Attitudes toward COVID-19 vaccination among pregnant and lactating women in SAMARICA District, Occidental Mindoro: A health belief model perspective
Keywords:
COVID-19 vaccine, female, lactation, pregnancy, pregnant women, vaccination, vaccine intentionAbstract
COVID-19 vaccination is crucial for public health, yet hesitancy persists among specific populations, including pregnant and lactating women. This study aimed to determine the willingness of pregnant and lactating women in SAMARICA District, Occidental Mindoro, Philippines, to receive the COVID-19 vaccine and identify factors influencing their attitudes. This is an analytical cross-sectional study design using Health Belief Model survey interview. The total of 82 pregnant and lactating women from SAMARICA district in Occidental Mindoro were included through convenience sampling. Data were collected on demographics, perceived health status, vaccine information sources, and attitudes towards COVID-19 vaccination. Results shows that government trust (r=.492; p value=.000); perceived severity (r=.384; p value=.000); perceived benefits of COVID-19 vaccination (r=.522; p value=.000); perceived barriers of COVDI-19 vaccination (r=.364; p value=.001) were positively correlated with the respondents’ cues to action. Rural residence was also associated with higher vaccination intention. While overall vaccination intention was high, targeted interventions are necessary to address remaining hesitancy among this vulnerable population. Strengthening health communication campaigns and addressing specific concerns regarding vaccine safety during pregnancy and lactation are crucial for improving COVID-19 vaccine uptake.
References
Al-Ashwal, F. Y., Kubas, M., Zawiah, M., Bitar, A. N., Saeed, R. M., Sulaiman, S. A. S., Khan, A. H., & Ghadzi, S. M. S. (2020). Healthcare workers’ knowledge, preparedness, counselling practices, and perceived barriers to confront COVID-19: A cross-sectional study from a war-torn country, Yemen. PLOS ONE, 15(12), e0243962. https://doi.org/10.1371/JOURNAL.PONE.0243962
Al-Jayyousi, G. F., Sherbash, M. A. M., Ali, L. A. M., El-Heneidy, A., Alhussaini, N. W. Z., Elhassan, M. E. A., & Nazzal, M. A. (2021). Factors Influencing Public Attitudes towards COVID-19 Vaccination: A Scoping Review Informed by the Socio-Ecological Model. Vaccines, 9(6). https://doi.org/10.3390/VACCINES9060548
Al-Mistarehi, A. H., Kheirallah, K. A., Yassin, A., Alomari, S., Aledrisi, M. K., Ata, E. M. B., Hammad, N. H., Khanfar, A. N., Ibnian, A. M., & Khassawneh, B. Y. (2021). Determinants of the willingness of the general population to get vaccinated against COVID-19 in a developing country. Clinical and Experimental Vaccine Research, 10(2), 171–182. https://doi.org/10.7774/CEVR.2021.10.2.171
Alzoubi, H., Alnawaiseh, N., Al-Mnayyis, A., Abu-Lubad, M., Aqel, A., & Al-Shagahin, H. (2020). Covid-19 - Knowledge, attitude and practice among medical and non-medical university students in Jordan. Journal of Pure and Applied Microbiology, 14(1), 17–24. https://doi.org/10.22207/JPAM.14.1.04
Amin, A. B., Bednarczyk, R. A., Ray, C. E., Melchiori, K. J., Graham, J., Huntsinger, J. R., & Omer, S. B. (2017). Association of moral values with vaccine hesitancy. Nature Human Behaviour, 1(12), 873–880. https://doi.org/10.1038/S41562-017-0256-5
