Advertisement

Efficacy of a Web-Based Intervention to Increase Uptake of Maternal Vaccines: An RCT

      Introduction

      Tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines are recommended for pregnant women in each pregnancy, yet uptake is suboptimal. This study tested the efficacy of an online vaccine resource in increasing uptake of Tdap and influenza vaccines among pregnant women.

      Study design

      RCT.

      Setting/participants

      This study was conducted among women in the third trimester of pregnancy in an integrated healthcare system in Colorado in September 2013–July 2016, with data analysis in 2017–2018.

      Intervention

      Women were randomly assigned to 1 of 3 arms: website with vaccine information and interactive social media components, website with vaccine information only, or usual care. Participants in the website with vaccine information and interactive social media components and website with vaccine information only arms had access to the same base vaccine content. The website with vaccine information and interactive social media components also included a blog, discussion forum, and “Ask a Question” portal.

      Main outcome measures

      Tdap and influenza vaccination. These outcomes were analyzed separately.

      Results

      For influenza (n=289), women in both the website with vaccine information and interactive social media components (OR=2.19, 95% CI=1.06, 4.53) and website with vaccine information only (OR=2.20, 95% CI=1.03, 4.69) arms had higher vaccine uptake than the usual care arm. The proportions of women receiving the influenza vaccine were 57%, 55%, and 36% in the website with vaccine information and interactive social media components, website with vaccine information only, and usual care arms, respectively. For Tdap (n=173), there were no significant differences in vaccine uptake between study arms. The proportions of women receiving Tdap were 71%, 69%, and 68% in the website with vaccine information and interactive social media components, website with vaccine information only, and usual care arms, respectively.

      Conclusions

      Web-based vaccination information sent to pregnant women can positively influence maternal influenza vaccine uptake. Because of potential scalability, the impact of robust vaccination information websites should be studied in other settings.

