Knowledge, Utilization and Barriers of Pregnant Women to Influenza Vaccine in Primary Health Care Centers in Dammam and Al Khobar, Saudi Arabia, 2017-2018

"[A] higher level of awareness and uptake of influenza vaccine during pregnancy could be achieved in Saudi Arabia by a change in behavior from health care providers..."

The World Health Organization (WHO) recommends that all pregnant women receive the influenza vaccine for seasonal influenza. To that end, in 2014, the Ministry of Health in the Kingdom of Saudi Arabia launched a seasonal influenza vaccine to prevent influenza complications in high-risk groups, including pregnant women, during influenza season. This study aimed to evaluate the knowledge and utilisation of, as well as barriers to, influenza vaccine uptake, and how these things relate to personal factors in pregnant women in Saudi Arabia. The goal was to provide recommendations to improve influenza vaccine uptake and encourage further research in Eastern Province.

Between November 2017 and April 2018, a cross-sectional survey was conducted among 410 pregnant women attending 23 primary health care centres in Dammam and Al Khobar, Saudi Arabia. Selected findings:

• A total of 57.1% of participants had good knowledge about influenza vaccine during pregnancy, and 19.8% took the vaccine.
• Fewer than half of the participants (43.9%) were against taking the influenza vaccine during pregnancy.
• The most influential factor among those who did not take the vaccine was belief that the flu vaccine has side effects (34%).
• Only 36.6% of all participants were ever offered the flu vaccine during pregnancy by a healthcare provider.
• 52% of those who were offered the vaccine took it, while 98.8% of those who were not offered the vaccine did not take it.

In reflecting on the findings, the researchers note that level of knowledge is not the only determinant for behaviour; when healthcare providers recommend influenza vaccination directly, the likelihood of vaccine acceptance and receipt is much higher. Furthermore, studies have shown that women who are concerned about vaccine safety still indicate they would accept it if their healthcare provider recommended it.

The results of this study point to the following suggested ways forward, according to the researchers:

• "Physicians should be trained to establish a holistic approach with their clients when offering influenza vaccine and directly address all their patients' behavioral determinants, such as knowledge, value, consequences, benefits, and other factors."
• Educational programmes and campaigns for the public, in addition to social media marketing, could increase acceptance of the vaccine.
• A mandatory policy that imposes influenza vaccine uptake to high-risk groups, including pregnant women, could be enacted.
• Further research regarding the uptake of influenza vaccination in pregnancy should be encouraged and supported by the Ministry of Health, universities, and other health organisations.

In conclusion, the low influenza vaccine uptake due to misconceptions about the associated side effects calls for active awareness programmes not only for pregnant women and the general public but also for healthcare providers in Saudi Arabia. The expectation is that such an approach would raise the awareness and utilisation of the influenza vaccine, thus preventing severe illness and complications in mothers and their fetuses.