Abstract
BACKGROUND AND AIMS: Despite significant advancements in COVID-19 vaccine research and development, hesitancy in its acceptance, particularly among pregnant women, is recognized as a health threat. Based on the Health Belief Model, this study aimed to identify the factors influencing vaccine nonacceptance among pregnant women in the cities of Zahedan and Tabriz, Iran. METHODS: The present research was a multicenter cross-sectional study conducted among pregnant women in two Iranian provinces, Zahedan and Tabriz, covering both high and low fertility regions. The study was conducted from February 2022 to August 2022. The sample size comprised 650 pregnant women attending selected healthcare centers. Data collection tools included questionnaires on sociodemographic characteristics, awareness, vaccine acceptance, and health beliefs related to vaccination. Data were analyzed using descriptive and analytical methods, including Analysis of variance (ANOVA), Independent t-test, and multivariable logistic regression. RESULTS: Among the 650 pregnant women, the vaccine acceptance rate was 47.4% and 52.6% of pregnant women reported vaccine nonacceptance during pregnancy. The logistic regression model indicated that the odds of vaccine acceptance increase with maternal employment (OR = 11.53, 95% CI: 4.81-27.63), higher maternal education levels (OR = 6.97, 95% CI: 3.11-15.63), higher income (OR = 1.60, 95% CI: 1.07-2.55), and increased awareness levels (OR = 1.37, 95% CI: 1.03-1.52). Additionally, the odds of vaccine acceptance increase with increased perceived susceptibility (OR = 2.55, 95% CI: 0.47-3.76), increased perceived benefits (OR = 2.22, 95% CI: 1.06-4.61), increased perceived barriers (OR = 0.42, 95% CI: 0.18-1.12), and increased cues to action (OR = 2.01, 95% CI: 1.03-3.92). CONCLUSION: Our study underscores the multifaceted nature of COVID-19 vaccine acceptance among pregnant women, with socioeconomic, awareness-related, and psychological factors all playing pivotal roles. These findings can inform targeted interventions and strategies aimed at increasing vaccine acceptance in this vulnerable population, ultimately contributing to enhanced maternal and fetal health during the ongoing pandemic.