Ayson, M. E., & Reyes, lara G. (2021). The Philippines 2021: Populist legacy and looming uncertainties - Asia Maior - An Italian think tank on Asia. Asia Maior. https://www.asiamaior.org/the-journal/15-asia-maior-vol-xxxii-2021/the-philippines-2021-populist-legacy-and-looming-uncertainties.html
Alfonso, C., Dayrit, M., Mendoza, R. & Ong, M. (2021). From Dengvaxia to Sinovac: Vaccine Hesitancy in the Philippines – The Diplomat. The Diplomat. https://thediplomat.com/2021/03/from-dengvaxia-to-sinovac-vaccine-hesitancy-in-the-philippines/
Department of Health. (2021a). IATF Adopts COVID-19 Vaccination Priority Framework Amid Limited Vaccine Supply. Department of Health Website. https://doh.gov.ph/doh-press-release/IATF-ADOPTS-COVID-19-VACCINATION-PRIORITY-FRAMEWORK-AMID-LIMITED-VACCINE-SUPPLY
Department of Health. (2021b, March 30). Can pregnant women get the COVID-19 vaccine? | Department of Health website. Department of Health. https://doh.gov.ph/node/28465
Diesel, J., Sterrett, N., Dasgupta, S., Kriss, J. L., Barry, V., Esschert, K. Vanden, Whiteman, A., Cadwell, B. L., Weller, D., Qualters, J. R., Harris, L. T., Bhatt, A., Williams, C., Fox, L. A. M., Delman, D. M., Black, C. L., & Barbour, K. E. (2022). COVID-19 Vaccination Coverage Among Adults — United States, December 14, 2020–May 22, 2021. MMWR. Morbidity and Mortality Weekly Report, 70(25), 922–927. https://doi.org/10.15585/MMWR.MM7025E1
Dubé, E., Gagnon, D., Nickels, E., Jeram, S., & Schuster, M. (2014). Mapping vaccine hesitancy--country-specific characteristics of a global phenomenon. Vaccine, 32(49), 6649–6654. https://doi.org/10.1016/J.VACCINE.2014.09.039
Enserink, M. (2020). Fact-checking Judy Mikovits, the controversial virologist attacking Anthony Fauci in a viral conspiracy video. Science. https://doi.org/10.1126/SCIENCE.ABC7103
Gianfredi, V., Stefanizzi, P., Berti, A., D’Amico, M., De Lorenzo, V., Lorenzo, A. Di, Moscara, L., & Castaldi, S. (2023). A Systematic Review of Population-Based Studies Assessing Knowledge, Attitudes, Acceptance, and Hesitancy of Pregnant and Breastfeeding Women towards the COVID-19 Vaccine. Vaccines, 11(8). https://doi.org/10.3390/VACCINES11081289
Glanz, K., Rimer, B., & Viswanath, K. (2008). Health Behavior and Health Education: Theory, Research, and Practice. In John Wiley & Sons, Inc. https://iums.ac.ir/files/hshe-soh/files/beeduhe_0787996149(1).pdf
Goncu Ayhan, S., Oluklu, D., Atalay, A., Menekse Beser, D., Tanacan, A., Moraloglu Tekin, O., & Sahin, D. (2021). COVID-19 vaccine acceptance in pregnant women. International Journal of Gynecology & Obstetrics, 154(2). https://doi.org/10.1002/IJGO.13713
Hetherington, M. J., & Husser, J. A. (2012). How Trust Matters: The Changing Political Relevance of Political Trust. American Journal of Political Science, 56(2), 312–325. https://doi.org/10.1111/J.1540-5907.2011.00548.X
Huynh, G., Tran, T. T., Nguyen, H. T. N., & Pham, L. A. (2021). Perceived susceptibility, severity, and reinfection of COVID-19 may influence vaccine acceptance-Authors’ reply. Asian Pacific Journal of Tropical Medicine, 14(5), 239. https://doi.org/10.4103/1995-7645.316400
