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Vaccination in pregnancy (VIP) protects pregnant individuals and their newborns; yet, uptake remains suboptimal. Pregnant individuals face unique decision-making challenges, and communication with their health care provider (HCP) is crucial for uptake. While there is extensive data on barriers to VIP, interventions applying evidence-based behavior change strategies and co-designed with end users are scarce. Our prior work indicated that a new Canadian intervention was needed. This study aimed to co-design a multicomponent intervention to support informed decision-making and vaccine communication in pregnancy. Our multimethod study followed the Double Diamond phases (ie, 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, our previous work, we explored gaps and barriers to VIP in Canada and defined the behavior change strategies to address those needs. During the Develop phase, we co-designed and conducted iterative prototyping of four intervention components: (1) a pregnancy-specific communication approach, (2) a skills course for HCPs, (3) a practice change plan, and (4) a website with evidence-based resources for patients and HCPs. We used online and in-person participatory co-design sessions and peer-to-peer, patient-oriented online focus groups and semistructured in-depth interviews. During the Deliver phase, we refined the intervention components through functionality and usability testing. The Vaccines in Pregnancy Canada (VIP Canada) intervention consists of four integrated components: (1) DECIDE (Determine, Elicit, Consent, Interactive discussion, Deliver, and Empower): a patient-centered, pregnancy-specific communication approach for providers to deliver a clear vaccine recommendation while respecting autonomy. (2) Skills course for HCPs: 4 self-paced, online modules to learn the rationale for VIP and the DECIDE communication approach and 2 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 their practice. (4) VIP Canada website: an evidence-based website with resources to support informed vaccine decision-making for patients and providers. Patient feedback informed iterative refinements to the 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. The VIP Canada is a promising intervention co-designed to drive behavior change by addressing key barriers to vaccine communication and informed decision-making around our patient partners' and HCPs' perspectives and lived experiences to bridge theoretical frameworks with real-world relevance. Next steps include a feasibility study for further refinement and a subsequent effectiveness study.

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 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.BACKGROUNDVaccination 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 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.Co-design a multicomponent intervention to support informed decision-making and vaccine communication in pregnancy.OBJECTIVECo-design a multicomponent intervention to support informed decision-making and vaccine communication in pregnancy.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 healthcare providers. During the Discover and Define phases, our previous work, we explored gaps and barriers 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) a pregnancy-specific communication approach, (2) a skills course for healthcare providers, (3) a practice change plan, and (4) a website with evidence-based resources for patients and healthcare providers. We used online and in-person participatory co-design sessions and 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.METHODSOur 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 healthcare providers. During the Discover and Define phases, our previous work, we explored gaps and barriers 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) a pregnancy-specific communication approach, (2) a skills course for healthcare providers, (3) a practice change plan, and (4) a website with evidence-based resources for patients and healthcare providers. We used online and in-person participatory co-design sessions and 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.The Vaccines in Pregnancy Canada (VIP Canada) intervention consists of 4 integrated components: 1. DECIDE Communication Approach: A patient-centered, pregnancy-specific communication approach for providers to deliver a clear vaccine recommendation while respecting autonomy; 2. Skills Course for Healthcare Providers: 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 healthcare providers make to integrate vaccine The Vaccines in Pregnancy Canada (VIP Canada) intervention consists of 4 integrated components: 1. DECIDE Communication Approach: A patient-centered, pregnancy-specific communication approach for providers to deliver a clear vaccine recommendation while respecting autonomy; 2. Skills Course for Healthcare Providers: 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 healthcare providers make to integrate vaccine communication into their practice; 4. VIP Canada Website: An evidence-based website with resources to support informed vaccine decision-making for patients and providers. 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.communication into their practice; 4. VIP Canada Website: An evidence-based website with resources to support informed vaccine decision-making for patients and providers. 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.RESULTSThe Vaccines in Pregnancy Canada (VIP Canada) intervention consists of 4 integrated components: 1. DECIDE Communication Approach: A patient-centered, pregnancy-specific communication approach for providers to deliver a clear vaccine recommendation while respecting autonomy; 2. Skills Course for Healthcare Providers: 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 healthcare providers make to integrate vaccine The Vaccines in Pregnancy Canada (VIP Canada) intervention consists of 4 integrated components: 1. DECIDE Communication Approach: A patient-centered, pregnancy-specific communication approach for providers to deliver a clear vaccine recommendation while respecting autonomy; 2. Skills Course for Healthcare Providers: 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 healthcare providers make to integrate vaccine communication into their practice; 4. VIP Canada Website: An evidence-based website with resources to support informed vaccine decision-making for patients and providers. 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.communication into their practice; 4. VIP Canada Website: An evidence-based website with resources to support informed vaccine decision-making for patients and providers. 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.The VIP Canada is a promising intervention co-designed to drive behaviour change by addressing key barriers to vaccine communication and informed decision-making around our patient partners' and healthcare providers' perspectives and lived experiences to bridge theoretical frameworks with real-world relevance. Next steps include a feasibility study for further refinement and a subsequent effectiveness study.CONCLUSIONSThe VIP Canada is a promising intervention co-designed to drive behaviour change by addressing key barriers to vaccine communication and informed decision-making around our patient partners' and healthcare providers' perspectives and lived experiences to bridge theoretical frameworks with real-world relevance. Next steps include a feasibility study for further refinement and a subsequent effectiveness study.

Background Cancer disparities are a major public health concern in Canada, affecting racialized communities of Latin American and African descent, among others. This is evident in lower screening rates, lower access to curative, and palliative-intent treatments, higher rates of late cancer diagnoses and lower survival rates than the general Canadian population. We will develop an Access to Palliative Care Strategy informed by health equity and patient-oriented research principles to accelerate care improvements for patients with advanced cancer of African and Latin American descent. Methods This is a community-based participatory research study that will take place in two Canadian provinces. Patients and community members representatives have been engaged as partners in the planning and design of the study. We have formed a patient advisory council (PAC) with patient partners to guide the development of the Access to Palliative Care Strategy for people of African and Latin American descent. We will engage100 participants consisting of advanced cancer patients, families, and community members of African and Latin American descent, and health care providers. We will conduct in-depth interviews to delineate participants’ experiences of access to palliative care. We will explore the intersections of race, gender, socioeconomic status, language barriers, and other social categorizations to elucidate their role in diverse access experiences. These findings will inform the development of an action plan to increase access to palliative care that is tailored to our study population. We will then organize conversation series to examine together with community partners and healthcare providers the appropriateness, effectiveness, risks, requirements, and convenience of the strategy. At the end of the study, we will hold knowledge exchange gatherings to share findings with the community. Discussion This study will improve our understanding of how patients with advanced cancer from racialized communities in Canada access palliative care. Elements to address gaps in access to palliative care and reduce inequities in these communities will be identified. Based on the study findings a strategy to increase access to palliative care for this population will be developed. This study will inform ways to improve access to palliative care for racialized communities in other parts of Canada and globally.