced the intention to accept pertussis vaccination for cocooning.
  
  
  CONCLUSIONS
  This study has identified nine perceived determinants that influence the intention to accept pertussis cocooning vaccination. We add the following determinants to the literature: perceived cost-effectiveness (as a concept of outcome expectations), justice (as a concept of moral norms), anticipated regret, and decisional uncertainty. We recommend considering these determinants in vaccination programmes for pertussis cocooning vaccination. Experience, information and trust emerged as predominant themes within these determinants. These themes require particular attention in future research on vaccination acceptance, especially with regard to their role in use and implementation in policy and practice.
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Olga
authors.identifier: http://orcid.org/0000-0003-1228-2108
authors.initials: O
authors.lastname: Visser
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Jeannine L A
authors.initials: JL
authors.lastname: Hautvast
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Koos
authors.initials: K
authors.lastname: van der Velden
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Marlies E J L
authors.initials: ME
authors.lastname: Hulscher
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008880:Midwifery; D009426:Netherlands; D009726:Nurses; D010290:Parents; D011795:Surveys and Questionnaires; D014611:Vaccination; D014612:Vaccines / Q000009:adverse effects / Q000627:therapeutic use*; D014917:Whooping Cough / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission
chemical_list: D014612:Vaccines