Socioecological and message framing factors influencing maternal influenza immunization among minority women

Vaccine. 2014 Mar 26;32(15):1736-44. doi: 10.1016/j.vaccine.2014.01.030. Epub 2014 Jan 28.


Objective: A suboptimal level of seasonal influenza vaccination among pregnant minority women is an intractable public health problem, requiring effective message resonance with this population. We evaluated the effects of randomized exposure to messages which emphasize positive outcomes of vaccination ("gain-frame"), or messages which emphasize negative outcomes of forgoing vaccination ("loss-frame"). We also assessed multilevel social and community factors that influence maternal immunization among racially and ethnically diverse populations.

Study design: Minority pregnant women in metropolitan Atlanta were enrolled in the longitudinal study and randomized to receive intervention or control messages. A postpartum questionnaire administered 30 days postpartum evaluated immunization outcomes following baseline message exposure among the study population. We evaluated key outcomes using bivariate and multivariate analyses.

Results: Neither gain- [OR=0.5176, (95% CI: 0.203,1.322)] nor loss-framed [OR=0.5000, 95% CI: (0.192,1.304)] messages were significantly associated with increased likelihood of immunization during pregnancy. Significant correlates of seasonal influenza immunization during pregnancy included healthcare provider recommendation [OR=3.934, 95% CI: (1.331,11.627)], use of hospital-based practices as primary source of prenatal care [OR=2.584, 95% CI: (1.091,6.122)], and perceived interpersonal support for influenza immunization [OR=3.405, 95% CI: (1.412,8.212)].

Conclusion: Dissemination of vaccine education messages via healthcare providers, and cultivating support from social networks, will improve seasonal influenza immunization among pregnant minority women.

Keywords: Immunization coverage; Influenza vaccination; Message framing; Pregnant women; Prospect theory; Racial/ethnic minorities; Socioecological model.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Georgia
  • Health Communication / methods*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Influenza Vaccines / administration & dosage*
  • Influenza, Human / prevention & control
  • Information Dissemination
  • Middle Aged
  • Minority Groups / statistics & numerical data*
  • Patient Education as Topic
  • Pregnancy
  • Pregnant Women*
  • Socioeconomic Factors
  • Vaccination / statistics & numerical data*
  • Young Adult


  • Influenza Vaccines