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Difficulty by motivation matrix. PIVOT with MI, Presumptively Initiating Vaccines and Optimizing Talk with Motivational Interviewing; VHP, vaccine-hesitant parent.
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Introduction
A key contributor to underimmunisation is parental refusal or delay of vaccines due to vaccine concerns. Many clinicians lack confidence in communicating with vaccine-hesitant parents (VHP) and perceive that their discussions will do little to change parents’ minds. Improving clinician communication with VHPs is critical to increasing...
Citations
... Motivational interviewing is a patient-centered approach to enhancing behavior change by leveraging a patient's inherent motivations [76,77]. The evidence for using MI when addressing vaccine-hesitant patients or parents is growing, and additional studies are ongoing [78][79][80][81][82][83]. Multiple RCTs have found that training providers on MI strategies improved HPV vaccine uptake [78,80,84]. ...
The worldwide elimination of measles and rubella is feasible, but not without overcoming the substantial challenge of vaccine hesitancy. This challenge is complicated by the spread of misinformation and disinformation fueled by rapidly progressing technologies and evolving forms of online communication. The recent COVID-19 pandemic has only added further complexity to this challenge. However, considerable progress has been made in understanding the scope of the problem and the complex factors that influence vaccine hesitancy. Our understanding of evidence-based strategies for addressing vaccine hesitancy has grown significantly, including evidence for effective communication and behavioral interventions. In this article, we review measles and rubella vaccines and vaccine hesitancy. We then provide an overview of evidence-based strategies for addressing vaccine hesitancy, including communication strategies and behavioral interventions. This article is relevant to healthcare professionals, health system leaders, public health professionals, policymakers, community leaders, and any individuals who have a role in addressing vaccine hesitancy in their communities. Finally, we review future directions and major areas of research need.
... Healthcare providers and public health officials need to be able to communicate effectively and persuasively with patients and communities about the safety and effectiveness of the COVID-19 vaccines at preventing severe disease and long COVID, as well as accurately describe the potential side-effects [46] and address concerns of patients [47]. These strategies may include interventions shown effective for other vaccines, such as motivational interviewing [48][49][50][51][52][53] and presumptive recommendations [50]. Other strategies that may be effective, especially in communities experiencing healthcare mistrust or other disparities in health literacy or healthcare access, include community engaged approaches such as Community Translation (sometimes called Boot Camp Translation) [35,54,55], which engages community members in translating medical evidence (such as COVID-19 vaccine safety) into relevant and responsive messages and dissemination plans tailored to their communities. ...
... Healthcare providers and public health officials need to be able to communicate effectively and persuasively with patients and communities about the safety and effectiveness of the COVID-19 vaccines at preventing severe disease and long COVID, as well as accurately describe the potential side-effects [46] and address concerns of patients [47]. These strategies may include interventions shown effective for other vaccines, such as motivational interviewing [48][49][50][51][52][53] and presumptive recommendations [50]. Other strategies that may be effective, especially in communities experiencing healthcare mistrust or other disparities in health literacy or healthcare access, include community engaged approaches such as Community Translation (sometimes called Boot Camp Translation) [35,54,55], which engages community members in translating medical evidence (such as COVID-19 vaccine safety) into relevant and responsive messages and dissemination plans tailored to their communities. ...
Purpose
To understand motivators, concerns, and factors associated with COVID-19 vaccine initiation for adults in five racial/ethnic communities across Colorado.
Methods
Community-based data collectors surveyed participants from five Colorado communities (urban and rural Latina/o/x, urban Black, rural African American immigrant, and urban American Indian) about vaccine attitudes, intentions, and uptake from September to December 2021. Bivariate and multivariable logistic regression models were used to examine factors associated with the primary outcome of COVID-19 vaccine “initiation.”
Results
Most participants (71.1%) reported having initiated COVID-19 vaccination; vaccine series completion was 65.1%. Both motivators and concerns about COVID-19 vaccines were prevalent. Vaccine hesitancy (OR: 0.41, 95% CI:0.32–0.53; p < .001) and low perceptions of COVID-19 vaccination social norms (OR: 0.48, 95% CI:0.27–0.84; p = .01) were associated with vaccine initiation.
