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

Document Type : Systematic Review


Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.



Introduction: The most effective way to prevent influenza during pregnancy is through vaccination. This study aimed to determine the knowledge, attitude, practice (KAP), and barriers associated with the uptake of influenza vaccination during pregnancy among pregnant women worldwide.
Method: 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 screened to identify all studies that considered KAP, and barriers of pregnant women to vaccination during pregnancy, with no time limit up to June 2022.
Results: A total of 24 studies from 16 countries, were included. The overall correct knowledge, positive attitude, and good practice ranged from 5.5-96%, 34.6-79.5%, and 1.1-73.8%, respectively. The highest and lowest knowledge scores were related to Thailand and Iran pregnant women. The highest positive attitude was related to Iranian pregnant women, and the lowest attitude was related to Italian women. The results also showed that the highest positive performance was related to pregnant women in the UK, and the lowest rate was related to Turkish women. Concern regarding the side effects of the vaccine was the most mentioned barrier (80.9%). Other barriers were lack of awareness on the safety of influenza vaccination, lack of medical endorsement by health care providers, unawareness of the advantages of influenza vaccination for the mother and infant, level of education, and negative attitude of pregnant women towards influenza vaccination (p<0.05).
Conclusion: The pregnant women had low knowledge, moderate attitude, and low vaccination behavior toward the flu vaccine uptake during pregnancy. Concern regarding the side effects of the vaccine was the most mentioned barrier.