Iorfa, S. K., Ottu, I. F. A., Oguntayo, R., Ayandele, O., Kolawole, S. O., Gandi, J. C., Dangiwa, A. L., & Olapegba, P. O. (2020). COVID-19 Knowledge, Risk Perception, and Precautionary Behavior Among Nigerians: A Moderated Mediation Approach. Frontiers in Psychology, 11. https://doi.org/10.3389/FPSYG.2020.566773
Kansal, N., Weaver, K., Vasudevan, L., & Hughes, B. (2022). Evaluating Influenza and COVID-19 Vaccine Hesitancy Among Pregnant Women Using the Health Belief Model. American Journal of Obstetrics and Gynecology, 226(2), 314. https://doi.org/10.1016/j.ajog.2021.11.1319
Kong, K. L., Chu, S., & Giles, M. L. (2020). Factors influencing the uptake of influenza vaccine vary among different groups in the hard-to-reach population. Australian and New Zealand Journal of Public Health, 44(2), 163–168. https://doi.org/10.1111/1753-6405.12964
Konopińska, J., Obuchowska, I., Lisowski, Ł., Dub, N., Kozera, M., & Rękas, M. (2021). Intention to Get COVID-19 Vaccinations among Ophthalmology Residents in Poland: A Cross-Sectional Survey. Vaccines, 9(4). https://doi.org/10.3390/VACCINES9040371
Kuciel, N., Mazurek, J., Hap, K., Marciniak, D., Biernat, K., & Sutkowska, E. (2022). COVID-19 Vaccine Acceptance in Pregnant and Lactating Women and Mothers of Young Children in Poland. International Journal of Women’s Health, 14, 415–424. https://doi.org/10.2147/IJWH.S348652
Lang, R., Benham, J. L., Atabati, O., Hollis, A., Tombe, T., Shaffer, B., Burns, K. K., MacKean, G., Léveillé, T., McCormack, B., Sheikh, H., Fullerton, M. M., Tang, T., Boucher, J. C., Constantinescu, C., Mourali, M., Manns, B. J., Marshall, D. A., Hu, J., & Oxoby, R. J. (2021). Attitudes, behaviours and barriers to public health measures for COVID-19: a survey to inform public health messaging. BMC Public Health, 21(1), 1–15. https://doi.org/10.1186/S12889-021-10790-0/TABLES/3
Lazarus, J. V., Ratzan, S. C., Palayew, A., Gostin, L. O., Larson, H. J., Rabin, K., Kimball, S., & El-Mohandes, A. (2020). A global survey of potential acceptance of a COVID-19 vaccine. Nature Medicine 2020 27:2, 27(2), 225–228. https://doi.org/10.1038/s41591-020-1124-9
Lin, Y., Hu, Z., Zhao, Q., Alias, H., Danaee, M., & Wong, L. P. (2020). Understanding COVID-19 vaccine demand and hesitancy: A nationwide online survey in China. PLOS Neglected Tropical Diseases, 14(12), e0008961. https://doi.org/10.1371/JOURNAL.PNTD.0008961
Lu, P. J., O’Halloran, A., & Williams, W. W. (2015). Impact of health insurance status on vaccination coverage among adult populations. American Journal of Preventive Medicine, 48(6), 647. https://doi.org/10.1016/J.AMEPRE.2014.12.008
Malik, A. A., McFadden, S. A. M., Elharake, J., & Omer, S. B. (2020). Determinants of COVID-19 vaccine acceptance in the US. EClinicalMedicine, 26. https://doi.org/10.1016/j.eclinm.2020.100495
Marnach, M. (2017). Update on Immunization and Pregnancy: Tetanus, Diphtheria, and Pertussis Vaccination. Obstetrics and Gynecology, 130(3), e153–e157. https://doi.org/10.1097/AOG.0000000000002301
Marzo, R. R., Ahmad, A., Abid, K., Khatiwada, A. P., Ahmed, A., Kyaw, T. M., Abidin, I. B. Z., Srithar, M., Sinnathamby, S., Sarvasundram, A. P., & Shrestha, S. (2022). Factors influencing the acceptability of COVID-19 vaccination: A cross-sectional study from Malaysia. Vacunas, 23, S33–S40. https://doi.org/10.1016/J.VACUN.2021.07.007
