Journal Article

Supporting Informed Vaccine Decision-Making and Communication in Pregnancy Through the Vaccines in Pregnancy Canada Intervention: Multi-Method Co-Design

Kaufman, Jessica, Surti, Monica Santosh, Donald, Maoliosa, Bruce, Marcia, Castillo, Eliana, Patey, Andrea M, Danchin, Margie, Myers-Stewart, Medea, Castrellon Pardo, Maria, Bettinger, Julie A, Jamal, Zaileen, Kennedy, Madison

2025

Overview

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.