Vaccine Hesitant Parents
Parents want to do what is best for their child, even those who ask questions. While every parent is different and not all methods of communicating work for every parent or physician, below is a brief review of parental immunization attitudes and communication methods that have worked to reassure parents in some circumstances. To begin:
- Listen to parents' concerns and acknowledge them in a non-confrontational manner. Allowing parents to express their concerns will increase their willingness to listen to the pediatrician's views.
- Promote partnerships with parents in decision-making and personalize these relationships. Provide the important information first. Make sure the parent understands the information. Clarify and reaffirm parents' correct beliefs about immunization and modify misconceptions.
- Discuss the benefits of vaccines and the possibility of adverse events. Be open about what is known about immunizations and what is not known. Provide parents with Vaccine Information Statements, educational resources, and reliable Web sites. Personalize the information provided to parents based on cultural beliefs, vaccine concerns, and literacy level.
- Stress the number of lives saved by immunization, as a positive approach, rather than focusing on the number of deaths from not immunizing.
- Discuss state laws for school entry and the rationale for them. Some parents disagree with mandatory immunization and resist immunization because they believe their rights as parents are being taken away. Explain that vaccines benefit individual children and communities through herd immunity.
- Provider attitudes and beliefs about vaccine safety have been linked to vaccination coverage in preschool children. The majority of parents believe immunization is important and trust pediatricians as the most important source of immunization information.
Kimmel SR, Wolfe RM. Communicating the benefits and risks of vaccines. The Journal of Family Practice. 2005; 54:S51-S57
Zhang J, Yu KF. What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998; 280:1690-1691
Types of parental immunization attitudes:
|Parent Type||Belief about vaccines||Percentage of Parents|
|Immunization Advocates||Strongly agree vaccines are necessary and safe||33%|
|Go Along to Get Alongs||Agree vaccines are necessary and safe||26%|
|Health Advocate||Agree vaccines are necessary but are less sure about their safety||25%|
|Fence-sitters||Who slightly agree that vaccines are necessary and safe||13%|
|Worrieds||Slightly disagree that vaccines are necessary and strongly disagree that vaccines are safe||3%|
Gust, et al. American Journal of Health Behavior, 2005. http://www.ncbi.nlm.nih.gov/pubmed/15604052
Key points to consider:
- Parents from all groups include their health care provider as a source of information to help decide about their child's health care.
- Most parents still vaccinate their children, despite concerns.
Strategies for Talking to Parents:
Presumptive Vs. Participatory Recommendations
Researchers found that pediatricians who provided a "presumptive recommendation" – informed parents that shots were due, rather than a "participatory recommendation" – asking what the parent thought about shots, were more likely to see parents accept vaccines.
Opel, et al. The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits. 2013. Pediatrics, 134, 139, 2013-2037. http://pediatrics.aappublications.org/content/early/2013/10/30/peds.2013-2037.abstract.
- "Do you want to vaccinate your child today?"
- "What do you think about vaccines?"
- "Would you like to hear about the vaccines we offer for today's visit?"
- "Today your child is due for 2 vaccines. We will be giving MMR and Varicella."
- "It's time for an annual influenza vaccine. Your child is old enough to receive either the inactivated shot or the live nasal spray."
CASE is an acronym for Corroborate, About Me, Science, Explain/Advise.
- Corroborate: Acknowledge the parents' concern and find some point on which you can agree. Set the tone for a respectful, successful talk.
- About Me: Describe what you have done to build your knowledge base and expertise.
- Science: Describe what the science says.
- Explain/Advise: Give your advice to patient, based on the science.
*Developed by Alison Singer, MBA, Autism Science Foundation
: Do vaccines cause autism?CASE Response:
View videos demonstrating this model
- Corroborate: I understand why you might think this. There is a lot of information online and in the news about vaccines and autism.
- About Me: I like to make sure that I always have the most up-to-date information on this topic so I can inform families about what we do know about vaccines and autism, so I've researched this thoroughly.
- Science: The scientific evidence does not show any link between vaccines and autism. There have been several studies that have looked for a connection, but none has been seen. The CDC, the AAP, the National Institutes for Health, and the Institute of Medicine agree that vaccines do not cause autism.
- Explain/Advise: But vaccines are critical to maintaining health and wellbeing. They prevent diseases that cause real harm. Choosing not to vaccinate does not protect children from autism, but does leave them open to diseases. I would recommend that your child receive these vaccines today.