Conclusion
Despite the limitation of a moderate sample size, our findings support the need for further interventions to increase vaccination against COVID-19 by reducing vaccine hesitancy and improving perceived social norms of vaccination in underserved Colorado communities.
Implications
To improve trust in vaccines and promote vaccine uptake, community messaging should be tailored to vaccination motivators and concerns and demonstrate COVID-19 vaccination as the community default.
... Working with practitioners and dental leaders is critical to developing a workflow that is flexible given the variability in how dental dyads or care teams work together. A successful intervention must allow care teams to play to one another's strengths, ultimately allowing for a stronger HPV vaccine recommendation which has been shown to be predictive of vaccine uptake [41]. Similarly, workflow flexibility is needed when making HPV vaccine recommendations to minors. ...
The human papillomavirus (HPV) vaccine can prevent HPV-related oropharyngeal cancers. Dental practitioners are uniquely positioned to promote HPV vaccines during routine dental care but experience barriers to doing so. Qualitative interviews were conducted with dental practitioners to understand barriers and inform intervention strategies to promote HPV vaccines. Dental practitioners were invited to participate in phone interviews about knowledge, self-efficacy, and the fear of negative consequences related to HPV vaccine promotion as well as feedback on potential interventions to address these barriers. Interviews were audio recorded, transcribed, and analyzed using rapid qualitative analysis with a sort-and-sift matrix approach. Interviews were completed with 11 practitioners from six dental clinics (avg. 31 min). Though most thought HPV vaccination was important, they lacked detailed knowledge about when and to whom the vaccine should be recommended. This led to a hypothesized need for discussions of sexual history, feelings of limited self-efficacy to make the recommendation, and fear of patient concerns. Still, practitioners were supportive of additional training opportunities and provided input into specific interventions. The nuance of how these barriers were described by practitioners, as well as the possible solutions they identified, will help shape future interventions supporting HPV vaccine promotion in dental care.
... The results of a trial designed to assess the effect of a similar communication strategy on childhood vaccination status by 2 years of age are expected in 2024. 168,169 Other adjunctive clinician vaccine communication strategies with some evidence supporting their effectiveness include (1) pursuing adherence to the recommended vaccines for which the child is due at a visit despite parent initial reluctance, and (2) bundling the discussion of all vaccines for which a child is eligible at the visit at once. Pursuing adherence refers to responding immediately to a parent's initial reluctance to the vaccines for which their child is due with a reiteration of the importance of the recommended vaccines for the child, such as "He really needs these shots." ...
Vaccines have led to a significant decrease in rates of vaccine-preventable diseases and have made a significant impact on the health of children. However, some parents express concerns about vaccine safety and the necessity of vaccines. The concerns of parents range from hesitancy about some immunizations to refusal of all vaccines. This clinical report provides information about the scope and impact of the problem, the facts surrounding common vaccination concerns, and the latest evidence regarding effective communication techniques for the vaccine conversation.
After reading this clinical report, readers can expect to:Understand concepts and underlying determinants of vaccine uptake and vaccine hesitancy.Understand the relationship between vaccine hesitancy and costs of preventable medical care.Recognize and address specific concerns (eg, vaccine safety) with caregivers when hesitancy is present.
... In addition to the usual guideline-related courses, methods such as presumed initiation of vaccines, optimizing conversations through motivational interviewing (PIVOT with MI), case-based learning, and emulation of the "social vaccine" model are worth exploring in future training to improve the coping capacity of vaccination workers (10,15,16). Concerns about the safety and e cacy of COVID-19 vaccines were listed as the main reasons for vaccine hesitancy (17). ...
Objectives
Vaccination workers play an important role in the acceptance of various vaccines in patients with chronic liver diseases. We mainly investigated the attitude of vaccination workers toward COVID-19 vaccination in patients with chronic liver disease.
Methods
An anonymous, population-based, cross-sectional online survey were completed by 721 out of 1008 (71.5%) vaccination workers from July 1st to July 14th, 2022, in patients with chronic liver disease in Taizhou, China. The data were uploaded to Wen-Juan-Xing, one of the largest online platforms for collecting survey data.
