Providers Are Most Persuasive On Vaccinations When Speaking with Confidence and Conviction
Nov 06, 2013

Doctors have been using science to evaluate the safety and efficacy of vaccines for decades.  Yet, we’re only just beginning to explore how the science of communication can help doctors to improve parental vaccine acceptance. A new study published in Pediatrics this week explains that it’s all in the “architecture” of the provider-parent conversation.
The study, entitled The Architecture of the Provider-Parent Vaccine Discussions At Health Supervision Visits examined the way in which providers discussed vaccine recommendations with parents and how varying techniques may have impacted vaccine acceptance.  The emphasis was not on what the provider was saying about vaccines, but more specifically on how the conversation was both initiated and pursued by the provider.   The study determined that if a provider initiates a vaccine recommendation by using a presumptive method, (such as “Well, we have to do some shots”) rather than a more participatory initiation (such as “What do you want to do about shots?”), parents were more likely to accept the provider’s recommendations.

The full report elaborates on how the provider-parent conversations were captured, analyzed and recorded, and then notes the following observations:

•  The majority of providers (74%) initiated vaccine recommendations by using presumptive formats, but significantly more providers used participatory initiation formats with vaccine hesitant parents than with non-vaccine hesitant parents (41% vs 11%).
• Among all parents, a larger proportion resisted vaccine recommendations when providers used a participatory rather than presumptive initiation format (83% vs 26%)
• Analysis showed that provider use of participatory initiation formats for their vaccine recommendations was associated with a significantly increased odd of parental resistance.   
• Nearly half of initially resistant parents accepted the provider’s original vaccine recommendation if the provider continued to pursue it. These findings seem especially important given that only 50% of providers pursued their original recommendation after initial parent resistance.

As a parent, my initial reaction to this “presumptive” and “persistent” language was one of concern.
Don’t parents want providers to address their vaccine related concerns?  Won’t they be turned off by providers who are perceived to be telling them what to do or pressuring them to vaccinate?  
But my concerns were addressed when I made a closer examination of the language that was utilized by the providers in this study.  The presumptive language was very subtle and handled by providers in a professional and respectful manner.  The study affirms that providers can be most persuasive in their vaccine recommendations when they are sharing them with confidence and conviction.
Patsy Stinchfield, MS, RN, CPNP, Pediatric Nurse Practitioner, and Infectious Disease and Immunology Director at Children’s Hospitals and Clinics of Minnesota, said it best when she explained,

We wouldn’t expect a cardiologist to say “Your child has a big hole in their heart.  What do you want to do about that?  It is up to you.”  We, as health care professionals, need to approach vaccination conversations with the same clear conviction that we would recommend life-saving heart surgery.

This approach, though effective, may seem to conflict with the idea that providers should be engaging in collaborative communication with parents.  While a participatory approach may be considered a “best practice” in many instances, this study affirms that it’s not as effective when addressing decisions that have only one medically accepted choice – such as vaccination.
While the study concluded that the presumptive approach was more effective in eliciting parental vaccination approval, it was concerning to see that providers were most often observed using a participatory approach when dealing with hesitant parents.  This leads us to question whether these providers may have sensed the parental hesitancy, which led to a conscious decision to be less confrontational and more understanding by using a participatory, as opposed to presumptive approach.  Only now that the study is concluded, we recognize that this  approach has proven to be less effective – information that will be valuable to providers who may encounter hesitant parents in the future.
The encouraging fact is that persistence paid off.  This should encourage those providers, who are reluctant to be too forceful in their vaccine recommendations, to take a more aggressive approach.  Many health care providers that I speak with explain how frustrating it can be to continually pursue a vaccination conversation with a hesitant parent, yet this study should reinvigorate providers to make that emotional investment since it may likely result in parental consent of vaccination at some point in the future.
It’s clear that the provider’s role is not an easy one.  The communication techniques that have been deemed most effective often demand an enormous amount of tact and sensitivity, as well as a great deal of practice.  But previous studies reinforce the fact that this is an important investment since a child’s provider is consistently cited as a trusted source of vaccine information and a key factor in parental vaccine decision-making.  When it comes to vaccine-hesitancy, parents cite reassurance and vaccine information from their child’s provider as the reason they ultimately changed their minds and accepted vaccines.
So now, armed with the science behind this study, providers can effectively evaluate their own communication techniques and continue their great efforts to improve childhood vaccination rates.   Hopefully this research will validate their tendency to make an important presumption – that parents want to do what is best for their children by vaccinating them according to the recommended schedule.

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