JMIR Publications

ABSTRACT

Background:

Vaccination in pregnancy (VIP) protects pregnant individuals and their newborns, yet vaccine uptake remains suboptimal. Pregnant individuals face unique decision-making challenges, and communication with their healthcare provider (HCP) is crucial for uptake. Whilst there is extensive data on barriers to VIP, interventions that apply evidence-based behaviour change strategies and that are co-designed with end-users are scarce. Our prior work led us to conclude that a new Canadian intervention was needed.

Objective:

Co-design a multicomponent intervention to support informed decision-making and vaccine communication in pregnancy.

Methods:

Our multi-method study followed the Double Diamond phases: Discover, Define, Develop, and Deliver, and partnered with a diverse patient advisory council and a multidisciplinary team of HCPs. During the Discover and Define phases, we explored barriers and enablers to VIP in Canada, and defined the behaviour change strategies to address those needs. During the Develop phase we co-designed and conducted iterative prototyping of four intervention components: (1) pregnancy-specific communication approach, (2) skills course for HCPs, (3) HCPs practice change plan, and (4) website with evidence-based resources for patients and HCPs. We used online and in-person participatory co-design sessions and a peer-to-peer, patient-oriented online focus groups and semi-structured in-depth interviews. During the Deliver phase, we refined the intervention components through functionality and usability testing.

Results:

The Vaccines in Pregnancy Canada (VIP Canada) intervention was co-designed to drive behaviour change by addressing the key barriers to vaccine communication and informed decision-making identified in our previous work; it consists of 4 integrated components: 1. DECIDE Communication Approach: A patient-centered, pregnancy-specific communication approach for HCPs to deliver a clear vaccine recommendation while respecting autonomy. 2. VIP Skills Course for HCPs: Four self-paced, online modules to learn the rationale for VIP and the DECIDE communication approach and two group sessions. Providers found the skills course clear, practical, and applicable across diverse clinical roles and settings. Feedback led to enhancements including improved audio-visual synchronization, consistent closed captioning, and the addition of downloadable reference materials to support learning. 3. Practice Change Plan: An action plan HCPs make to integrate vaccine communication into practice. 4. VIP Canada Website: An evidence-based website with resources to support informed vaccine decision-making for patients and HCPs. Patient feedback informed iterative refinements to layout and content of the website to enhance navigation, readability and representation of diverse identities. Functionality and usability testing demonstrated that patients found the VIP Canada website visually appealing, easy to navigate, and supportive of informed decision-making.

Conclusions:

Our innovative approach to co-design the VIP Canada intervention combined a rigorous problem-understanding inquiry informed by behavioural and implementation sciences with a co-design process centred around our patient partners’ and HCPs' perspectives and lived experiences to bridge theoretical frameworks with real-world relevance.