"I try to take all the time needed, even if i do not have it!": Knowledge, attitudes, practices of perinatal care providers in canada about vaccination.

Objective: Successful clinical conversations about vaccination in pregnancy (pertussis, COVID-19, and influenza) are key to improving low uptake rates of both vaccination in pregnancy and infancy. The purpose of this study was to understand Canadian perinatal care providers' knowledge, attitudes, and practices around vaccination in pregnancy. Methods: Qualitative interviews with 49 perinatal care providers (nurse practitioner, general practitioner, registered nurse, registered midwife, obstetrician-gynecologist, and family physicians) in 6 of 13 provinces and territories were deductively coded using directed content analysis [1] and analyzed according to key themes. Results: Participants detailed their professional training and experiences, patient community demographics, knowledge of vaccines, views and beliefs about vaccination in pregnancy, and attitudes about vaccine counselling. Providers generally described having a good range of information sources to keep vaccine knowledge up to date. Some providers lacked the necessary logistical setups to administer vaccines within their practice. Responses suggest diverging approaches to vaccine counselling. With merely hesitant patients, some opted to dig in and have more in-depth discussions, while others felt the likelihood of persuading an outright vaccine-refusing patient to vaccinate was too low to be worthwhile. Conclusion: Provider knowledge, attitudes, and practices around vaccination varied by professional background. To support perinatal providers' knowledge and practices, clinical guidelines should detail the importance of vaccination relative to other care priorities, emphasize the positive impact of engaging hesitant patients in vaccine counselling.

Lessons learned from the experiences and perspectives of frontline healthcare workers on the COVID-19 response: a qualitative descriptive study.

BACKGROUND: During the COVID-19 pandemic, healthcare systems and healthcare workers (HCWs) faced significant demands and unique challenges. In this qualitative study, we explore the effects of the COVID-19 public health policies on British Columbia's frontline HCWs, describe what worked in the management of the pandemic, and elucidate the lessons learned that could be applied to future pandemic preparedness, recovery and response. METHODS: This qualitative descriptive study is part of a larger, national multi-case study on pandemic policy communication and uptake. Semi-structured interviews were conducted from November 2020- June 2021 with fourteen HCWs working in long-term care (LTC), acute care and public health settings. Data were inductively coded, and analyzed following a resilience framework for public health emergency preparedness, which emphasizes the essential elements of a public health system, vital to all phases of health emergency management, readiness, response and recovery. RESULTS: HCWs experienced confusion, frustration, uncertainty, anxiety, fatigue and stress, during the pandemic and detailed challenges that affected policy implementation. This included communication and coordination inconsistencies between the province and regional health authorities; lack of involvement of frontline staff in pandemic planning; inadequate training and support; inadequate personal protective equipment resource capacity and mobilization; and staffing shortages. HCWs recommended increased collaboration between frontline staff and policy makers, investment in preparing and practicing pandemic plans, and the need for training in emergency management and infection prevention and control. CONCLUSIONS: Pandemic planning, response and recovery should include inputs from actors/key stakeholders at the provincial, regional and local levels, to facilitate better coordination, communication and outcomes. Also, given the critical roles of frontline HCWs in policy implementation, they should be adequately supported and consideration must be given to how they interpret and act on policies. Bi-directional communication channels should be incorporated between policymakers and frontline HCWs to verify the appropriate adoption of policies, reflective learning, and to ensure policy limitations are being communicated and acted upon by policy makers.

Proof-of-vaccination credentials for COVID-19 and considerations for future use of digital proof-of-immunization technologies: Results of an expert consultation.

Objective: As part of COVID-19 pandemic control efforts, digital proof-of-vaccination credentials were launched in Canada in 2021-2022 following widespread vaccine availability. Given the controversy over proof-of-vaccination credentials-often colloquially called vaccine or immunization "passports"-it is imperative to document successes, shortcomings, and recommendations for any future uses. Methods: This expert consultation applied inductive qualitative content analysis to online video interviews with key informants whose expertise ranged from ethics to public health to computer science to identify what we can learn from this experience with proof-of-vaccination credentials, and what decision-makers must keep in mind for possible future use of such technologies. Results: There remains a lack of consensus regarding appropriate language and scope for digital proof-of-vaccination technologies, the respective roles of the technology sector versus government in design and implementation, and parameters for future use. However, experts agree on many recommendations, including the importance of clear communication, evidence-based rationale for the use of proof-of-vaccination credentials, multidisciplinary consultation including academic experts and the public, and the importance of pan-Canadian standards for accessibility and interoperability. Identified risks of use that emerged, and should be minimized in the future, include risks of coercion and backlash; threats to access, equity and privacy; and impacts such as costs of the technology and workload burden of enforcement and fraud detection. Conclusions: There is much to learn from this first major use of digital proof-of-vaccination credentials. A full scientific review of the impacts on health and equity should be combined with expert recommendations to create pan-Canadian guidelines for the future use of digital proof-of-vaccination solutions.

"Ultimately, the choice is theirs": Informed choice vaccine conversations and Canadian midwives.

