The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits

Abstract

WHAT'S KNOWN ON THIS SUBJECT: An increasing number of parents have concerns about childhood vaccines. Parents consistently cite their child' s provider as influential in their vaccine decision-making. Little is known about how providers communicate with parents about vaccines and which communication strategies are important.WHAT THIS STUDY ADDS: How providers initiate the vaccine recommendation at health supervision visits appears to be an important determinant of parent resistance. Also, when providers pursue their original vaccine recommendations in the face of parental resistance, many parents subsequently agree to vaccination. abstract OBJECTIVE: To characterize provider-parent vaccine communication and determine the influence of specific provider communication practices on parent resistance to vaccine recommendations. METHODS:We conducted a cross-sectional observational study in which we videotaped provider-parent vaccine discussions during health supervision visits. Parents of children aged 1 to 19 months old were screened by using the Parent Attitudes about Childhood Vaccines survey. We oversampled vaccine-hesitant parents (VHPs), defined as a score $50. We developed a coding scheme of 15 communication practices and applied it to all visits. We used multivariate logistic regression to explore the association between provider communication practices and parent resistance to vaccines, controlling for parental hesitancy status and demographic and visit characteristics. RESULTS:We analyzed 111 vaccine discussions involving 16 providers from 9 practices; 50% included VHPs. Most providers (74%) initiated vaccine recommendations with presumptive (eg, "Well, we have to do some shots") rather than participatory (eg, "What do you want to do about shots?") formats. Among parents who voiced resistance to provider initiation (41%), significantly more were VHPs than non-VHPs. Parents had significantly higher odds of resisting vaccine recommendations if the provider used a participatory rather than a presumptive initiation format (adjusted odds ratio: 17.5; 95% confidence interval: 1.2-253.5). When parents resisted, 50% of providers pursued their original recommendations (eg, "He really needs these shots"), and 47% of initially resistant parents subsequently accepted recommendations when they did. CONCLUSIONS:How providers initiate and pursue vaccine recommendations is associated with parental vaccine acceptance. Pediatrics

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

“…The announcement training, informed by the work of Opel and colleagues, 16,17 included the steps shown in Fig 2A. The darker boxes indicate requisite steps for delivering announcements, whereas lighter boxes are necessary only if the previous step did not result in HPV vaccination. We instructed providers to first announce that the child is due for 3 vaccines to be given today.…”

“…Announcements are commonly used for early childhood vaccines and other routine clinical care. Furthermore, analyses of videotaped clinician encounters 16,17 and a nationally representative survey 18 suggest that announcements are associated with higher vaccine uptake. 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.…”

Countering antivaccination attitudes

“…Indeed, many vaccination decisions will not be made immediately after exposure to educational interventions, calling for additional research to assess the risk of backfire effects and to evaluate the longevity and robustness of the improvements in vaccine attitudes that we observed. Still, even a temporary improvement in parents' vaccination attitudes could increase vaccination rates if such interventions were incorporated into doctor-parent interactions (5).…”

Countering Vaccine Hesitancy

“…64 Opel et al 9 reported that only 55% of practitioners routinely provide parents with the rationale for why vaccines are administered and their potential adverse effects. They reported that nearly half of parents who were initially vaccine hesitant ultimately accepted vaccines after practitioners provided a rationale for vaccine administration.…”

“…Another observational study found that when physicians continued to engage parents, up to 47% of parents ultimately accepted vaccines after initially refusing them. 9 Although the majority of parents accept vaccines, the increasing frequency of refusal and the requests for alternative vaccine schedules indicate that there are still significant barriers to overcome. 10 …”