Mayo, S., & Monfort, S. (2021). Letter to the Editor: Breastfeeding and COVID-19 Vaccine: Yes We Can. Https://Doi.Org/10.1177/08903344211004443, 37(2), 275–276. https://doi.org/10.1177/08903344211004443
McKee, C., & Bohannon, K. (2016). Exploring the Reasons Behind Parental Refusal of Vaccines. The Journal of Pediatric Pharmacology and Therapeutics : JPPT, 21(2), 104. https://doi.org/10.5863/1551-6776-21.2.104
Moghimi, S., Seraji, M., & Arab Borzu, Z. (2023). Predicting the Factors Related to the Acceptance of COVID-19 Vaccination by Pregnant and Lactating Women Referring to Comprehensive Health Service Centers in Zahedan, Iran, Using the Health Belief Model. Iran Journal of Nursing, 36(144), 386–397. https://doi.org/10.32598/IJN.36.144.3323.2
Murthy, B. P., Sterrett, N., Weller, D., Zell, E., Reynolds, L., Toblin, R. L., Murthy, N., Kriss, J., Rose, C., Cadwell, B., Wang, A., Ritchey, M. D., Gibbs-Scharf, L., Qualters, J. R., Shaw, L., Brookmeyer, K. A., Clayton, H., Eke, P., Adams, L., … Harris, L. T. Q. (2021). Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties - United States, December 14, 2020-April 10, 2021. MMWR. Morbidity and Mortality Weekly Report, 70(20), 759–764. https://doi.org/10.15585/MMWR.MM7020E3
Nalubega, P., Karafillakis, E., Atuhaire, L., Akite, P., Zalwango, F., Chantler, T., Cochet, M., Seeley, J., & Le Doare, K. (2021). Maternal Vaccination in Uganda: Exploring Pregnant Women, Community Leaders and Healthcare Workers’ Perceptions. Vaccines, 9(6). https://doi.org/10.3390/VACCINES9060552
Nguyen, K. H., Srivastav, A., Razzaghi, H., Williams, W., Lindley, M. C., Jorgensen, C., Abad, N., & Singleton, J. A. (2021). COVID-19 vaccination intent, perceptions, and reasons for not vaccinating among groups prioritized for early vaccination — United States, September and December 2020. American Journal of Transplantation, 21(4), 1650–1656. https://doi.org/10.1111/ajt.16560
Noronha, V., Abraham, G., Bondili, S., Rajpurohit, A., Menon, R., Gattani, S., Trikha, M., Tudu, R., Kota, K., Singh, A., Elamarthi, P., Panda, G., Rai, R., Krishna, M., Chinthala, S., Shah, M., Shah, D., Tiwari, A., Vora, D., … Prabhash, K. (2021). COVID-19 vaccine uptake and vaccine hesitancy in Indian patients with cancer: A questionnaire-based survey. Cancer Research, Statistics, and Treatment, 4(2), 211–218. https://doi.org/10.4103/CRST.CRST_138_21
Olaimat, A. N., Aolymat, I., Shahbaz, H. M., & Holley, R. A. (2020). Knowledge and Information Sources About COVID-19 Among University Students in Jordan: A Cross-Sectional Study. Frontiers in Public Health, 8, 254. https://doi.org/10.3389/FPUBH.2020.00254/BIBTEX
Paterson, P., Meurice, F., Stanberry, L. R., Glismann, S., Rosenthal, S. L., & Larson, H. J. (2016). Vaccine hesitancy and healthcare providers. Vaccine, 34(52), 6700–6706. https://doi.org/10.1016/J.VACCINE.2016.10.042
Phadke, V. K., Bednarczyk, R. A., Salmon, D. A., & Omer, S. B. (2016). Association Between Vaccine Refusal and Vaccine-Preventable Diseases in the United States: A Review of Measles and Pertussis. JAMA, 315(11), 1149–1158. https://doi.org/10.1001/JAMA.2016.1353
Piltch-Loeb, R., Silver, D. R., Kim, Y., Norris, H., McNeill, E., & Abramson, D. M. (2022). Determinants of the COVID-19 vaccine hesitancy spectrum. PLOS ONE, 17(6), e0267734. https://doi.org/10.1371/JOURNAL.PONE.0267734
