Tag: CASE method

We Don’t Know How To Talk About Vaccines

There is a dirty little secret about vaccines that people don’t seem to like to talk about.

No, it’s not about toxins or autism.

“Our systematic review did not reveal any convincing evidence on effective interventions to address parental vaccine hesitancy and refusal. We found a large number of studies that evaluated interventions for increasing immunization coverage rates such as the use of reminder/recall systems, parent, community-wide, and provider-based education and incentives as well as the effect of government and school immunization policies.

However, very few intervention studies measured outcomes linked to vaccine refusal such as vaccination rates in refusing parents, intent to vaccinate, or change in attitudes toward vaccines.

Most of the studies included in the analysis were observational studies that were either under-powered or provided indirect evidence.”

Sadaf et al on A systematic review of interventions for reducing parental vaccine refusal and vaccine hesitancy

It’s that we don’t really know how to talk about vaccines to vaccine hesitant parents, at least not in a way that we know will consistently get them to vaccinate and protect their kids.

Understanding Studies About Vaccine Hesitancy

Sure, a lot of studies have been done about talking to vaccine hesitant parents.

We have all seen the headlines:

  • Study: You Can’t Change an Anti-Vaxxer’s Mind
  • Pro-vaccine messages can boost belief in MMR myths, study shows
  • UWA study shows attacking alternative medicines is not the answer to get parents to vaccinate kids
  • Training Doctors To Talk About Vaccines Fails To Sway Parents

Does that mean that you shouldn’t try to talk to vaccine hesitant parents?

Of course not.

“How providers initiate and pursue vaccine recommendations is associated with parental vaccine acceptance.”

Opel et al on The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits

Just understand that these headlines are usually about small studies, which if they were about treating a child with asthma or strep throat,  likely wouldn’t change how you do things.

Why do anti-vaccine websites still post misinformation about fake recommendations to stop breastfeeding?
Why do people continue to believe misinformation about fake recommendations to stop breastfeeding?

In one study that concluded that “physician-targeted communication intervention did not reduce maternal vaccine hesitancy or improve physician self-efficacy,” the physicians got a total of 45 minutes of training!

So they shouldn’t have so much influence about how you might talk to parents about vaccines that you throw up your hands at the thought of talking to a vaccine hesitant parent and won’t even think about learning how to use the CASE method, why presumptive language might work, or about vaccination-focused motivational interviewing techniques.

The bottom line is that no matter what the headlines say, we just haven’t found the best way to talk to vaccine-hesitant parents and help them overcome their cognitive biases. And until more studies are done, none of the existing studies about anti-vaccine myth-busting should likely overly influence how you do things.

“Physicians should aim for both parental satisfaction and a positive decision to vaccinate. Researchers must continue to develop conceptually clear, evidence-informed, and practically implementable approaches to parental vaccine hesitancy, and agencies need to commit to supporting the evidence base. Billions of dollars fund the research and development of vaccines to ensure their efficacy and safety. There needs to be a proportional commitment to the “R&D” of vaccine acceptance because vaccines are only effective if people willingly take them up.”

Leask et al on Physician Communication With Vaccine-Hesitant Parents: The Start, Not the End, of the Story

If you spend any time talking to vaccine hesitant parents, especially those who are on the fence, you quickly learn that many are eager to get good information about vaccines and all want to do what is best for their kids.

It’s just hard for many of them to do what is best when their decisions are getting influenced by vaccine scare videos and many of the 100s of myths about vaccines that are out there.

“…while the drivers of vaccine hesitancy are well documented, effective intervention strategies for addressing the issue are sorely lacking. Here, we argue that this may be because existing strategies have been guided more by intuition than by insights from psychology and by the erroneous assumption that humans act rationally.”

Rossen et al on Going with the Grain of Cognition: Applying Insights from Psychology to Build Support for Childhood Vaccination

So while we need more studies on the best ways to talk to vaccine hesitant parents, don’t dismiss all of the ways that might be effective, such as:

It is also important to become familiar with the myths and anti-vaccine talking points that may be scaring your patients away from getting vaccinated on time.

Why is this important?

