Examining the role of influence and trust in information sources on the COVID-19 vaccine decision-making process for pregnant and postpartum women in Brazil, Ghana, Kenya, and Pakistan: A mixed methods study

Introduction: This study examined associations between information sources and COVID-19 vaccination behavior among pregnant and postpartum women in Brazil, Ghana, Kenya, and Pakistan. Methods: This mixed methods study involved concurrent in-depth interviews and cross-sectional surveys. Results: A total of 1797 women participated in the study. Overall, participants were more likely to be vaccinated if they believed that they knew enough about safety to make a decision (aOR: 1.51; CI: 1.04–2.20) and trusted the information they received from healthcare providers (aoR: 1.74; CI: 1.19–2.54). Odds of vaccination were higher among those who trusted information provided by scientists (aoR:1.86; CI: 1.31–2.63) and among those who believed that leaders in their community recommended the COVID-19 vaccine (aOR: 1.4; CI: 1.01–1.92). Higher odds of vaccination were observed among participants in Pakistan who had the information they needed to make a decision (aOR: 2.58; CI: 1.35–4.94), knew enough about safety to make a decision (aOR: 3.82; CI: 1.85–7.89), trusted the information they received from healthcare providers (aOR: 3.20; CI: 1.39–7.34), and believed that community leaders recommended the COVID-19 vaccine (aOR: 2.53; CI: 1.22–5.25). Participants in Brazil who trusted information provided by scientists (aOR: 4.70; CI: 1.23–18.05); participants in Kenya who trusted information from the media (aOR: 1.94; CI: 1.10–3.44); and participants in Ghana who trusted recommendations from their government (aOR: 2.66; CI: 1.42–5.0) had higher odds of vaccination. Interviewed women noted that they felt overwhelmed with the amount of information and misinformation related to COVID-19 and the vaccine specifically. Discussion: Trusted COVID-19 vaccine information sources reported by pregnant and postpartum women vary by country, suggesting the need to identify sources across different target populations to improve vaccine acceptability and uptake with the goal of realizing the population level benefits of vaccination.