COVID-19 ile Enfekte Olmuş Gebe Kadınların Aşıya Yönelik Tereddütleri, Görüşleri ve Deneyimleri: Türkiye’den Nitel Bir Çalışma

Yıl 2025, Cilt: 12 Sayı: 1, 51 - 63, 26.03.2025

Rukiye Sülü Dursun , Ebru Gözüyeşil , Şule Gökyıldız Sürücü , Burcu Avcıbay

Öz

Arka Plan ve Amaç: Tüm dünyayı etkisi altına alan COVID-19 pandemisini kontrol altına almak amacıyla ilaç ve aşı çalışmaları yapılmıştır. COVID-19 aşılarının geliştirilmesi ve ülkelerce yaygın kullanıma girmesi ile beraber ağır hastalık ve ölüm oranları azalmıştır. Gebe kadınlarda hastaneye yatış ve ağır hastalık görülme riski daha yüksek olduğu için COVID-19 enfeksiyonuna karşı en etkili korunma yöntemi aşılardır. Ancak pandemiyle birlikte salgının aşı çalışmalarına etkisi, aşıya erişim, tedarik ve dağıtım, öncelikli grupların belirlenmesi, aşılarda patent sorunu, aşı kararsızlığı veya karşıtlığı başlıca etik sorun kümelerini oluşturmaktadır. Bu çalışma, Türkiye’de COVID-19 ile enfekte olmuş gebe kadınların aşıya yönelik görüşleri, deneyimleri ve tereddütlerini belirlemek amacıyla nitel çalışma deseninde yürütülmüştür. Gereç ve Yöntem: Yarı yapılandırılmış görüşme tekniği kullanılarak 18 COVID-19 ile enfekte olmuş gebe kadın ile görüşme sağlanmıştır.
Bulgular: Elde edilen veriler nitel tematik ve içerik analizi ile değerlendirilmiştir. Çalışmanın içerik analizi sonucunda 3 ana tema ve 7 alt tema belirlenmiştir. Belirlenen ana temalar şunlardır: (1) Korku, (2) Deneyimler, (3) Sosyal destek. Her tema ayrı ayrı tartışılmıştır. Sonuç: Bu çalışma sonucunda, gebe kadınların, aşıya karşı güvensizlik, aşı çalışmalarının yetersiz olduğuna inanma ve fetal sağlığa ilişkin kaygılar nedeniyle korku yaşamıştır. COVID-19 ile enfekte olmuş gebe kadınların semptomları ağır yaşama ve sağlık profesyonelleri ile iletişim kurduklarında aşıya yönelik olumlu tutum geliştirmiştir. Ayrıca aşıya karşı olumlu tutum geliştirmesinde sosyal medyanın ve eş desteğinin etkili olduğu belirlenmiştir.

Anahtar Kelimeler

Covid-19, tıp etiği, gebe kadın, nitel çalışma, aşı

Hesitations, Views and Experiences of Pregnant Women Infected with COVID-19 About Vaccines: A Qualitative Study

Öz

Background and Objective: Drug and vaccine studies have been carried out to control the COVID-19 pandemic, which has affected the whole world. With the development of COVID-19 vaccines and their widespread use in countries, rates of severe illness and death have decreased. Since pregnant women have a higher risk of hospitalization and severe disease, the most effective method of protection against COVID-19 infection is vaccination. However, with the pandemic, the impact of the epidemic on vaccine studies, access to vaccines, supply and distribution, determination of priority groups, patent problems in vaccines, vaccine hesitancy or opposition constitute the main ethical problem groups. This study utilized a qualitative study design to determine the vaccine-related hesitations, views and experiences of pregnant women who were infected with COVID-19 in Turkiye.
Material and Methods: Eighteen women infected with COVID-19 were interviewed using the semi-structured interview technique.
Results: The data obtained were analyzed using qualitative thematic and content analysis methods, which revealed 3 main themes and 7 sub-themes. The main themes were determined as Fear (1), Experiences (2), and Social Support (3).
Conclusion: The results showed that pregnant women experienced fear due to distrust of vaccines, beliefs about the inadequacy of vaccine research, and concerns about fetus health, while those who were infected reported to experience severe symptoms and develop positive attitudes toward vaccines when they communicated with the health personnel. Besides, partner support was found to be effective in developing positive attitudes toward vaccines.

Anahtar Kelimeler

covid-19, medical ethics, pregnant women, qualitative research, Vaccines

Etik Beyan

Ethics approval was obtained from the Scientific Research and Publication Ethics Committee of Çukurova University (Number:2022.10.07/28-126; Date: October 22, 2022). Pregnant women who were accessed were given information about the purpose of the study as well as the confidentiality of the data collected. They were assured that participation was on a voluntary basis and that they could withdraw from the study anytime they wanted.

