Page 79 - Preventing pertussis in early infancy - Visser

with one item, which could have reduced measurement specificity. At the time of the study, pertussis cocooning vaccination for HCWs was under review for regular care and was not being recommended. Our choice to include specific HCW target groups was not extensive. Given the differences among our HCW groups, this might limit the representativeness for other specific HCW groups who work with infants, such as peadiatricians. Furthermore, this study is performed within the Dutch healthcare system, which might limit the generalisability of the findings to other healthcare systems where especially maternity assistants and midwives have different professional roles.
Another limitation is a potential response bias. The HCWs who returned the questionnaire were possibly the HCWs with the most distinct opinions about vaccination. An indication for some selection might be that the midwives who declined vaccination in the National Immunisation Programme for their own children were overrepresented (21.4% versus around 5% in the general Dutch population (van Lier et al. 2015)), and that a relatively high number of HCWs indicated to be influenced by a specific philosophical background (11.7% for the maternity assistants, 16.3% for the midwives, and 13.0% for the paediatric nurses, compared to 8.2% in the general population (Mollema L 2009)). This potential response bias might affect the generalisability of the presented frequencies. However, it should not have any effect on the relation between determinants and outcome measures, which was the main aim of our study, particularly because of the high number of total participants (1006) in this study.
Conclusion
We conclude that about half of the participating HCWs intended to accept a pertussis cocooning vaccination, but the intention rate varied among the HCW groups. Attitude, anticipated affect regarding non-acceptance, and decisional uncertainty were the most important determinants of intention. Attitude was further explained by their general vaccination beliefs, agreement with a policy advice to vaccinate HCWs, the perceived cost-benefit ratio, and the perceived personal responsibility to prevent pertussis in patients. This study helps build the evidence base describing determinants of the intention of HCWs to accept a pertussis cocooning vaccination. Along with country-specific factors, such as costs and logistical barriers, this is essential information for designing an effective vaccination programme. Furthermore, it provides a robust framework for these determinants, which could also apply in other vaccination contexts.
Acknowledgements
The authors thank the maternity care organisations, the Royal Dutch organisation of Midwives and the participating university and general hospitals for their contributions to the data collection. We also want to thank all the healthcare workers who participated for the data they provided.
Quantitative study HCWs
Quantitative study HCWs
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