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DECIDE, A Pregnancy-specific Patient-provider Communication Approach: Multi-method and Codesign
Medea Myers-Stewart1, Monica Santosh Surti1, Madison Kennedy1
1From the Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta.
Background:
Vaccination in pregnancy is recommended for preventing maternal and infant morbidity, but uptake is low. Existing presumptive and participatory vaccine communication approaches for childhood vaccinations may not encompass the nuanced decision-making during pregnancy.
Methods:
We employed a multi-method study using the double diamond design framework to codesign a pregnancy-specific, person-centered communication approach. Key activities of each double diamond phase are listed below:Discover: Conducted a scoping review, a survey assessing psychological antecedents of (n = 237) pregnant or lactating individuals, qualitative interviews with (n = 169) patients and (n = 47) healthcare providers (HCPs) and gathered insights through (n = 20) community outreach events to understand the problem.Define: Synthesized findings through thematic analysis and key informant interviews, to validate our understanding of the problem.Develop: Prototyped solutions through role-playing, iterative feedback with patient partners and HCPs, and qualitative inquiry into parental preferences.Deliver: Finalized the communication approach after iterative usability testing with (n = 15) HCPs and feedback-driven refinement with (n = 9) patient partners.
Results:
We confirmed the need for a pregnancy-specific communication approach and identified key gaps. We then built a prototype where perinatal HCPs could use either a presumptive if acceptant or participatory if hesitant approach but questioned the applicability of vaccine hesitancy to pregnancy. We abandoned a solely presumptive approach given parental insights: it is normal to "question" during pregnancy and developed a balanced approach. The final DECIDE (determine, elicit, consent, interactive discussion, deliver, empower) communication approach balances shared decision-making with a clear recommendation. It addresses pregnant individuals' desire for autonomy and support, and HCPs call for simple tools to improve their confidence and communication skills without alienating their patients.
Conclusion And Next Steps:
DECIDE is a pregnancy-specific vaccine communication approach potentially applicable to other interventions beyond vaccination.
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