      Trial registration

      This study is registered at www.clinicaltrials.gov NCT01873040.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Stupiansky NW
        • Zimet GD
        • Cummings T
        • Fortenberry JD
        • Shew M
        Accuracy of self-reported human papillomavirus vaccine receipt among adolescent girls and their mothers.
        J Adolesc Health. 2012; 50: 103-105
        • Creanga AA
        • Johnson TF
        • Graitcer SB
        • et al.
        Severity of 2009 pandemic influenza A (H1N1) virus infection in pregnant women.
        Obstet Gynecol. 2010; 115: 717-726
        • Hartert TV
        • Neuzil KM
        • Shintani AK
        • et al.
        Maternal morbidity and perinatal outcomes among pregnant women with respiratory hospitalizations during influenza season.
        Am J Obstet Gynecol. 2003; 189: 1705-1712
        • Louie JK
        • Acosta M
        • Jamieson DJ
        • Honein MA
        • California Pandemic (H1N1) Working Group
        Severe 2009 H1N1 influenza in pregnant and postpartum women in California.
        N Engl J Med. 2010; 362: 27-35
        • Neuzil KM
        • Reed GW
        • Mitchel EF
        • Simonsen L
        • Griffin MR
        Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women.
        Am J Epidemiol. 1998; 148: 1094-1102
        • Ampofo K
        • Gesteland PH
        • Bender J
        • et al.
        Epidemiology, complications, and cost of hospitalization in children with laboratory-confirmed influenza infection.
        Pediatrics. 2006; 118: 2409-2417
        • Izurieta HS
        • Thompson WW
        • Kramarz P
        • et al.
        Influenza and the rates of hospitalization for respiratory disease among infants and young children.
        N Engl J Med. 2000; 342: 232-239
        • Mullooly JP
        • Barker WH
        Impact of type A influenza on children: a retrospective study.
        Am J Public Health. 1982; 72: 1008-1016
        • Cortese MM
        • Baughman AL
        • Zhang R
        • Srivastava PU
        • Wallace GS
        Pertussis hospitalizations among infants in the United States, 1993 to 2004.
        Pediatrics. 2008; 121: 484-492
        • Vitek CR
        • Pascual FB
        • Baughman AL
        • Murphy TV
        Increase in deaths from pertussis among young infants in the United States in the 1990s.
        Pediatr Infect Dis J. 2003; 22: 628-634
        • CDC
        Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women–Advisory Committee on Immunization Practices (ACIP), 2012.
        MMWR Morb Mortal Wkly Rep. 2013; 62: 131-135
        • Harper SA
        • Fukuda K
        • Uyeki TM
        • et al.
        Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP).
        MMWR Recomm Rep. 2004; 53: 1-40
        • Dabrera G
        • Zhao H
        • Andrews N
        • et al.
        Effectiveness of seasonal influenza vaccination during pregnancy in preventing influenza infection in infants, England, 2013/14.
        Euro Surveill. 2014; 19: 20959
        • Eick AA
        • Uyeki TM
        • Klimov A
        • et al.
        Maternal influenza vaccination and effect on influenza virus infection in young infants.
        Arch Pediatr Adolesc Med. 2011; 165: 104-111
        • Zaman K
        • Roy E
        • Arifeen SE
        • et al.
        Effectiveness of maternal influenza immunization in mothers and infants.
        N Engl J Med. 2008; 359: 1555-1564
        • Poehling KA
        • Szilagyi PG
        • Staat MA
        • et al.
        Impact of maternal immunization on influenza hospitalizations in infants.
        Am J Obstet Gynecol. 2011; 204: S141-S148
        • Benowitz I
        • Esposito DB
        • Gracey KD
        • Shapiro ED
        • Vazquez M
        Influenza vaccine given to pregnant women reduces hospitalization due to influenza in their infants.
        Clin Infect Dis. 2010; 51: 1355-1361
        • Amirthalingam G
        • Andrews N
        • Campbell H
        • et al.
        Effectiveness of maternal pertussis vaccination in England: an observational study.
        Lancet. 2014; 384: 1521-1528
        • Winter K
        • Cherry JD
        • Harriman K
        Effectiveness of prenatal Tdap vaccination on pertussis severity in infants.
        Clin Infect Dis. 2017; 64: 9-14
        • Winter K
        • Nickell S
        • Powell M
        • Harriman K
        Effectiveness of prenatal versus postpartum Tdap vaccination in preventing infant pertussis.
        Clin Infect Dis. 2017; 64: 3-8
        • Munoz FM
        • Greisinger AJ
        • Wehmanen OA
        • et al.
        Safety of influenza vaccination during pregnancy.
        Am J Obstet Gynecol. 2005; 192: 1098-1106
        • Nordin JD
        • Kharbanda EO
        • Benitez GV
        • et al.
        Maternal safety of trivalent inactivated influenza vaccine in pregnant women.
        Obstet Gynecol. 2013; 121: 519-525
        • Kharbanda EO
        • Vazquez-Benitez G
        • Lipkind HS
        • et al.
        Evaluation of the association of maternal pertussis vaccination with obstetric events and birth outcomes.
        JAMA. 2014; 312: 1897-1904
        • Berenson AB
        • Hirth JM