Results
We found that only 51.9% of vaccination workers recommended all chronic liver diseases vaccinations. 81% of vaccination workers fully recommended vaccination in patients with fatty liver and chronic hepatitis B, while 53.1% of them fully recommended in patients with cirrhosis and liver cancer. Logistic regression analysis showed that vaccination workers who had undergone systematic training were more likely to recommend that patients with four chronic liver diseases get vaccinated (OR: 1.59; 95% CI: 1.05–2.43, p = 0.030). Vaccination workers that believed it is safe to vaccinate against patients with four chronic liver diseases were likely to recommend (OR: 8.12; 95% CI: 1.84–35.88, p = 0.006).
Conclusion
Vaccination workers who hold a positive attitude towards recommending vaccination for patients with chronic liver disease needs to be improved. Strengthening the training of vaccination workers could improve vaccine immunization coverage.
... [9][10][11][12] Yet, interventions that mitigate parental vaccine hesitancy are often reactive, focusing on the period after the birth of the child when parents have already started delaying or refusing vaccines. [13][14][15] Proactive touchpoints for vaccine education in prenatal care may be particularly salient for individuals who are expecting their first child since they lack prior experience with making childhood vaccination decisions. In a study in 2015, Weiner et al. 10 found that many pregnant individuals who are expecting their first child are unfamiliar with childhood vaccination recommendations. ...
Objective
The current study assessed pregnant individuals' intention to accept routine and COVID‐19 vaccines for their baby after birth, and to identify key demographic (e.g., age) and nondemographic characteristics (e.g., prior birth) associated with vaccination intention.
Methods
The authors conducted a cross‐sectional survey with pregnant individuals attending prenatal practices affiliated with a large academic medical center and two rural county health departments in the southeastern United States. The survey included 11 questions and was self‐administered by pregnant individuals in clinic settings. The final analysis included responses from 443 pregnant individuals.
Results
Only 67% of pregnant individuals planned to vaccinate their baby with all recommended routine vaccines; an additional 22% reported having questions about recommendations. Only 35% of pregnant individuals said they would vaccinate their baby as soon as possible with a COVID‐19 vaccine. Younger pregnant individuals and those identifying as Black or African American had lower routine and COVID‐19 vaccination intention. Routine vaccination, but not COVID‐19 vaccination intention, was associated with familiarity with routine vaccination schedule, trimester of pregnancy, Hispanic ethnicity, history of prior birth, and having access to a computer.
Conclusion
Study findings support differential tailoring of future interventions targeting pregnant individuals to promote routine and COVID‐19 vaccines for children.
... The videos incorporate introductions and conclusions from obstetricians and pediatricians of different races/ethnicities with narrated animation to communicate messages in an interesting and engaging manner. The videos were designed based on approaches shown to be effective in training healthcare providers to improve their vaccine discussions with patients: for patients already intending to vaccinate, taking a presumptive approach; and for patients with concerns, establishing empathy, then carefully addressing the concerns within the context of the risk of disease, the benefits of vaccination, and the ability to protect through vaccinating [50][51][52][53][54]. Videos covered both maternal and infant vaccination, though videos provided to pregnant women focused more on the former and videos provided to new mothers focused more on the latter. ...
... Other similar interventions do not offer this potential combination of effectiveness and scalability. In-person training of providers to improve their vaccine communication with patients has been shown to be effective, but scale-up would be cost-and time-intensive [52][53][54]. Several other educational vaccine apps and websites have been developed [70,71,[76][77][78][79][80]. ...
Background
Many pregnant women and parents have concerns about vaccines. This analysis examined the impact of MomsTalkShots, an individually tailored educational application, on vaccine attitudes of pregnant women and mothers.
Methods
MomsTalkShots was the patient-level component of a multi-level intervention to improve maternal and infant vaccine uptake that also included provider- and practice-level interventions. The impact of these interventions was studied using a two-by-two factorial design, randomizing at both the patient- and the practice-level. Study staff recruited pregnant women from a diverse set of prenatal care practices in Colorado and Georgia between June 2017 and July 2018. All participants ( n = 2087) received a baseline survey of maternal and infant vaccine intentions and attitudes, and two follow-up surveys at least 1 month and 1 year after their infant’s birth, respectively. Half of participants ( n = 1041) were randomly assigned to receive educational videos through MomsTalkShots, algorithmically tailored to their vaccine intentions, attitudes, and demographics. Since the practice/provider intervention did not appear impactful, this analysis focused on MomsTalkShots regardless of the practice/provider intervention.
