Courage in decision-making: A mixed-methods study of COVID-19 vaccine uptake in women of reproductive age in the UK

Laura Magee; Julia R.B. Brown; Vicky Bowyer; Gillian Horgan; Harriet Boulding; Asma Khalil; Nathan Cheetham; Nick Harvey; The CSSB Study Group; The RESILIENT Study Group; Hiten Mistry; Carole H. Sudre; Sergio A. Silverio; Peter von Dadelszen; Emma Duncan

doi:10.3390/vaccines12040440

Courage in decision-making: A mixed-methods study of COVID-19 vaccine uptake in women of reproductive age in the UK

Laura Magee^*, Julia R.B. Brown, Vicky Bowyer, Gillian Horgan, Harriet Boulding, Asma Khalil, Nathan Cheetham, Nick Harvey, The CSSB Study Group, The RESILIENT Study Group, Hiten Mistry, Carole H. Sudre, Sergio A. Silverio, Peter von Dadelszen, Emma Duncan

^*Corresponding author for this work

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Abstract

COVID-19 vaccination rates are lower in women of reproductive age (WRA), including pregnant/postpartum women, despite their poorer COVID-19-related outcomes. We evaluated the vaccination experiences of 3568 U.K. WRA, including 1983 women (55.6%) experiencing a pandemic pregnancy, recruited through the ZOE COVID Symptom Study app. Two staggered online questionnaires (Oct–Dec 2021: 3453 responders; Aug–Sept 2022: 2129 responders) assessed reproductive status, COVID-19 status, vaccination, and attitudes for/against vaccination. Descriptive analyses included vaccination type(s), timing relative to age-based eligibility and reproductive status, vaccination delay (first vaccination >28 days from eligibility), and rationale, with content analysis of free-text comments. Most responders (3392/3453, 98.2%) were vaccinated by Dec 2021, motivated by altruism, vaccination supportiveness in general, low risk, and COVID-19 concerns. Few declined vaccination (by Sept/2022: 20/2129, 1.0%), citing risks (pregnancy-specific and longer-term), pre-existing immunity, and personal/philosophical reasons. Few women delayed vaccination, although pregnant/postpartum women (vs. other WRA) received vaccination later (median 3 vs. 0 days after eligibility, p < 0.0001). Despite high uptake, concerns included adverse effects, misinformation (including from healthcare providers), ever-changing government advice, and complex decision making. In summary, most women in this large WRA cohort were promptly vaccinated, including pregnant/post-partum women. Altruism and community benefit superseded personal benefit as reasons for vaccination. Nevertheless, responders experienced angst and received vaccine-related misinformation and discouragement. These findings should inform vaccination strategies in WRA.

Original language	English
Article number	440
Pages (from-to)	1-16
Journal	Vaccines
Volume	12
Issue number	4
DOIs	https://doi.org/10.3390/vaccines12040440 https://doi.org/10.3390/vaccines12040440
Publication status	Published - 18 Apr 2024

Keywords

Vaccination
Hesitancy
COVID-19

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Magee, Brown, Bowyer, [...] Silverio, von Dadelszen, & Duncan (2024) - UK vaccine uptake in women of reproductive age - VaccinesFinal published version, 479 KB

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Magee, L., Brown, J. R. B., Bowyer, V., Horgan, G., Boulding, H., Khalil, A., Cheetham, N., Harvey, N., The CSSB Study Group, The RESILIENT Study Group, Mistry, H., Sudre, C. H., Silverio, S. A., von Dadelszen, P., & Duncan, E. (2024). Courage in decision-making: A mixed-methods study of COVID-19 vaccine uptake in women of reproductive age in the UK. Vaccines, 12(4), 1-16. Article 440. https://doi.org/10.3390/vaccines12040440, https://doi.org/10.3390/vaccines12040440

