title: Evaluation of two vaccine education interventions to improve pertussis vaccination among pregnant African American women: A randomized controlled trial.
abstract: Vaccination coverage with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in pregnancy or immediately postpartum has been low. Limited data exist on rigorously evaluated interventions to increase maternal vaccination, including Tdap. Tailored messaging based on the Elaboration Likelihood Model (ELM) framework has been successful in improving uptake of some public health interventions. We evaluated the effect of two ELM-based vaccine educational interventions on Tdap vaccination among pregnant African American women, a group of women who tend to have lower vaccine uptake compared with other groups.
  
  
  
  We conducted a prospective randomized controlled trial to pilot test two interventions - an affective messaging video and a cognitive messaging iBook - among pregnant African American women recruited during routine prenatal care visits. We measured Tdap vaccination during the perinatal period (during pregnancy and immediately postpartum), reasons for non-vaccination, and intention to receive Tdap in the next pregnancy.
  
  
  
  Among the enrolled women (n=106), 90% completed follow-up. Tdap vaccination in the perinatal period was 18% in the control group; 50% in the iBook group (Risk Ratio [vs. control group]: 2.83; 95% CI, 1.26-6.37), and 29% in the video group (RR: 1.65; 95% CI, 0.66-4.09). From baseline to follow-up, women's reported intention to receive Tdap during the next pregnancy improved in all three groups. Among unvaccinated women, the most common reason reported for non-vaccination was lack of a recommendation for Tdap by the woman's physician.
  
  
  
  Education interventions that provide targeted information for pregnant women in an interactive manner may be useful to improve Tdap vaccination during the perinatal period. However, larger studies including multiple racial and ethnic groups are needed to evaluate robustness of our findings.
  
  
  
  clinicaltrials.gov Identifier: NCT01740310.
authors.affiliation: Emory University, Department of Epidemiology and Laney Graduate School, Atlanta, GA, United States. Electronic address: JKriss@cdc.gov.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kriss
authors.affiliation: Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, and Division of Infectious Diseases, Department of Medicine, Atlanta, GA, United States; Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, United States.
authors.forename: Paula M
authors.initials: PM
authors.lastname: Frew
authors.affiliation: Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, United States.
authors.forename: Marielysse
authors.initials: M
authors.lastname: Cortes
authors.affiliation: Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, United States.
authors.forename: Fauzia A
authors.initials: FA
authors.lastname: Malik
authors.affiliation: Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA, United States.
authors.forename: Allison T
authors.initials: AT
authors.lastname: Chamberlain
authors.affiliation: Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, United States.
authors.forename: Katherine
authors.initials: K
authors.lastname: Seib
authors.affiliation: Emory University, School of Medicine, Department of Gynecology and Obstetrics, Atlanta, GA, United States.
authors.forename: Lisa
authors.initials: L
authors.lastname: Flowers
authors.affiliation: University of Kansas Medical Center, Department of Obstetrics and Gynecology, Kansas City, KS, United States.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Ault
authors.affiliation: Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA, United States.
authors.forename: Penelope P
authors.initials: PP
authors.lastname: Howards
authors.affiliation: Emory University, Emory Vaccine Center and School of Medicine, Atlanta, GA, United States.
authors.forename: Walter A
authors.initials: WA
authors.lastname: Orenstein
authors.affiliation: Emory University, Rollins School of Public Health, Hubert Department of Global Health, Atlanta, GA, United States; Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA, United States; Emory University, Department of Pediatrics, Atlanta, GA, United States.
authors.forename: Saad B
authors.initials: SB
authors.lastname: Omer
mesh_terms: D000328:Adult; D001741:Black or African American; D001521:Behavior Therapy / Q000379:methods*; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000008:administration & dosage*; D005260:Female; D006266:Health Education / Q000379:methods*; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D037841:Pregnant People; D011446:Prospective Studies; D014611:Vaccination / Q000523:psychology* / Q000706:statistics & numerical data*; D000073887:Vaccination Coverage; D014917:Whooping Cough / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines
keywords: Elaboration Likelihood Model; Maternal immunization; Pertussis; Tdap; Vaccine; Whooping cough