Results
By 1 month post-birth, MomsTalkShots increased perceived risk of maternal influenza disease (61% among MomsTalkShots recipients vs 55% among controls; Odds Ratio: 1.61, 95% Confidence Interval: 1.23–2.09), confidence in influenza vaccine efficacy (73% vs 63%; OR: 1.97, 95%CI: 1.47–2.65), and perceived vaccine knowledge (55% vs 48%; OR: 1.39, 95%CI: 1.13–1.72). Among those intending not to vaccinate at baseline, MomsTalkShots increased perceived risk of maternal influenza disease (38% vs 32%; OR: 2.07, 95%CI: 1.15–3.71) and confidence in influenza vaccine efficacy (44% vs 28%; OR: 2.62, 95%CI: 1.46–4.69).
By 1 year post-birth, MomsTalkShots increased perceived vaccine knowledge (62% vs 50%; OR: 1.74, 95%CI: 1.36–2.24) and trust in vaccine information from obstetricians and pediatricians (64% vs 55%; OR: 1.53, 95%CI: 1.17–2.00). Among those uncertain about vaccinating at baseline, MomsTalkShots increased perceived vaccine knowledge (47% vs 12%; OR: 6.89, 95%CI: 1.52–31.25) and reduced infant vaccine safety concerns (71% vs 91%; OR: 0.24, 95%CI: 0.06–0.98).
Conclusions
MomsTalkShots improved pregnant women’s and mothers’ knowledge and perceptions of maternal and infant vaccines and the diseases they prevent, and offers a scalable tool to address vaccine hesitancy.
Trial registration
Registered at Clinicaltrials.gov on 13/09/2016 (registration number: NCT02898688).
... Our findings suggest a participatory approach is less effective at promoting COVID-19 uptake, consistent with what is known about other vaccines, such as influenza and HPV [14][15][16][17] particularly among less hesitant (initially "not sure") individuals. At the same time, an explicit recommendation was not more effective than other messages among the more hesitant (initially "no") participants, indicating a need for alternative communication strategies with more vaccine hesitant individuals, such as motivational interviewing [32,33]. ...
Objective
To test the impact of varied physician recommendations on COVID-19 vaccine hesitancy.
Methods
We conducted a vignette-based experimental survey on Prolific, an online research platform. COVID-19 vaccine hesitant, adult panel members were assigned to one of five messages that varied by recommendation style (participatory vs explicit) and strategy (acknowledgement of concerns; comparison to the flu shot; statement that millions of people have already received it; emphasis on protecting others). Vaccine hesitancy was re-assessed with the question, “Would you get vaccinated at this visit?”.
Results
Of the 752 participants, 60.1% were female, 43.4% Black, 23.6% Latino, and 33.0% White; mean age was 35.6 years. Overall, 33.1% of the initially “not sure” and 13.1% of the initially “no” participants became less hesitant following any recommendation. Among the “not sure” participants, 20.3% of those who received a participatory recommendation became less hesitant compared with 34.3%-39.5% for the explicit recommendations. The “protect others” message was most effective among initially “no” participants; 19.8% become less hesitant, compared to 8.7% for the participatory recommendation.
Conclusion
A physician recommendation may reduce COVID-19 vaccine hesitancy.
Practice Implications
An explicit recommendation and “protect others” message appear to be important elements of a physician recommendation for COVID-19 vaccination.
... We conducted a natural experiment using cross-sectional survey data collected from parents enrolled in an ongoing cluster randomized controlled trial designed to assess the effect of a novel, multifaceted clinician vaccine communication intervention on child immunization status by study completion in 2023. 11 The trial includes 24 primary care pediatric clinics in Washington and Colorado (13 urban, 6 suburban, 1 rural, and 4 with multiple geographic settings given that these clinics had more than one site) and began enrolling parent participants on September 27, 2019. The study activities for this trial were formally reviewed and approved by the Colorado Multiple Institutional Review Board, Washington State Institutional Review Board, and Swedish Health Services Institutional Review Board. ...