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title = "Courage in decision-making: A mixed-methods study of COVID-19 vaccine uptake in women of reproductive age in the UK",

abstract = "COVID-19 vaccination rates are lower in women of reproductive age (WRA), including pregnant/postpartum women, despite their poorer COVID-19-related outcomes. We evaluated the vaccination experiences of 3568 U.K. WRA, including 1983 women (55.6%) experiencing a pandemic pregnancy, recruited through the ZOE COVID Symptom Study app. Two staggered online questionnaires (Oct–Dec 2021: 3453 responders; Aug–Sept 2022: 2129 responders) assessed reproductive status, COVID-19 status, vaccination, and attitudes for/against vaccination. Descriptive analyses included vaccination type(s), timing relative to age-based eligibility and reproductive status, vaccination delay (first vaccination >28 days from eligibility), and rationale, with content analysis of free-text comments. Most responders (3392/3453, 98.2%) were vaccinated by Dec 2021, motivated by altruism, vaccination supportiveness in general, low risk, and COVID-19 concerns. Few declined vaccination (by Sept/2022: 20/2129, 1.0%), citing risks (pregnancy-specific and longer-term), pre-existing immunity, and personal/philosophical reasons. Few women delayed vaccination, although pregnant/postpartum women (vs. other WRA) received vaccination later (median 3 vs. 0 days after eligibility, p < 0.0001). Despite high uptake, concerns included adverse effects, misinformation (including from healthcare providers), ever-changing government advice, and complex decision making. In summary, most women in this large WRA cohort were promptly vaccinated, including pregnant/post-partum women. Altruism and community benefit superseded personal benefit as reasons for vaccination. Nevertheless, responders experienced angst and received vaccine-related misinformation and discouragement. These findings should inform vaccination strategies in WRA.",

keywords = "Vaccination, Hesitancy, COVID-19",

author = "Laura Magee and Brown, {Julia R.B.} and Vicky Bowyer and Gillian Horgan and Harriet Boulding and Asma Khalil and Nathan Cheetham and Nick Harvey and {The CSSB Study Group} and Michela Antonelli and {Dos Santos Canas}, Liane and {Capdevila Pujol}, Joan and Jie Deng and Katherine Doores and Alexander Hammers and Christina Hu and Eric Kerfoot and Michael Malim and Marc Modat and Erika Molteni and Ben Murray and Marc Osterdahl and Sebastien Ourselin and Tim Spector and Claire Steves and Jonathan Wolf and {The RESILIENT Study Group} and Debra Bick and Abigail Easter and Julia Fox-Rushby and Nelson, {Eugene C.} and Lucilla Poston and Seed, {Paul Townsend} and {Soley Bori}, Marina and {Van Citters}, Aricca and Sara White and Ingrid Wolfe and Duffy, {James M. N.} and Glyn Elwyn and Hodson, {Kenneth K.} and Nathalie Macdermott and Rebecca Reynolds and Rachel Roberts and Hiten Mistry and Sudre, {Carole H.} and Silverio, {Sergio A.} and {von Dadelszen}, Peter and Emma Duncan",

note = "Publisher Copyright: {\textcopyright} 2024 by the authors.",

year = "2024",

month = apr,

day = "18",

doi = "10.3390/vaccines12040440",

language = "English",

volume = "12",

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Magee, L, Brown, JRB, Bowyer, V, Horgan, G, Boulding, H, Khalil, A, Cheetham, N , Harvey, N, The CSSB Study Group, The RESILIENT Study Group, Mistry, H , Sudre, CH , Silverio, SA , von Dadelszen, P & Duncan, E 2024, 'Courage in decision-making: A mixed-methods study of COVID-19 vaccine uptake in women of reproductive age in the UK', Vaccines, vol. 12, no. 4, 440, pp. 1-16. https://doi.org/10.3390/vaccines12040440, https://doi.org/10.3390/vaccines12040440

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T1 - Courage in decision-making

T2 - A mixed-methods study of COVID-19 vaccine uptake in women of reproductive age in the UK

AU - Magee, Laura

AU - Brown, Julia R.B.

AU - Bowyer, Vicky

AU - Horgan, Gillian

AU - Boulding, Harriet

AU - Khalil, Asma

AU - Cheetham, Nathan

AU - Harvey, Nick

AU - The CSSB Study Group

AU - Antonelli, Michela

AU - Dos Santos Canas, Liane

AU - Capdevila Pujol, Joan

AU - Deng, Jie

AU - Doores, Katherine

AU - Hammers, Alexander

AU - Hu, Christina

AU - Kerfoot, Eric

AU - Malim, Michael

AU - Modat, Marc

AU - Molteni, Erika

AU - Murray, Ben

AU - Osterdahl, Marc

AU - Ourselin, Sebastien

AU - Spector, Tim

AU - Steves, Claire

AU - Wolf, Jonathan

AU - The RESILIENT Study Group

AU - Bick, Debra

AU - Easter, Abigail

AU - Fox-Rushby, Julia

AU - Nelson, Eugene C.