If a parent is concerned about glyphosate, you might not sound too convincing telling them not to worry if you don’t even know what glyphosate is.

What to Know About Vaccine Hesitancy Studies

While we learn better ways to talk about vaccines, so that vaccine-hesitant parents can more easily understand that vaccines are safe and necessary, don’t dismiss current strategies because of small studies and attention grabbing headlines.

More on Vaccine Hesitancy Studies

 

How Pediatricians Should Talk to Vaccine Hesitant Parents

Vaccine hesitant parents sometimes don’t get time to talk with a pediatrician about vaccines.

They might not even get an appointment with their new baby if they express doubts about wanting to vaccinate their kids or about wanting to skip or delay some vaccines.

That’s unfortunate, as I think many would choose to vaccinate and protect their kids if they got answers to the anti-vaccine talking points that scare them.

Myth busting by itself doesn’t always seem to work though.

How Pediatricians Should Talk to Vaccine Hesitant Parents

It is understandable that pediatricians get frustrated talking to some anti-vaccine parents.

Pediarix, Hib, Prevnar, and Rota vaccines have been prepared for an infant at her well child visit.
Pediarix, Hib, Prevnar, and Rota vaccines for my daughter at her 2 month well visit 10 years ago. Photo by Vincent Iannelli, MD

One strategy that might work includes asking open ended questions about why the parent is hesitant to vaccinate their kids. Next, while responding to a few of their biggest concerns, be sure to affirm what the parent is saying and use reflective listening.

How might these vaccination-focused motivational interviewing techniques work during a typical visit at a pediatrician’s office? Instead of getting frustrated and accepting a copy of Dr. Bob’s alternative schedule, you might ask them:

  • What specifically are you afraid of?
  • You are really worried that your child might get sick after their vaccines.
  • It sounds like you think kids get too many shots.

Now, address a few of those concerns.

Pediatricians often feel like they don’t have enough time to have long discussions about vaccines, when they also need to talk about many other important topics at each visit, including nutrition, development, and safety, etc. The vaccine talk doesn’t have to be extensive though. Just get it started and come back to it again at the next visit.

You can also recommend some good vaccine books and websites to help parents do more research.

Talking About Vaccines

It is not enough to simply tell your vaccine hesitant parents to read a book, visit a website, or offer them some handouts though. It is important that pediatricians also talk to parents about vaccines.

Study after study show that pediatricians are the most influential, most convincing, and most used source of information about vaccines for many parents.

“How providers initiate and pursue vaccine recommendations is associated with parental vaccine acceptance.”

Opel et al on The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits

Just remember, when you have these talks, to:

  • Use vaccination-focused motivational interviewing techniques for vaccine-hesitant parents.
  • Avoid using scientific and medical jargon.
  • Help parents who may have a skewed perception of the risks of vaccines vs risks of vaccine preventable diseases, by emphasizing that vaccines are very safe.
  • Avoid simply minimizing or dismissing a parent’s concerns about vaccines without providing a fact based explanation for why they shouldn’t be worried.
  • Highlight the benefits of vaccines, including all of the social benefits.
  • Avoid a “data dump,” in which you might overwhelm a vaccine hesitant parent with too much information all at once and in what they might see as a lecture about accepting vaccines.
  • Always use presumptive language and high-quality recommendations when you talk about vaccines.
  • Include stories and anecdotes about kids who have gotten sick and parents who regret not vaccinating their kids.
  • Become familiar with the anti-vaccine talking points that may be scaring your patients away from getting vaccinated on time. Why is this important? If they are concerned about glyphosate, you might not sound too convincing telling them not to worry if you don’t even know what glyphosate is.
  • Try the CASE Method for talking about vaccine concerns.

Are your kids fully vaccinated? Talk about that too.

There is much more to all of this than simply letting parents follow non-standard, parent-selected, delayed protection vaccine schedules and arguing with them about getting caught up.

What to Know About Talking to Vaccine Hesitant Parents

Learning new ways to talk to vaccine hesitant parents, including the use of vaccination-focused motivational interviewing techniques, presumptive language, and high-quality recommendations, might help pediatricians have more success and get less frustrated.

More About Talking to Vaccine Hesitant Parents