        • Rahman M
        • et al.
        Maternal and infant outcomes among women vaccinated against pertussis during pregnancy.
        Hum Vaccin Immunother. 2016; 12: 1965-1971
        • Munoz FM
        • Bond NH
        • Maccato M
        • et al.
        Safety and immunogenicity of tetanus diphtheria and acellular pertussis (Tdap) immunization during pregnancy in mothers and infants: a randomized clinical trial.
        JAMA. 2014; 311: 1760-1769
        • Shakib JH
        • Korgenski K
        • Sheng X
        • et al.
        Tetanus, diphtheria, acellular pertussis vaccine during pregnancy: pregnancy and infant health outcomes.
        J Pediatr. 2013; 163 (1422‒1426.e4)
        • Sukumaran L
        • McCarthy NL
        • Kharbanda EO
        • et al.
        Association of Tdap vaccination with acute events and adverse birth outcomes among pregnant women with prior tetanus-containing immunizations.
        JAMA. 2015; 314: 1581-1587
        • Ding H
        • Black CL
        • Ball S
        • et al.
        Influenza vaccination coverage among pregnant women–United States, 2014‒15 influenza season.
        MMWR Morb Mortal Wkly Rep. 2015; 64: 1000-1005
        • Ding H
        • Black CL
        • Ball S
        • et al.
        Influenza vaccination coverage among pregnant women–United States, 2013‒14 influenza season.
        MMWR Morb Mortal Wkly Rep. 2014; 63: 816-821
        • Kharbanda EO
        • Vazquez-Benitez G
        • Lipkind HS
        • et al.
        Maternal Tdap vaccination: coverage and acute safety outcomes in the vaccine safety datalink, 2007‒2013.
        Vaccine. 2016; 34: 968-973
        • Koepke R
        • Kahn D
        • Petit AB
        • et al.
        Pertussis and influenza vaccination among insured pregnant women - Wisconsin, 2013‒2014.
        MMWR Morb Mortal Wkly Rep. 2015; 64 (Accessed January 15, 2019): 746-750
        • CDC
        Influenza Vaccination Coverage Among Pregnant Women; 2011‒12 influenza season, United States.
        MMWR Morb Mortal Wkly Rep. 2012; 61: 758-763
        • O'Leary ST
        • Pyrzanowski J
        • Brewer SE
        • et al.
        Influenza and pertussis vaccination among pregnant women and their infants’ close contacts: reported practices and attitudes.
        Pediatr Infect Dis J. 2015; 34: 1244-1249
        • Link-Gelles R
        • Chamberlain AT
        • Schulkin J
        • et al.
        Missed opportunities: a national survey of obstetricians about attitudes on maternal and infant immunization.
        Matern Child Health J. 2012; 16: 1743-1747
        • Grant L
        • Hausman BL
        • Cashion M
        • et al.
        Vaccination persuasion online: a qualitative study of two provaccine and two vaccine-skeptical websites.
        J Med Internet Res. 2015; 17: e133
        • Kata A
        A postmodern Pandora's box: anti-vaccination misinformation on the Internet.
        Vaccine. 2010; 28: 1709-1716
        • Betsch C
        • Renkewitz F
        • Betsch T
        • Ulshöfer C
        The influence of vaccine-critical websites on perceiving vaccination risks.
        J Health Psychol. 2010; 15: 446-455
        • Venkatraman A
        • Garg N
        • Kumar N
        Greater freedom of speech on Web 2.0 correlates with dominance of views linking vaccines to autism.
        Vaccine. 2015; 33: 1422-1425
        • Betsch C
        • Brewer NT
        • Brocard P
        • et al.
        Opportunities and challenges of Web 2.0 for vaccination decisions.
        Vaccine. 2012; 30: 3727-3733
        • Witteman HO
        • Zikmund-Fisher BJ
        The defining characteristics of Web 2.0 and their potential influence in the online vaccination debate.
        Vaccine. 2012; 30: 3734-3740
        • Glanz JM
        • Wagner NM
        • Narwaney KJ
        • et al.
        Web-based social media intervention to increase vaccine acceptance: a randomized controlled trial.
        Pediatrics. 2017; 140e20171117
        • Chew LD
        • Griffin JM
        • Partin MR
        • et al.
        Validation of screening questions for limited health literacy in a large VA outpatient population.
        J Gen Intern Med. 2008; 23: 561-566
        • Opel DJ
        • Taylor JA
        • Zhou C
        • et al.
        The relationship between parent attitudes about childhood vaccines survey scores and future child immunization status: a validation study.
        JAMA Pediatr. 2013; 167: 1065-1071
        • Benevenuto F
        • Rodrigues T
        • Cha M
        • Almeida V
        Characterizing user navigation and interactions in online social networks.
        Inf Sci. 2012; 195: 1-24
        • van Mierlo T
        The 1% rule in four digital health social networks: an observational study.
        J Med Internet Res. 2014; 16: e33
        • Mullooly J
        • Drew L
        • DeStefano F
        • et al.
        Quality of HMO vaccination databases used to monitor childhood vaccine safety.
        Am J Epidemiol. 1999; 149: 186-194
        • Morgan MG
        • Fischoff B
        • Bostrom A
        • Altman CJ
        Risk Communication: A Mental Models Approach.
        Cambridge University Press, New York, NY2002
        • Shoup JA