Reno, C., Maietti, E., Fantini, M. P., Savoia, E., Manzoli, L., Montalti, M., & Gori, D. (2021). Enhancing covid-19 vaccines acceptance: results from a survey on vaccine hesitancy in northern Italy. Vaccines, 9(4), 378. https://doi.org/10.3390/VACCINES9040378/S1
Thomson, A., Robinson, K., & Vallée-Tourangeau, G. (2016). The 5As: A practical taxonomy for the determinants of vaccine uptake. Vaccine, 34(8), 1018–1024. https://doi.org/10.1016/J.VACCINE.2015.11.065
Thorneloe, R., Wilcockson, H., Lamb, M., Jordan, C., & Arden, M. (2020). Willingness to receive a COVID-19 vaccine among adults at high-risk of COVID-19: a UK-wide survey. PsyArXiv Preprints. https://doi.org/10.31234/osf.io/fs9wk
Tibbetts, J. (2020). Will a COVID Vaccine Be Accepted? Social, behavioral scientists needed to advance effective public health messaging. American Institute of Biological Sciences. https://doi.org/https://doi.org/10.1093/biosci/biaa133
Tsai, R., Hervey, J., Hoffman, K. D., Wood, J., Novack, J., Johnson, J., Deighton, D. C., Loew, B., & Goldberg, S. L. (2021). COVID-19 vaccine hesitancy among individuals with cancer, autoimmune diseases, and other serious comorbid conditions. MedRxiv, 2021.04.06.21254014. https://doi.org/10.1101/2021.04.06.21254014
Wong, L. P., Alias, H., Wong, P. F., Lee, H. Y., & AbuBakar, S. (2020). The use of the health belief model to assess predictors of intent to receive the COVID-19 vaccine and willingness to pay. Human Vaccines & Immunotherapeutics, 16(9), 2204–2214. https://doi.org/10.1080/21645515.2020.1790279
Wong, M. C. S., Wong, E. L. Y., Huang, J., Cheung, A. W. L., Law, K., Chong, M. K. C., Ng, R. W. Y., Lai, C. K. C., Boon, S. S., Lau, J. T. F., Chen, Z., & Chan, P. K. S. (2021). Acceptance of the COVID-19 vaccine based on the health belief model: A population-based survey in Hong Kong. Vaccine, 39(7), 1148–1156. https://doi.org/10.1016/J.VACCINE.2020.12.083
World Health Organization. (2019a). Immunization. World Health Organization. https://www.who.int/newsroom/facts-in-pictures/detail/immunization
World Health Organization. (2019b). Ten threats to global health in 2019. World Health Organization. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019
World Health Organization. (2020). WHO calls for healthy, safe and decent working conditions for all health workers, amidst COVID-19 pandemic. World Health Organization. https://www.who.int/news/item/28-04-2020-who-calls-for-healthy-safe-and-decent-working-conditions-for-all-health-workers-amidst-covid-19-pandemic
World Health Organization. (2021). Weekly epidemiological update on COVID-19 - 30 March 2021. World Health Organization. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---31-march-2021
Zambrano, L. D., Ellington, S., Strid, P., Galang, R. R., Oduyebo, T., Tong, V. T., Woodworth, K. R., Nahabedian, J. F., Azziz-Baumgartner, E., Gilboa, S. M., Meaney-Delman, D., Akosa, A., Bennett, C., Burkel, V., Chang, D., Delaney, A., Fox, C., Griffin, I., Hsia, J., … Zapata, L. (2020). Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–October 3, 2020. MMWR. Morbidity and Mortality Weekly Report, 69(44), 1641–1647. https://doi.org/10.15585/MMWR.MM6944E3
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Arnold Jann L. Cariaso, Artemio M. Gonzales Jr (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
