Physician Communication Training and Parental Vaccine Hesitancy: A Randomized Trial

Abstract

BACKGROUND AND OBJECTIVES: Physicians have a major influence on parental vaccine decisions. We tested a physician-targeted communication intervention designed to (1) reduce vaccine hesitancy in mothers of infants seen by trained physicians and (2) increase physician confidence in communicating about vaccines. METHODS:We conducted a community-based, clinic-level, 2-arm cluster randomized trial in Washington State. Intervention clinics received physician-targeted communications training. We enrolled mothers of healthy newborns from these clinics at the hospital of birth. Mothers and physicians were surveyed at baseline and 6 months. The primary outcome was maternal vaccine hesitancy measured by Parental Attitudes on Childhood Vaccines score; secondary outcome was physician self-efficacy in communicating with parents by using 3 vaccine communication domains. RESULTS:We enrolled 56 clinics and 347 mothers. We conducted intervention trainings at 30 clinics, reaching 67% of eligible physicians; 26 clinics were randomized to the control group. Maternal vaccine hesitancy at baseline and follow-up changed from 9.8% to 7.5% in the intervention group and 12.6% to 8.0% in the control group. At baseline, groups were similar on all variables except maternal race and ethnicity. The intervention had no detectable effect on maternal vaccine hesitancy (adjusted odds ratio 1.22, 95% confidence interval 0.47-2.68). At follow-up, physician self-efficacy in communicating with parents was not significantly different between intervention and control groups.CONCLUSIONS: This physician-targeted communication intervention did not reduce maternal vaccine hesitancy or improve physician self-efficacy. Research is needed to identify physician communication strategies effective at reducing parental vaccine hesitancy in the primary care setting.

Announcements Versus Conversations to Improve HPV Vaccination Coverage: A Randomized Trial

“…This outcome mirrors the findings of a trial by Henrikson and colleagues who found that participatory communication training was ineffective in reducing hesitant attitudes toward early childhood vaccination, as assessed by a survey of 347 mothers. 19 The absence of change for 3-dose HPV vaccine series completion observed in the current trial may be due to the intervention's focus on vaccine initiation, the 6-month follow-up period, and a decline in visits to a provider. We speculate an absence of change in vaccine coverage among older adolescents may also be due, in part, to a decline in visits to a provider.…”

“…Alternatively, a "conversation" approach that engages parents in open-ended discussions may build rapport and thus increase parental openness to HPV vaccination for their children. 19 Although a previous trial did not find evidence that conversations improve parents' vaccination attitudes, the impact of the approach on vaccination outcomes has not been tested. 19 In the absence of previously published randomized trials, it is unclear whether providers who are trained to improve their recommendations using announcements or conversations are more successful in increasing HPV vaccination coverage compared with providers who do not receive such training.…”

“…19 Although a previous trial did not find evidence that conversations improve parents' vaccination attitudes, the impact of the approach on vaccination outcomes has not been tested. 19 In the absence of previously published randomized trials, it is unclear whether providers who are trained to improve their recommendations using announcements or conversations are more successful in increasing HPV vaccination coverage compared with providers who do not receive such training. We hypothesized that either announcement training or conversation training would lead to larger increases in HPV vaccination coverage compared with no training.…”

Comparing human papillomavirus vaccine knowledge and intentions among parents of boys and girls

“…However, there is a dearth of evidence-based strategies to address vaccine hesitancy via policies, parental education, or provider communication techniques. [38][39] This analysis is subject to at least 2 limitations. First, the cellular phone household response rate was only 23%, and the landline household response rate was 51%.…”

Practical Approaches to Optimize Adolescent Immunization

“…18 Although 1 randomized trial did not show an effect of physician-targeted communication interventions on vaccine hesitancy, these suggestions can be helpful, even though their effects are not proven. 19 Most important, physicians should avoid confrontation, reflect on and summarize the conversation, and schedule follow-up to reinforce the value of immunization. and the ability to think abstractly.…”