Midwives' Perceptions of Promoting Pregnancy Vaccines in Wales: Identifying Factors Influencing Vaccine Uptake Using the COM-B Framework.

Introduction: Vaccinations are vital for global health; however, since the onset of the COVID-19 pandemic in 2020, there has been a notable decline in maternal vaccine acceptance in Wales, UK. It is a key part of a midwife's role to promote vaccine uptake in pregnancy. Therefore, gaining an understanding of midwives' perceptions of the issue is crucial for identifying factors influencing vaccine uptake in Wales. Methods: A quantitative, cross-sectional descriptive survey was conducted amongst 143 registered midwives working in Wales using the Capability, Opportunity, Motivation-Behaviour (COM-B) approach to identify factors affecting vaccine uptake. Results: Midwives lacked training and confidence to promote vaccines, and some noted language barriers as a problem to providing equitable care. Other problems included lack of access to vaccination appointments and inconsistencies in vaccine promotion depending on care provider. Midwives perceived vaccine hesitancy to be high, with 71% saying they thought vaccine hesitancy was common amongst pregnant women and 40% saying they thought it was common amongst their colleagues. Conclusion: A national approach is required to ensure effective vaccination training amongst midwives in Wales, as well as improved availability of language diverse resources. Additional qualitative research is needed in Wales and the United Kingdom to further understand vaccine hesitancy and barriers to promoting vaccine uptake in pregnancy.