AU - Poston, Lucilla

AU - Seed, Paul Townsend

AU - Soley Bori, Marina

AU - Van Citters, Aricca

AU - White, Sara

AU - Wolfe, Ingrid

AU - Duffy, James M. N.

AU - Elwyn, Glyn

AU - Hodson, Kenneth K.

AU - Macdermott, Nathalie

AU - Reynolds, Rebecca

AU - Roberts, Rachel

AU - Mistry, Hiten

AU - Sudre, Carole H.

AU - Silverio, Sergio A.

AU - von Dadelszen, Peter

AU - Duncan, Emma

PY - 2024/4/18

Y1 - 2024/4/18

N2 - COVID-19 vaccination rates are lower in women of reproductive age (WRA), including pregnant/postpartum women, despite their poorer COVID-19-related outcomes. We evaluated the vaccination experiences of 3568 U.K. WRA, including 1983 women (55.6%) experiencing a pandemic pregnancy, recruited through the ZOE COVID Symptom Study app. Two staggered online questionnaires (Oct–Dec 2021: 3453 responders; Aug–Sept 2022: 2129 responders) assessed reproductive status, COVID-19 status, vaccination, and attitudes for/against vaccination. Descriptive analyses included vaccination type(s), timing relative to age-based eligibility and reproductive status, vaccination delay (first vaccination >28 days from eligibility), and rationale, with content analysis of free-text comments. Most responders (3392/3453, 98.2%) were vaccinated by Dec 2021, motivated by altruism, vaccination supportiveness in general, low risk, and COVID-19 concerns. Few declined vaccination (by Sept/2022: 20/2129, 1.0%), citing risks (pregnancy-specific and longer-term), pre-existing immunity, and personal/philosophical reasons. Few women delayed vaccination, although pregnant/postpartum women (vs. other WRA) received vaccination later (median 3 vs. 0 days after eligibility, p < 0.0001). Despite high uptake, concerns included adverse effects, misinformation (including from healthcare providers), ever-changing government advice, and complex decision making. In summary, most women in this large WRA cohort were promptly vaccinated, including pregnant/post-partum women. Altruism and community benefit superseded personal benefit as reasons for vaccination. Nevertheless, responders experienced angst and received vaccine-related misinformation and discouragement. These findings should inform vaccination strategies in WRA.

AB - COVID-19 vaccination rates are lower in women of reproductive age (WRA), including pregnant/postpartum women, despite their poorer COVID-19-related outcomes. We evaluated the vaccination experiences of 3568 U.K. WRA, including 1983 women (55.6%) experiencing a pandemic pregnancy, recruited through the ZOE COVID Symptom Study app. Two staggered online questionnaires (Oct–Dec 2021: 3453 responders; Aug–Sept 2022: 2129 responders) assessed reproductive status, COVID-19 status, vaccination, and attitudes for/against vaccination. Descriptive analyses included vaccination type(s), timing relative to age-based eligibility and reproductive status, vaccination delay (first vaccination >28 days from eligibility), and rationale, with content analysis of free-text comments. Most responders (3392/3453, 98.2%) were vaccinated by Dec 2021, motivated by altruism, vaccination supportiveness in general, low risk, and COVID-19 concerns. Few declined vaccination (by Sept/2022: 20/2129, 1.0%), citing risks (pregnancy-specific and longer-term), pre-existing immunity, and personal/philosophical reasons. Few women delayed vaccination, although pregnant/postpartum women (vs. other WRA) received vaccination later (median 3 vs. 0 days after eligibility, p < 0.0001). Despite high uptake, concerns included adverse effects, misinformation (including from healthcare providers), ever-changing government advice, and complex decision making. In summary, most women in this large WRA cohort were promptly vaccinated, including pregnant/post-partum women. Altruism and community benefit superseded personal benefit as reasons for vaccination. Nevertheless, responders experienced angst and received vaccine-related misinformation and discouragement. These findings should inform vaccination strategies in WRA.

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KW - Hesitancy

KW - COVID-19

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DO - 10.3390/vaccines12040440

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SN - 2076-393X

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JO - Vaccines

JF - Vaccines

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M1 - 440

ER -

Courage in decision-making: A mixed-methods study of COVID-19 vaccine uptake in women of reproductive age in the UK

Abstract

Keywords

UN SDGs

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