BACKGROUND: In Canada, vaccination that protects against pertussis and influenza is recommended in every pregnancy, but uptake remains low. Communicating the risks and benefits of vaccination is key to clinical conversations about vaccination, which may influence the uptake of pregnancy and subsequent infant vaccines. Canadian midwives use an informed choice model of care, which is distinct from informed consent and prioritizes client autonomy in decision-making. METHODS: Using institutional ethnography, which treats lived experience as expertise, we aimed to understand how Canadian midwives, governed by intersecting professional standards and regulations, navigate vaccine discussions with their clients. We conducted interviews with individuals involved in midwifery training, regulation, and continuing education, as well as key public health professionals with expertise in immunization training. Following the phases of thematic analysis outlined by Braun and Clarke, data were analyzed holistically, emergent themes identified, and coding categories developed. RESULTS: Two types of confidence emerged as important to midwives' ability to conduct a thoroughly informed choice discussion about vaccines: confidence in vaccination itself (vaccine confidence), and confidence in vaccine knowledge and counseling skills (vaccine counseling confidence). A deferred or shortened vaccine discussion could be the result of either vaccine hesitancy or counseling hesitancy. DISCUSSION: Currently, available clinical communication tools and recommended techniques for addressing vaccine hesitancy do not always adapt well to the needs of midwives working to support clients' informed choice decisions. Our findings suggest that Canadian midwives require more and clearer resources on both the risks and benefits of vaccination in pregnancy.

Public health community engagement with Asian populations in British Columbia during COVID-19: towards a culture-centered approach.

OBJECTIVES: COVID-19 has posed significant challenges to those who endeavour to provide equitable public health information and services. We examine how community leaders, advocates, and public health communication specialists have approached community engagement among Asian immigrant and diaspora communities in British Columbia throughout the pandemic. METHODS: Qualitative interviews with 27 participants working with Asian communities in a healthcare, community service, or public health setting, inductively coded and analyzed following the culture-centred approach to health communication, which focuses on intersections of structure, culture, and agency. RESULTS: Participants detailed outreach efforts aimed at those who might not be reached by conventional public health communication strategies. Pre-existing structural barriers such as poverty, racial disparities, and inequitable employment conditions were cited as complicating Asian diaspora communities' experience of the pandemic. Such disparities exacerbated the challenges of language barriers, information overload, and rapidly shifting recommendations. Participants suggested building capacity within existing community service and public health outreach infrastructures, which were understood to be too lean to meet community needs, particularly in a pandemic setting. CONCLUSION: A greater emphasis on collaboration is key to the provision of health services and information for these demographic groups. Setting priorities according to community need, in direct collaboration with community representatives, and further integrating pre-existing bonds of trust within communities into public health communication and engagement strategies would facilitate the provision of more equitable health information and services. This mode of engagement forgoes the conventional focus on individual behaviour change, and focuses instead on fostering community connections. Such an approach harmonizes with community support work, strengthening the capacity of community members to secure health during public health emergencies.

RéSUMé: OBJECTIFS: La pandémie de la COVID-19 a posé des défis importants à ceux qui visent à transmettre des informations et à offrir des services de santé publique équitables. Nous examinons comment les responsables d'organismes communautaires, les militants pour les droits et les spécialistes de la communication en santé publique ont abordé l'engagement communautaire auprès de communautés de la diaspora asiatique en Colombie-Britannique durant la pandémie. MéTHODES: Des entretiens qualitatifs ont été réalisés auprès de 27 participants travaillant avec des communautés asiatiques dans un cadre de soins de santé, de services communautaires ou de santé publique. Les entretiens ont été codés et analysés de manière inductive selon l'approche centrée sur la culture de la communication en matière de santé, qui se concentre sur les intersections entre structure, culture et agencéité. RéSULTATS: Les participants ont décrit les efforts de sensibilisation destinés à ceux qui ne sont potentiellement pas rejoints par les stratégies conventionnelles de communication en santé publique. Selon les participants, les barrières structurelles préexistantes telles que la pauvreté, les disparités raciales et les conditions d'emploi inéquitables ont aggravé l'expérience de la pandémie par les communautés de la diaspora asiatique. Ces disparités ont exacerbé les enjeux liés aux barrières linguistiques, à la surcharge d'informations et à l'évolution rapide des recommandations. Les participants ont suggéré de renforcer les capacités de communication et de sensibilisation au sein des services communautaires existants, qui étaient considérées comme trop faibles pour répondre aux besoins de la communauté, particulièrement en contexte pandémique. CONCLUSION: Il est essentiel d'améliorer la collaboration afin d'offrir des services et de mieux communiquer auprès de ces communautés. Pour des communications et des services de santé publique plus équitables, les besoins et les priorités doivent être identifiés en collaboration directe avec les représentants des communautés, et les relations de confiance préexistantes au sein des communautés doivent être mises à profit. Une telle approche s'harmonise avec le travail de soutien communautaire et contribuerait de façon durable à améliorer les capacités des communautés à protéger la santé pendant les urgences de santé publique.

Suitable but requiring support: How the midwifery model of care offers opportunities to counsel the vaccine hesitant pregnant population.

Uptake of vaccination during pregnancy in Canada is lower than comparator countries. A recommendation from a trusted perinatal healthcare provider is a key opportunity to promote vaccine uptake and improve confidence. This study aims to identify barriers and opportunities to vaccination in midwifery care. Seventeen semi-structured telephone interviews with practicing midwives, educators and public health professionals with immunization training experiences were conducted. Documents pertaining to the midwifery profession (approx. 50) were reviewed. Inductive thematic analysis identified logistical, interprofessional, and information barriers preventing Canadian midwives from administering vaccines and counseling clients about vaccination, as well as opportunities to address each barrier. Key interventions at the level of logistics, training, and client information materials would help address barriers to the integration of midwives into the provision and recommendation of vaccines in perinatal care across Canada.