High-involvement Cognitive Messaging: Increasing Tdap Uptake

The number of outbreaks of pertussis across the country has been growing.

The number of outbreaks of pertussis across the country has been growing. The Advisory Committee on Immunization Practices (ACIP) recommends vaccinating all women with Tdap during every pregnancy or immediately postpartum, regardless of immunization history. However, Tdap vaccination in this population is low, particularly among African American women.

Researchers from the Emory University in Atlanta, GA and the University of Kansas Medical Center, in Kansas City, KS designed tailored messaging based on the Elaboration Likelihood Model (ELM) framework to determine if such interventions might increase vaccine uptake in African American women. Clinicians have used the ELM successfully with other public health interventions.

The prospective randomized controlled trial piloted 2 interventions during routine prenatal care visits. The first was an affective messaging video called ‘‘Pregnant Pause.” The video showed physicians providing detailed information on Tdap and influenza vaccines. It also described pertussis and influenza, and their potential to cause serious health care problems. This program described how vaccines protect pregnant women and babies.

The second was a cognitive messaging iBook. It used a question-and-answer format that allowed women to select topics of most interest to them and complete sections separately. It covered topics similar to those in the video.

One hundred and six women enrolled in the study, and 90% completed follow-up.

Among women who received neither the video nor the iBook, Tdap vaccination in the perinatal period was 18%. One-half of participants who used the iBook received Tdap, and 29% of participants who viewed the video group did. Study participants rated the iBook as less relatable and more difficult to understand than the video.

Unvaccinated women most often reported that they were not vaccinated with Tdap because their physicians did not recommend it.

The study, published in the journal Vaccine, concluded that high-involvement cognitive messaging interventions may increase the likelihood of vaccination.


Kriss JL, Frew PM, Cortes M, et al. Evaluation of two vaccine education interventions to improve pertussis vaccination among pregnant African American women: A randomized controlled trial. Vaccine. 2017 Feb 16. pii: S0264-410X(17)30086-5. doi: 10.1016/j.vaccine.2017.01.037. [Epub ahead of print]

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