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Table 3 Patient trust and views on patient autonomy – HCP Perspective

From: Patient and provider perspectives on how trust influences maternal vaccine acceptance among pregnant women in Kenya

Subtheme Quote
Expressed Trust “When they come, they just accept what the doctor gives them because they believe the doctor is always right. They have never challenged us by asking ‘why are you giving me this vaccine and not the other one?’”
“May be sometimes they do not have that chance to say no because they look at me as their savior, the last person for them and everything I tell them they do believe is right”
“Actually, patients just come for ANC clinics and it is us, the health care providers who decide what is deemed fit for them; they do not ask for anything.”
Respect for autonomy “We believe that the client is always right. Therefore, after taking our time and proving a detailed health talk and a woman still refuses to be vaccinated, we do not force them. Clients have the right to accept of refuse medication. We honor their requests and what they believe in. we always give them a lot of information anyway.”
“Most of the mothers who come here for the vaccine know that they have to be injected. Others had not received the tetanus vaccines in their previous pregnancies so they do not see the importance of the vaccine. We explain to them the importance and tell them to go think about it and come back because we cannot force them.”
“Normally after you have done all the necessary services you will tell the mother now it is time to give you the vaccine we normally tell the mother thatI want to give you a tetanus injection” during that time she has the right to tell you if she does not want the injection or she just accepts. However, we have never had a case in which a mother declines.”
Authoritative approach “We tell them what they need to have so I do not think decision-making is on their side so they just receive it.”
“I: Okay, once you make available, vaccines in your facility especially the tetanus vaccines, do you think mothers get ample time to make a timely decision whether or not to receive the vaccines in your facility?
P: They have no choice, we just tell them it is mandatory and it is good for them.”
Sources of trust
1. Education “Yes, they normally have time to accept because by the time they leave their homes to come to the clinic, they are very sure the doctors or the nurses or health care providers know more than they do, so they will just do what the health care ask them to do”
2. Altruism “I think it is the norm of the clients where you find that patients always feel that the doctor is the one who knows what she should receive as they believe the doctor will do the right thing.”