Written Briefing and Oral Counseling Increase the Willingness to Receive the SARS-CoV-2 Vaccination among Women in Puerperium: A Qualitative Prospective Cohort Study

Abstract

(1) Background: Vaccination rates for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) are low in Austria. International obstetric societies recommend the SARS-CoV-2 mRNA vaccination for women in puerperium. (2) Methods: A prospective two-stage cohort study was conducted at the Medical University of Vienna between October 2022 and December 2022. Firstly, women in puerperium were assigned to the evaluation group (step 1), and secondly, another cohort of unvaccinated women were randomly assigned to study group A (written briefing) or B (written and oral briefing) (step 2). We evaluated the vaccination status among women in the evaluation group and the willingness to receive the vaccination in all three cohorts. (3) Results: We included 217 women in puerperium (evaluation: n = 69, A: n = 68; B: n = 80). In the evaluation group, 66.7% (n = 46/69) of the women were unvaccinated. A total of 45.7% (21/46) of the unvaccinated women categorically declined the SARS-CoV-2 vaccination. A total of 26.5% (n = 18/68) of women in study group A, and 43.8% (n = 35/80) of women in study group B expressed their willingness to receive the vaccination (p = 0.029). There were no differences in willingness to receive the vaccination between different age strata of women in study groups A and B. (D) Conclusion: Our qualitative data demonstrate a benefit from oral counseling in addition to written briefing in order to increase the willingness to receive the vaccination among women in puerperium.

Keywords: SARS-CoV-2; pregnancy; puerperium; vaccination.

Figure 1

Patient flowchart. A total of 217 women in puerperium were included. A total of 69 (31.8%) patients were assigned to the evaluation group and received written questionnaires. A total of 148 patients were assigned to study groups A and B. Patients in study group A (n = 68, 31.3%) were handed out a written briefing recommending the SARS-CoV-2 vaccination during puerperium, while 80 (36.9%) patients were assigned to study group B and received an oral recommendation to undergo the SARS-CoV-2 vaccination during puerperium in addition to the written briefing.

Figure 2

In the evaluation group (n = 69), of women in puerperium, their SARS-CoV-2 vaccination status and willingness to receive the vaccination was assessed via a written questionnaire. Overall, 33.3% were vaccinated with at least one shot, while 66.7% were not vaccinated. Of the n = 46 unvaccinated patients, 39.1% were willing to receive a vaccination during puerperium, whereas 60.9% stated they would decline the SARS-CoV-2 vaccination during puerperium. Of the 28 unvaccinated patients who declined the SARS-CoV-2 vaccination in puerperium, 25% (n = 7) had plans on receiving the SARS-CoV-2 vaccination later on, while 75.0% (n = 21) declined the SARS-CoV-2 vaccination in general.

Figure 3

Comparison of the rate of willingness to receive the SARS-CoV-2 vaccination among women in study group A (written briefing only) and study group B (written briefing and oral recommendation) during puerperium. Women in study group B were more likely to receive the vaccination after giving birth than women in study group A (p = 0.029).

Figure 4

Stratification of the patients in different age groups of (A) the overall study group collective (i.e., study group A and B), (B) study group A and (C) study group B. There was no difference between age groups in the overall study group collective or study group B. In study group A (written briefing only), the group of women aged 40–49 showed no interest in receiving or planning to receive the SARS-CoV-2 vaccination.