Kaynakça

• Goodman T. Update on Who Interim recommendations on COVID-19 vaccination of pregnant and lactating women. World Health Organization (WHO), AFRO Webinar, June 2, 20221. Available from: https://www.who.int/publications/m/item/update-on-who-interim-recommendations-on-covid-19-vaccination-of-pregnant-and-lactating-women [cited: 2022 Nov 6]
• Coronavirus disease (COVID-19): Vaccines and vaccine safety. World Health Organization (WHO), 2021. Timeline: COVID-19 Vaccine Uptedates. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-(covid-19) [cited: 2022 Nov 6]
• WHO Health Emergencies Programme: WHO COVID-19 Dashboard. World Health Organization (WHO), 2022. Available from: https://data.who.int/dashboards/covid19/cases [cited: 2022 Jan 26]
• Yokoyama A, Suzuki H, Kataoka H, Mori Y, Watanabe Y, Miyatake N. Comparison of Impressions of COVID-19 Vaccinations Stratified by the Number of Vaccinations Among Japanese Healthcare Professional University Students. Cureus, 2024; 16(3):e55861. https://doi.org/10.7759/cureus.55861.
• Eberhardt J, Ling J. Predicting COVID-19 Vaccination Intention Using Protection Motivation Theory and Conspiracy Beliefs. Vaccine, 2021; 39(42):6269-6275. https://doi.org/10.1016/j.vaccine.2021.09.010
• Galanis P, Vraka I, Siskou O, Konstantakopoulou O, Katsiroumpa A, Kaitelidou D. Uptake of COVID-19 Vaccines Among Pregnant Women: A Systematic Review and Meta-Analysis. Vaccines, 2022;10(5):766. https://doi.org/10.3390/vaccines10050766
• Gencer H, Özkan S, Vardar O, Serçekuş P. The Effects of the COVID 19 Pandemic on Vaccine Decisions in Pregnant Women. Women and Birth, 2022;35(3):317-323. https://doi.org/10.1016/j.wombi.2021.05.003
• Januszek SM, Faryniak-Zuzak A, Barnaś E, Łoziński T, Góra T, Siwiec N, Szczerba P, Januszek R, Kluz T. The Approach of Pregnant Women to Vaccination Based on a COVID-19 Systematic Review. Medicina (Kaunas), 2021;57(9):977. https://doi.org/10.3390/medicina57090977
• Vitiello A, Ferrara F, Zovi A, Trama U, Boccellino, M. Pregnancy and COVID-19, Focus on Vaccine and Pharmacological Treatment. J Reprod Immuno, 2022;151:103630. https://doi.org/10.1016/j.jri.2022.103630
• Melo GC, Araújo KCGM. COVID-19 Infection in Pregnant Women, Preterm Delivery, Birth Weight, and Vertical Transmission: A Systematic Review and Meta-Analysis. Cadernos de Saúde Pública. 2020;36(7):e00087320. https://doi.org/10.1590/0102-311X00087320
• Atmar RL, Lyke KE, Deming ME, Jackson LA, Branche AR, El Sahly HM, Rostad CA, Martin JM, Johnston C, Rupp RE, Mulligan MJ, Brady RC, Frenck RW, Bäcker M, Kottkamp AC, Babu TM, Rajakumar K, Edupuganti S, Dobrzynski D, Coler RN, Posavad CM, Archer JI, Crandon S, Nayak SU, Szydlo D, Zemanek JA, Dominguez Islas CP, Brown ER, Suthar MS, McElrath MJ, McDermott AB, O’Connell SE, Montefiori DC, Eaton A, Neuzil KM, Stephens DS, Roberts PC, Beigel JH. Homologous and Heterologous COVID-19 Booster Vaccinations. New England J Med, 2022;386(11):1046-1057. https://doi.org/ 10.1056/NEJMoa2116414
• Moghadas SM, Vilches TN, Zhang K, Nourbakhsh S, Sah P, Fitzpatrick MC, Galvani AP. Evaluation of COVID-19 Vaccination Strategies with a Delayed Second Dose. PLoS Biol, 2021;19(4):e3001211. https://doi.org/10.1371/journal.pbio.3001211
• Kalafat E, Heath P, Prasad S, Pat O, Khalil A. COVID-19 Vaccination in Pregnancy. American J Obst Gyne, 2022;227(2):136-147. https://doi.org/10.1016/j.ajog.2022.05.020
• Anderson E, Brigden A, Davies A, Shepherd E, Ingram J. Maternal Vaccines during the Covid-19 Pandemic: A Qualitative Interview Study with UK Pregnant Women. Midwifery, 2021;100:103062. https://doi.org/10.1016/j.midw.2021.103062
