LAUSR

Although vaccination against pertussis and seasonal influenza during pregnancy is the safest and most efficient strategy to protect mothers and infants from related morbidity and mortality, maternal vaccination is unfortunately suboptimal. The aim of the current study is to assess vaccination compliance during pregnancy and the factors associated with adherence with the relevant Ministry of Health recommendations. The study included 344 women in a maternity ward of a hospital in northern Israel. After receiving approval from the Helsinki Commission and with the mothers' consent, data was collected through a self-administrated questionnaire from June to September 2019. Eighty-three percent of participants reported having been vaccinated against pertussis during pregnancy, and 44% reported having been vaccinated against influenza. The main reasons for not being vaccinated were distrust in vaccine efficiency, fear of vaccination during pregnancy, and lack of recommendations from health professionals. Multivariate logistic regressions analysis showed that compliance with influenza and pertussis vaccinations were significantly explained by women's attitudes (influenza: OR 2.88; 99% CI: 2.05, 4.05; pertussis: OR 4.77; 99% CI: 3.04, 7.47) and norms (influenza: OR 1.55; 95% CI: 1.15, 2.08; pertussis: OR 2.09; 99% CI: 1.46, 2.99). Process procedure for mediation reveals that the greater the level of trust in the healthcare system, the more positive the attitudes and subjective norms toward vaccination during pregnancy, and the greater the likelihood of complying with both vaccination requirements during pregnancy. Efforts should focus on raising women's trust in the healthcare system as an important part of shaping attitudes and creating a supportive environment for vaccination. Trust in the healthcare system is associated with positive attitudes and norms, which in turn contribute to vaccination compliance. Explicit recommendations for vaccinations among pregnant women made by health professionals are needed, including reassurance of vaccine safety and effectiveness.