Protocol maps lactating people's COVID-19 vaccine perceptions to guide communicationCOVID-19 Vaccine Views Among Breastfeeding People: A Review Plan

Lactating people experiencing SARS-CoV-2 infection encounter physical, emotional, and psychosocial challenges during the postpartum period compared to the general population. Despite the importance of COVID-19 vaccination globally, campaigns aimed at vaccinating at-risk populations, including pregnant and lactating people (PLP), have faced challenges, leading to a low uptake among PLP. The objectives of this study are to discover lactating people's perceptions toward COVID-19 vaccination uptake and to explore facilitators and barriers that inform their COVID-19 vaccination decision process. The search will be carried out using the MEDLINE (PubMed), CINAHL, Embase and Scopus databases. The search will utilise Medical Subject Headings (MeSH) terms and keywords to optimise results. The MeSH terms used will include ‘breastfeeding OR lactation’, ‘COVID-19 vaccine’, and ‘vaccination hesitancy’, along with various iterations of these keywords. Boolean operators ‘AND’ and ‘OR’ will be applied to expand the search scope. The search criteria will be limited to recent articles published between 2020 and 2026, in English, and with available abstracts. Two reviewers will independently screen titles/abstracts and full texts, while two reviewers will extract data. Study selection will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol guidelines, and study quality will be evaluated using the Appraisal Tool for Cross-sectional Studies (AXIS), JBI qualitative checklist and MMAT. Data will be analysed thematically following the approach outlined by Braun & Clarke (2006), presenting findings as a narrative summary. This review will help to design clear communication and targeted campaigns, building trust in vaccine safety and effectiveness. No formal ethical approval is necessary since this study does not involve the collection of primary data. The findings will be shared via a peer-reviewed journal article and presented at conferences. Clinical Trial registration number: International Prospective Register for Systematic Reviews (PROSPERO) number CRD42024568930 (Version 1.5).