A randomized trial of maternal influenza immunization decision-making: A test of persuasive messaging models.
We sought to examine the effectiveness of persuasive communication interventions on influenza vaccination uptake among black/African American pregnant women in Atlanta, Georgia.



We recruited black/African American pregnant women ages 18 to 50 y from Atlanta, GA to participate in a prospective, randomized controlled trial of influenza immunization messaging conducted from January to April 2013. Eligible participants were randomized to 3 study arms. We conducted follow-up questionnaires on influenza immunization at 30-days post-partum with all groups. Chi-square and t tests evaluated group differences, and outcome intention-to-treat assessment utilized log-binomial regression models.



Of the 106 enrolled, 95 women completed the study (90% retention), of which 31 were randomly assigned to affective messaging intervention ("Pregnant Pause" video), 30 to cognitive messaging intervention ("Vaccines for a Healthy Pregnancy" video), and 34 to a comparison condition (receipt of the Influenza Vaccine Information Statement). The three groups were balanced on baseline demographic characteristics and reported health behaviors. At baseline, most women (63%, n = 60) reported no receipt of seasonal influenza immunization during the previous 5 y. They expressed a low likelihood (2.1 ± 2.8 on 0-10 scale) of obtaining influenza immunization during their current pregnancy. At 30-days postpartum follow-up, influenza immunization was low among all participants (7-13%) demonstrating no effect after a single exposure to either affective messaging (RR = 1.10; 95% CI: 0.30-4.01) or cognitive messaging interventions (RR = 0.57; 95% CI: 0.11-2.88). Women cited various reasons for not obtaining maternal influenza immunizations. These included concern about vaccine harm (47%, n = 40), low perceived influenza infection risk (31%, n = 26), and a history of immunization nonreceipt (24%, n = 20).



The findings reflect the limitations associated with a single exposure to varying maternal influenza immunization message approaches on vaccine behavior. For this population, repeated influenza immunization exposures may be warranted with alterations in message format, content, and relevance for coverage improvement.
a Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases , Atlanta , GA , USA.|b Emory University, Rollins School of Public Health , Department of Behavioral Sciences and Health Education , Atlanta , GA , USA.|c Emory University, Rollins School of Public Health , Hubert Department of Global Health , Atlanta , GA , USA.
Paula M
PM
Frew
d Emory University, Rollins School of Public Health , Department of Epidemiology , Atlanta , GA , USA.
Jennifer L
JL
Kriss
d Emory University, Rollins School of Public Health , Department of Epidemiology , Atlanta , GA , USA.
Allison T
AT
Chamberlain
c Emory University, Rollins School of Public Health , Hubert Department of Global Health , Atlanta , GA , USA.
Fauzia
F
Malik
a Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases , Atlanta , GA , USA.
Yunmi
Y
Chung
c Emory University, Rollins School of Public Health , Hubert Department of Global Health , Atlanta , GA , USA.
Marielysse
M
Cortés
c Emory University, Rollins School of Public Health , Hubert Department of Global Health , Atlanta , GA , USA.|d Emory University, Rollins School of Public Health , Department of Epidemiology , Atlanta , GA , USA.
Saad B
SB
Omer
D000293:Adolescent; D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D044383:Black People; D003657:Decision Making; D005260:Female; D005845:Georgia; D058015:Health Communication / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007114:Immunization / Q000523:psychology* / Q000706:statistics & numerical data*; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011446:Prospective Studies; D055815:Young Adult; D001741:Black or African American
D007252:Influenza Vaccines
Elaboration Likelihood Model; Health Messages; Maternal Immunization; Persuasion Theory; Pregnancy; Randomized Controlled Trial