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Effective messaging could lead to more flu shots for pregnant women and children

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Holly Korschun

Well-crafted messages about flu vaccination delivered through a message-framed, community-based approach, rather than through standard vaccination information sheets, could make it more likely for pregnant women in minority populations to plan immunizations for themselves and their infants, according to a study by researchers at Emory University.

The researchers conducted a randomized message-framing study in a group of pregnant women ages 18 to 50 from Sept. 2011 through May 2012. The women were exposed to messages that either promoted maternal-infant benefits associated with immunization (gain-frame messages) or that described negative consequences of not being immunized (loss-frame messages).d

The study also evaluated whether exposure to the film "Contagion" would influence women's perceptions and acceptance of the delivered messages. The film, which opened in Sept. 2011, depicts a pandemic outbreak caused by the rapid transmission of a new virus and the efforts to find a vaccine.

The study is published online by the Journal of Human Vaccines & Immunotherapeutics and will be published in the print edition in December.

"Influenza causes significant illness and death among vulnerable populations, including pregnant women," says Paula Frew, PhD, assistant professor at Emory University School of Medicine and the Rollins School of Public Health, and the study's lead author. "Yet despite the recognized benefits of seasonal flu immunization, vaccine coverage among pregnant women remains suboptimal, particularly among racial and ethnic minorities."

The American College of Obstetricians and Gynecologists and the Advisory Committee on Immunization Practices recommend that pregnant women receive the trivalent inactivated influenza vaccine. These immunizations protect both mothers and children, with infants up to six months having a decreased risk of influenza infection if their mothers were vaccinated. Maternal immunization also has been shown to reduce premature birth and low birth weight.

Despite these recommendations and benefits, common perceptions and economic status often prevent pregnant women from receiving flu shots. These include a perception that the vaccine transmits influenza or is ineffective, a lack of concern about influenza severity, and a lack of health insurance and inability to pay for vaccinations. Research shows racial and ethnic minority women also may be less likely to receive flu vaccines and to experience more illness, hospitalizations, and death from influenza.

"We focused our study on a community-based approach to raising vaccine coverage and awareness among this at-risk population," notes Frew.

The researchers enrolled 261 women in the study and assigned 87 to a gain-frame message group, 90 to a loss-frame message group, and 84 to a control group. The majority of women (88.5 percent) were black/African-American, while 7.3 percent were Hispanic and 4.2 percent were other/multicultural. The majority of women (69.2 percent) lived in households with total earnings of $20,000 or less. Fifty-five percent of the women were unemployed and 51.9 percent achieved high school or equivalent education. Seventy-two percent of the women were single.

Following the messaging, nearly half the respondents said they intended to vaccinate their new infants after six months of age. Compared with the controls group, both the gain-framed message group and the loss-framed message group were associated with a greater intention to vaccinate their infants.

Women who intended to be vaccinated themselves during pregnancy were also 10 times more likely to express intention to vaccinate their infants. Women who perceived influenza as very serious, or believed they were susceptible to illness, were more likely to express intention to vaccinate infants. Race was not a significant contributing factor in intent to immunize.

A higher proportion of women who saw the film "Contagion" considered the gain- and loss-frame messages more appealing, easy to remember, and new and fresh compared with those who did not see the film and were exposed to the same messages.

"Our study found that promoting immunization among women during pregnancy can achieve behavioral effects that not only provide protection for the mothers and their unborn children, but also establish a positive trajectory for immunization of infants," says Frew. "Based on these results we believe vaccination messages need to be incorporated into health care visits as standard of care."

Because viewing the movie "Contagion" made the immunization messages more appealing and easier to remember, the researchers also believe exposure to messages through mass media, including entertainment, movie advertising, and public service announcements, could potentially enhance recall of well-designed messages among pregnant women.

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