Information sources and COVID-19 vaccination in pregnancy: an exploratory survey from health facilities in São Paulo state, Brazil

To assess the influence of source of information on pregnant women's knowledge, attitudes, and practices regarding COVID-19 vaccination. This cross-sectional exploratory study was carried out at two Brazilian institutions. Pregnant women aged 18 years and older with knowledge about COVID-19 vaccination were included between August and December of 2023. We employed an instrument consisting of 76 quantitative questions, based on established models (5Cs, BeSD, HBM, Socioecological) and collected sociodemographic data, evaluated vaccine-related beliefs with Likert scales and vaccination history. Participants were categorized by their information sources as “official” (e.g., healthcare professionals, health agencies) or “non-official” (i.e., sources that did not include government agencies or healthcare professionals). Data were entered into REDCap, checked for inconsistencies, and analyzed using descriptive and bivariate statistics to compare vaccine acceptance based on information's source. 402 pregnant women were included. Among these, 233 (58.0%) used only non-official sources of information, while 169 (42.0%) used at least one official source. Women using official sources were more likely to be older than 35 years and have only primary education. Vaccination status was similar across groups, but those using official sources were more likely to have received 4 or 5 vaccine doses and be vaccinated during pregnancy. Reasons for vaccination were similar across groups, primarily for self-protection, while concerns about vaccine safety and pregnancy were common reasons for not vaccinating. Women using official sources were more confident in their vaccination decisions, had higher family encouragement, and trusted healthcare professionals more. They also felt better informed about vaccine safety and had greater trust in scientific information compared to those relying on non-official sources. The source of information influences the knowledge, attitudes, and practices of pregnant women regarding COVID-19 vaccination in Brazil. Women who relied on official information sources, such as healthcare professionals, had better knowledge, higher trust in vaccine safety, and were more likely to receive multiple doses, including during pregnancy. Implementation of policies promoting vaccination during pregnancy should account for using multiple sources of information to improve coverage and influence .