Table 3 Overview of categories and (sub-)themes, VIP-IDEAL study, 2022

Structural and organisational factors

Organisation of and access to ANC

Limited GP involvement due to new midwife-led ANC services and access via new online self-referral system (and related confusion); delayed access/ disrupted ANC; organisational challenges and changes due to the Covid-19 pandemic (including remote ANC visits and suspension of continuity of care system)

ANC booking visit

Lack of time and limited vaccination-related information

Subsequent ANC visits

Lack of time and lack of vaccination-related information and reminders

Access to influenza and pertussis vaccines within maternity and at GP clinics

Access to influenza and pertussis vaccines within maternity; access to influenza and pertussis vaccines via GP versus maternity and recent changes; opportunistic vaccination

Access to Covid vaccines within maternity and via vaccination centres

Temporary access to Covid vaccines in maternity in hospital; Access to Covid-vaccines at vaccination centres (including lack of special arrangement for pregnant women and reduced trust/confusion about change of guidance)

Access to maternal vaccines via pharmacies

Access to maternal vaccines via pharmacies (including advantages and barriers)

Resources, roles and responsibilities

Resource challenges in maternity services (including lack of staffing, space and supply) and in pharmacies; vaccination-related roles and responsibilities of different providers

Health information system and Apps

Insufficient information transfer between providers and shortcomings of electronic health records, referral systems and documentation; lack of user-friendliness of apps and not used to access vaccine information; information for participants via app versus hardcopy material (including digital exclusion and language barriers)

Behavioural factors

Passive versus active decision-making process

Passive decision-making; active decision-making (with own research)

Interaction with HCP/ Provider recommendations

Recommendation against Covid-19 vaccines or no clear recommendation or information;

no clear recommendation/ no information/dialogue regarding pertussis and influenza vaccines; importance of not putting pressure on women, and vaccination as personal decision; unambiguous recommendation as facilitator of vaccine uptake

Engagement with information material and social media

Hardcopy or electronic leaflets; Searching online/ via social media (including to fill information gaps and to search for personal stories from others)

Interaction with family, friends and others

Interaction with and influence of mothers, partners and others (including personal stories); interest in decisions of other pregnant women (including in waiting rooms)

Individual characteristics and influences on vaccination decisions:

Risk–benefit perceptions

Risk benefit evaluation and motivation to accept/recommend vaccines (including based on own/ others previous experience of vaccine/vaccine-preventable disease); perceived risk and benefit of vaccine/vaccine-preventable disease on baby and/or/versus mother; perception of pregnancy as vulnerability; perceived susceptibility/ risks in case of underlying health conditions or complications; perceived risk and individual biological differences; risk evaluation based on exposure; alternative risk-mitigating behaviour

Knowledge and skills

Conflicting information; misconceptions and general health knowledge; lack of awareness or information about vaccines; ability/ opportunity to ask HCPs questions; lack of HCP training, knowledge or specific information to pass on to clients; commitment of some HCP to relay information and have honest dialogue; lack of research evidence; language and digital skills

Emotions and trust

Fear of vaccine and/or vaccine-preventable disease; trust in healthcare system and HCP; reduced trust and/or confusion due to change of guidance; lack of trust and historical events; lack of trust and ethnicity; lack of trust and conspiracy theories/ misinformation; emotions and trust linked to pressure and mandatory vaccines

Cultural norms, philosophy and beliefs

Social and cultural norms, including in country of origin/ abroad; religion and Covid-19 vaccination; other beliefs and philosophy (including letting nature take its course, preference for natural products and homeopathy); attitudes regarding altruistic reasons for vaccination

Attitude towards mandatory Covid-19 vaccines

Vaccination needed for travel or work; planned mandatory vaccines for HCP; perceived pressure/ no pressure to get vaccinated

Participant recommendations

(Relating to various categories above)

Clearer provider recommendation, vaccination dialogue and more information; vaccination programmes and messages more targeted to pregnant women, and more personalised; provider training; organisational changes (including opt-out versus opt-in approach); increased accessibility; improved health information systems and apps; Provision of hardcopy information material to avoid digital exclusion; addressing language barriers