Mapping the maternal vaccination journey and influencing factors for Maori women in Aotearoa New Zealand: A qualitative study

Abstract

Introduction: Uptake of maternal vaccinations (MVs) is suboptimal in Aotearoa New Zealand, particularly for Maori. Aim: To describe Maori women's journeys regarding maternal pertussis and influenza vaccinations and explore influences on uptake. Methods: Semi-structured interviews were conducted in Waikato, Aotearoa New Zealand, with pregnant or recently pregnant Maori women, and separately with Maori healthcare professionals (HCPs) to understand women's decisions regarding MVs and enablers and barriers to uptake. Results: Nine women and nine HCPs were interviewed. Verbal communications from midwives, general practice and pharmacy strongly influenced women's journeys. Women's decisions appeared largely straight-forward, with influences including awareness, knowledge, underlying beliefs and previous MVs. Enablers for MV uptake included HCPs' discussions, pro-vaccination beliefs, and accessibility. Barriers for MV uptake included poverty (and transport), lack of awareness, insufficient knowledge of benefits, late presentation to the midwife and other commitments or challenges in the women's lives affecting prioritisation of the vaccine. Misconceptions, seasonality, and lower HCP emphasis impaired influenza vaccination uptake. Discussion: With multiple barriers to accessing MVs, HCPs who see pregnant women are the primary resource to improve awareness, knowledge, and access through korero (discussions) with the woman and, where possible, being able to administer the vaccinations. These HCPs need to be well-informed, aware of likely concerns women may have and how to address them, encourage these discussions and preferably be trusted.