Pregnant Women’s Knowledge, Attitude, Practice, and Barriers Associated with the Uptake of Influenza Vaccination: A Systematic Review

Document Type : Systematic Review


1 Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Kerman University Of Medical Sciences, Kerman, Iran.

3 Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran.



Background: Vaccination is the most effective way to prevent influenza during pregnancy. This study aims to determine the knowledge, attitude, practice (KAP), and barriers associated with the uptake of influenza vaccination during pregnancy among pregnant women worldwide.
Materials and Methods: In this systematic review, a systemic search of online databases (Medline, EMBASE, Scopus, Web of Science, Cochrane Library, ProQuest, CINAHL, and Google Scholar search engine) was performed to identify all studies that considered KAP and barriers to the vaccination of women during pregnancy with no time limit up to December 2022.
Results: A total of 24 studies from 22 countries were selected. The overall correct knowledge, positive attitude, and good practice ranged from 5.5 to 96%, 34.6 to 79.5%, and 1.1 to 73.8%, respectively. The highest and lowest knowledge scores belonged to women in Thailand and Iran. The highest positive attitude was related to Iranian pregnant women and the lowest to Italian women. The highest positive performance belonged to pregnant women in the UK and the lowest to Turkish women. The most mentioned barrier was concern regarding the side effects of the vaccine (80.9%). Other barriers were a lack of awareness of the safety of influenza vaccination, lack of medical endorsement by healthcare providers, unawareness of the advantages of influenza vaccination for the mother and infant, and the negative attitude of pregnant women towards influenza vaccination.
Conclusion: The pregnant women had low knowledge, moderate attitude, and low behavior toward the flu vaccine uptake during pregnancy. Concern regarding the side effects of the vaccine was the most mentioned barrier.