        • Wagner NM
        • Kraus CR
        • et al.
        Development of an interactive social media tool for parents with concerns about vaccines.
        Health Educ Behav. 2015; 42: 302-312
        • Cohrssen J
        • Covello V
        Risk Analysis: a Guide to Principles and Methods for Analyzing Health and Environmental Risks.
        Council on Environmental Quality, Washington, DC1989
        • Covello VT
        Best practices in public health risk and crisis communication.
        J Health Commun. 2003; 8: 5-8
        • Fischhoff B
        • Brewer NT
        • Downs JS
        Communicating risks and benefits: an evidence based user's guide.
        Government Printing Office, Silver Springs, MD2012
        • Hughes JF
        • Van Dam A
        • Foley JD
        • Feiner SK
        Computer Graphics: Principles and Practice.
        3rd edition. Pearson, Upper Saddle River, NJ2014
        • Flanagin AJ
        • Metzger MJ
        The role of site features, user attributes, and information verification behaviors on the perceived credibility of web-based information.
        N Media Soc. 2007; 9: 319-342
        • Fogg B
        • Soohoo C
        • Danielson DR
        • et al.
        How do users evaluate the credibility of web sites?: A study with over 2,500 participants.
        in: Paper presented at. Proceedings of DUX2003, Designing for User Experiences Conference. 2003
        • Sonis J
        Odds ratios vs risk ratios.
        JAMA. 2018; 320: 2041
        • Wong VW
        • Fong DY
        • Lok KY
        • et al.
        Brief education to promote maternal influenza vaccine uptake: a randomized controlled trial.
        Vaccine. 2016; 34: 5243-5250
        • Kriss JL
        • Frew PM
        • Cortes M
        • et al.
        Evaluation of two vaccine education interventions to improve pertussis vaccination among pregnant African American women: a randomized controlled trial.
        Vaccine. 2017; 35: 1551-1558
        • Chamberlain AT
        • Seib K
        • Ault KA
        • et al.
        Improving influenza and Tdap vaccination during pregnancy: a cluster-randomized trial of a multi-component antenatal vaccine promotion package in late influenza season.
        Vaccine. 2015; 33: 3571-3579
        • Stockwell MS
        • Westhoff C
        • Kharbanda EO
        • et al.
        Influenza vaccine text message reminders for urban, low-income pregnant women: a randomized controlled trial.
        Am J Public Health. 2014; 104: e7-e12
        • Moniz MH
        • Hasley S
        • Meyn LA
        • Beigi RH
        Improving influenza vaccination rates in pregnancy through text messaging: a randomized controlled trial.
        Obstet Gynecol. 2013; 121: 734-740
        • Liang JL
        • Tiwari T
        • Moro P
        • et al.
        Prevention of pertussis, tetanus, and diphtheria with vaccines in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP).
        MMWR Recomm Rep. 2018; 67: 1-44
        • Vitek WS
        • Akers A
        • Meyn LA
        • et al.
        Vaccine eligibility and acceptance among ambulatory obstetric and gynecologic patients.
        Vaccine. 2011; 29: 2024-2028
        • Barnard JG
        • Dempsey AF
        • Brewer SE
        • et al.
        Facilitators and barriers to the use of standing orders for vaccination in obstetrics and gynecology settings.
        Am J Obstet Gynecol. 2017; 216: 69.e1-69.e7
        • Opel DJ
        • Heritage Taylor JA
        • et al.
        The architecture of provider-parent vaccine discussions at health supervision visits.
        Pediatrics. 2013; 132: 1037-1046
        • Brewer NT
        • Hall ME
        • Malo TL
        • et al.
        Announcements versus conversations to improve HPV vaccination coverage: a randomized trial.
        Pediatrics. 2017; 139e20161764
        • Simis MJ
        • Madden H
        • Cacciatore MA
        • Yeo SK
        The lure of rationality: why does the deficit model persist in science communication.
        Public Underst Sci. 2016; 25: 400-414
        • Nyhan B
        • Reifler J
        Does correcting myths about the flu vaccine work? An experimental evaluation of the effects of corrective information.
        Vaccine. 2015; 33: 459-464
        • Nyhan B
        • Reifler J
        • Richey S
        • Freed GL
        Effective messages in vaccine promotion: a randomized trial.
        Pediatrics. 2014; 133: e835-e842
      1. Wood T, Porter E. The Elusive Backfire Effect: Mass Attitudes’ Steadfast Factual Adherence. Published August 6, 2016. https://doi.org/10.2139/ssrn.2819073.

        • Lewandowsky S
        • Ecker UK
        • Seifert CM
        • Schwarz N
        • Cook J
        Misinformation and its correction continued influence and successful debiasing.
        Psychol Sci Public Interest. 2012; 13: 106-131
        • Bennett GG
        • Glasgow RE
        The delivery of public health interventions via the Internet: actualizing their potential.
        Annu Rev Public Health. 2009; 30: 273-292
        • Webb T
        • Joseph J
        • Yardley L
        • Michie S
        Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy.
        J Med Internet Res. 2010; 12: e4