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Krug-Mushey, Alex

University of British Columbia

Background: While challenges surrounding vaccine acceptance in pregnancy were prevalent prior to the COVID-19 pandemic, this pandemic introduced a different context for pregnant people – including concerns about COVID-19 infection during pregnancy, changes to the format of perinatal care and social support, and the introduction of new vaccines. This thesis aims to examine these new influences on vaccine decision-making during pregnancy. Methods: Using data from a mixed-methods project headed by the University of British Columbia and McMaster University, this research seeks to answer the question, “How does trust influence the decision-making process of pregnant people around vaccination during pregnancy in the context of the COVID-19 pandemic?” Data from semi-structured interviews with 74 participants who gave birth in Ontario or British Columbia from May 1st, 2020 to December 1st, 2021 were analyzed. This process of reflexive thematic analysis was initially conducted with sensitizing constructs from the Theory of Reasoned Action, Theory of Planned Behaviour, and Health Belief Model but came to incorporate Maya J. Goldenberg’s “Crisis of Trust” framework following preliminary analysis. Results: With the role of trust as central to this analysis, an extended “Crisis of Trust” model was created, with three related, overlapping facets identified – trust in prenatal care providers, trust in institutions, and trust in networks. Trust in prenatal care providers was shaped by participants’ goals of alleviating their mental load, differential cultural norms influencing degrees of trust in healthcare providers, and perceived transparency of providers. Trust in institutions focused on overall trust in the government and healthcare system, trust in the goodwill of the pharmaceutical industry (or lack thereof) and perceptions of relationships between these institutions. Finally, trust in networks included social networks as a potent site of (dis)trust, lived experience forming an interpretive lens for prenatal care, and views of COVID-19 vaccines as a moral obligation or source of hope for the broader community. Conclusions: This study demonstrates that vaccine hesitancy in pregnant people extends beyond an informational problem into a deeper deficiency of trust. These insights allow for the implementation of public health policies which target these ideological conflicts to better improve vaccine acceptance.

Text

2025-04-25

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/90783

Population and Public Health

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/