Patient and provider perspectives on how trust influences maternal vaccine acceptance among pregnant women in Kenya

• Type of Material: Article
• Authors: Stacy W. Nganga, Emory University; Nancy A. Otieno, Center for Global Health Research; Maxwell Adero, Center for Global Health Research; Dominic Ouma, Center for Global Health Research; Sandra S. Chaves, Center for Disease Control and Prevention; Jennifer Verani, Emory University; Marc-Alain Widdowson, Emory University; Andrew Wilson, Emory University; Irina Bergenfeld, Emory University; Courtni Andrews, Emory University; Vincent L. Fenimore, Emory University; Ines Gonzalez Casanova, Emory University; Paula Frew, Emory University; Saad Omer, Emory University; Fauzia Malik, Emory University
• Language: English
• Date: 2019-10-24
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12913-019-4537-8
• Title of Journal or Parent Work: BMC Health Services Research
• Volume: 19
• Issue: 1
• Start Page: 747
• End Page: 747
• Grant/Funding Information: This work was supported by the Bill and Melinda Gates Foundation under grant OPP1120377.
• Keywords: Science & Technology; Developing countries; Maternal immunization; IMMUNOGENICITY; TRIAL; Attitudes; Life Sciences & Biomedicine; Pregnant women; SAFETY; HEALTHY WOMEN; IMMUNIZATION; Health care providers; PREVENTION; Kenya; Health Care Sciences & Services
• Research Categories: Health Sciences, Public Health

Abstract

Background: Pregnant women and newborns are at high risk for infectious diseases. Altered immunity status during pregnancy and challenges fully vaccinating newborns contribute to this medical reality. Maternal immunization is a strategy to protect pregnant women and their newborns. This study aimed to find out how patient-provider relationships affect maternal vaccine uptake, particularly in the context of a lower middle-income country where limited research in this area exists. Methods: We conducted semi-structured, in-depth narrative interviews of both providers and pregnant women from four sites in Kenya: Siaya, Nairobi, Mombasa, and Marsabit. Interviews were conducted in either English or one of the local regional languages. Results: We found that patient trust in health care providers (HCPs) is integral to vaccine acceptance among pregnant women in Kenya. The HCP-patient relationship is a fiduciary one, whereby the patients' trusts is primarily rooted in the provider's social position as a person who is highly educated in matters of health. Furthermore, patient health education and provider attitudes are crucial for reinstating and fostering that trust, especially in cases where trust was impeded by rumors, community myths and misperceptions, and religious and cultural factors. Conclusion: Patient trust in providers is a strong facilitator contributing to vaccine acceptance among pregnant women in Kenya. To maintain and increase immunization trust, providers have a critical role in cultivating a positive environment that allows for favorable interactions and patient health education. This includes educating providers on maternal immunizations and enhancing knowledge of effective risk communication tactics in clinical encounters.