Immunization rates for recommended childhood vaccines have consistently been high, with childhood series completion near 80% by 19-35 months. However, these high immunization coverage rates do not fully account for delays or refusals of early childhood (i.e., less than one year of age) vaccine uptake. Overall, the proportion of children not receiving all recommended vaccines or whose parents are consistently limiting visit-level vaccine administration is increasing. Children who do not receive all recommended vaccines are at greater risk of contracting vaccine-preventable diseases, which can lead to development of severe sequelae, hospitalizations, and death. Additionally, despite evidence showing the effect of vaccinating pregnant women in reducing disease among infants too young to be fully vaccinated, maternal immunization rates remain low. We developed and pilot tested a novel, innovative, evidence based, and comprehensive immunization intervention at the Practice, Provider, and Patient (P3) levels to meet the diverse and complex information needs of mothers. This P3 intervention included components such as use of practice-level vaccine champions, expanded reminder-recall systems, and provision of practice-level immunization rate feedback (practice-level interventions); physician peer-delivered training related to vaccines, vaccine-preventable diseases, vaccination recommendations, and vaccination system logistics, as well as standardized talking points for use when recommendation vaccination (provider-level interventions); and an interactive tablet computer (iPad) education application for pregnant women to view while waiting for care (patient-level intervention). Our pilot testing found this P3 intervention to be well received by providers and patients and indicated a few areas where the intervention could be improved. In the proposed project, we will develop and evaluate an improved version of the P3 intervention, to be called P3+. Improvements to the initial P3 framework will be based on findings from the original evaluation project as well as additional formative research. We will then evaluate the P3+ intervention in a geographically and socio-demographically diverse set of obstetrician- gynecologist offices in Georgia (community-level practices) and Colorado (offices of the Kaiser Permanente Colorado managed care organization). The research will be led by Multiple PIs who have extensive experienced in understanding and addressing barriers to vaccine uptake. The proposed evaluation will address vaccine uptake both for pregnant women and for their children, through 24 months of age, to test the hypothesis that increasing acceptability of vaccines during pregnancy will lead to positive changes in acceptance of vaccines for children.

Public Health Relevance

Vaccination of pregnant women can impart health benefits on the unborn and infant child, and increased acceptance of maternal vaccination may lead to increase in acceptability of childhood vaccination. However, maternal vaccination rates are low, and new comprehensive, evidence-based interventions are needed to increase vaccination uptake among pregnant women and their children. We will build off of a prior intervention at the practice, provider, and patient-levels (P3) to develop, implement and evaluate an enhanced intervention (P3+) to improve vaccination uptake among pregnant women, and later, their children.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Research Project (R01)
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Dissemination and Implementation Research in Health Study Section (DIRH)
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GU, Xin-Xing
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Emory University
Public Health & Prev Medicine
Schools of Public Health
United States
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Ellingson, Mallory K; Dudley, Matthew Z; Limaye, Rupali J et al. (2018) Enhancing uptake of influenza maternal vaccine. Expert Rev Vaccines :
Frew, Paula M; Randall, Laura A; Malik, Fauzia et al. (2018) Clinician perspectives on strategies to improve patient maternal immunization acceptability in obstetrics and gynecology practice settings. Hum Vaccin Immunother 14:1548-1557
Bednarczyk, Robert A; Chamberlain, Allison; Mathewson, Kara et al. (2018) Practice-, Provider-, and Patient-level interventions to improve preventive care: Development of the P3 Model. Prev Med Rep 11:131-138