• Vaccination Considerations for People who are Pregnant or Breastfeeding. Centers for Disease Control and Prevention (CDC), 2019. Available from: https://www.cdc.gov/coronavirus/2019ncov/vaccines/recommendations/pregnancy.html. [cited 2022 Nov 6]
• Practice Advisory: Novel Coronavirus 2019. American College of Obstetrics and Gynecologists (ACOG), 2020. Available from: https://www.acog.org/Clinical-Guidance-andPublications/Practice-Advisories/Practice-Advisory-Novel-Coronavirus2019 [cited 2022 Nov 1]
• COVID-19 Vaccines, Pregnancy and Breastfeeding. Royal College of Obstetricians and Gynaecologists (RCOG). Available from: https://www.rcog.org.uk/en/guidelines-research-services/coronavirus-covid-19-pregnancy-and-womens-health/covid-19-vaccines-and-pregnancy/covid-19vaccines [cited 2022 Nov 7]
• Clinical Management of Severe Acute Respiratory Infection (SARI) when COVID-19 Disease is Suspected. Interim guidance. World Health Organization (WHO), 2020. Available from: https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratoryinfectionwhen- novel-coronavirus-(ncov)-infection-is-suspected [cited 2022 Nov 7]
• Uludağ E, Serçekuş P, Yıldırım DF, Özkan S. A Qualitative Study of Pregnant Women's Opinions on COVID-19 Vaccines in Turkiye. Midwifery, 2022;114:103459. https://doi.org/10.1016/j.midw.2022.103459
• Braun V, Clarke V, Weate P. Using Thematic Analysis in Sport and Exercise Research. Editors Smith B, Sparkes AC. In Routledge Handbook of Qualitative Research in Sport and Exercise. London: Routledge, 2016:191-205.
• Neubauer BE, Witkop CT, Varpio L. How Phenomenology can Help us Learn from the Experiences of Others. Persp Med Educ, 2019;8(2):90-97. https://doi.org/10.1007/s40037-019-0509-2
• O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for Reporting Qualitative Research: A Synthesis of Recommendations. Acade Med, 2014;89(9):1245-1251. https://doi.org/10.1097/ACM.0000000000000388
• Byrne D. A Worked Example of Braun and Clarke’s Approach to Reflexive Thematic Analysis. Quality & Quantity, 2022;56(3):1391-1412. https://doi.org/10.1007/s11135-021-01182-y
• Sanders J, Blaylock R. “Anxious and Traumatised”: Users’ Experiences of Maternity Care in the UK during the COVID-19 Pandemic. Midwifery. 2021;102:103069. https://doi.org/10.1016/j.midw.2021.103069
• Kuckartz U, Rädiker S. Analyzing Qualitative Data with MAXQDA: Text, Audio, and Video. Switzerland: Springer, 2019.
• Blakeway H, Prasad S, Kalafat E, Heath PT, Ladhani SN, Le Doare K, Magee LA, O'Brien P, Rezvani A, von Dadelszen P, Khalil A. COVID-19 Vaccination during Pregnancy: Coverage and Safety. Am J Obstet Gynecol, 2022;226(2):236.e1-236.e14. https://doi.org/10.1016/j.ajog.2021.08.007
• Nakahara A, Biggio JR, Elmayan A, Williams FB. Safety-Related Outcomes of Novel mRNA COVID-19 Vaccines in Pregnancy. Am J Perinatol, 2022;39(13): 1484-1488. https://doi.org/ 10.1055/a-1745-1168
• Wainstock T, Yoles I, Sergienko R, Sheiner E. Prenatal Maternal COVID-19 Vaccination and Pregnancy Outcomes. Vaccine, 2021;39(41):6037-6040. https://doi.org/10.1016/j.vaccine.2021.09.012
• Dollinger S, Zlatkin R, Jacoby C, Shmueli A, Barbash-Hazan S, Chen R, Danieli HZ, Sukenik S, Hadar E, Wiznitzer A. Clinical Characteristics and Outcomes of COVID-19 During Pregnancy-a Retrospective Cohort Study. Reprod Sci, 2022;29(8):2342-2349. https://doi.org/10.1007/s43032-022-00949-4
• Dileep A, ZainAlAbdin S, AbuRuz S. Investigating the Association between Severity of COVID-19 Infection during Pregnancy and Neonatal Outcomes. Scientific Reports, 2022;12(1): 3024. https://doi.org/10.1038/s41598-022-07093-8
• Pairat K, Phaloprakarn C. Acceptance of COVID-19 Vaccination during Pregnancy among Thai Pregnant Women and their Spouses: A Prospective Survey. Reprod Health, 2022;19(1):74. https://doi.org/10.1186/s12978-022-01383-0