Objective:
To understand the influence of a novel infectious disease epidemic on parent general attitudes about childhood vaccines.
Methods:
We conducted a natural experiment utilizing cross-sectional survey data from parents of infants in Washington and Colorado participating in a larger trial that began on September 27, 2019. At enrollment, parents completed the short version of the Parental Attitudes about Childhood Vaccines (PACV-SF), a validated survey scored from 0-4, with higher scores representing more negative attitudes. The exposure variable was onset of the SARS-CoV-2 pandemic in the US, with the before-period defined as September 27, 2019 -- February 28, 2020 and the after-period defined as April 1, 2020 --December 10, 2020, with the after-period further separated into proximate (April 1, 2020-July 31, 2020) and distant periods (August 1, 2020-December 10, 2020). The outcome variable was parent negative attitudes about childhood vaccines, defined as a score of ≥2 on the PACV-SF. We estimated the probability of the outcome after (vs. before) the exposure using log-binomial regression with generalized estimating equations adjusted for demographic confounding variables.
Results:
Among 4,562 parents, the risk of negative attitudes was lower immediately after (vs. before) SARS-CoV-2 onset (adjusted risk ratio [aRR]: 0.58; 95% confidence interval [CI]: 0.36, 0.94; P=0.027), but by August-December 2020, the average rate of negative attitudes was 35% higher than during April-July 2020 (aRR: 1.35; 95% CI: 1.13, 1.61; P=0.0009).
Conclusions:
A reduced risk of negative general vaccine attitudes observed immediately after SARS-CoV-2 onset was quickly attenuated.
... By strongly recommending that people who are pregnant, who were recently pregnant (including those who are lactating), who are trying to become pregnant now, or who might become pregnant in the future receive all recommended COVID-19 vaccines doses through a variety of resources including healthcare providers, pharmacists, and allied health professionals can help increase vaccination rates and protect women and their infants from the severe effects from COVID-19. Finally, while these data highlight the importance of provider recommendation in COVID-19 vaccination uptake, additional strategies should be leveraged to make vaccination a standard of care; for example, improving reimbursement to providers who practice motivational interviewing may help overcome barriers to administration of vaccines or health systems could consider offering vaccination at all medical encounters including ensuring COVID-19 vaccine is readily available for administration at all clinic visits, emergency departments, obstetrical triage units and at discharge following delivery [44][45][46][47][48][49]. ...
Background
Pregnant and postpartum women are at increased risk for severe illness from COVID-19. We assessed COVID-19 vaccination coverage, intent, and attitudes among women of reproductive age overall and by pregnancy status in the United States.
Methods
Data from the National Immunization Survey Adult COVID Module collected during April 22-November 27, 2021, were analyzed to assess COVID-19 vaccination (receipt of ≥1 dose), intent for vaccination, and attitudes towards vaccination among women aged 18–49 years overall and by pregnancy status (trying to get pregnant, currently pregnant, breastfeeding, and not trying to get pregnant or current pregnant or breastfeeding). Logistic regression and predictive marginals were used to generate unadjusted and adjusted prevalence ratios (PRs and aPRs). Trend analyses were conducted to assess monthly changes in vaccination and intent.
Results
Our analyses included 110,925 women aged 18-49 years. COVID-19 vaccination coverage (≥1 dose) was 63.2% overall (range from 53.3% in HHS Region 4 to 76.5% in HHS Region 1). Vaccination coverage was lowest among pregnant women (45.1%), followed by women who were trying to get pregnant (49.5%), women who were breastfeeding (51.5%), and all other women (64.9%). Non-Hispanic (NH) Black women who were pregnant or breastfeeding had significantly lower vaccination coverage (aPR: 0.74 and 0.66, respectively) than NH White women.
Discussion
Our findings are consistent with other studies showing lower vaccination coverage among pregnant individuals, with substantially lower vaccine coverage among NH Black women who are pregnant or breastfeeding. Given the overlapping and disproportionate risks of COVID-19 and maternal mortality among Black women, it is critical that COVID-19 vaccination be strongly recommended for these populations and all women of reproductive age. Healthcare and public health providers may take advantage of every opportunity to encourage vaccination and enlist the assistance of community leaders, particularly in communities with low vaccination coverage.
