Thread by @AlabamaKidDoc

Discussing the architecture of conversations with vaccine-hesitant parents with @SeanOLearyMD this morning. @Alchapaap #AAP19

#Vaccine hesitancy is a spectrum: most are “happy vaccinators”, some have concerns, a small # desire alternative schedule, very few absolute refusers.

Start with triage: if they are outright refusers (trying to convince YOU that vaccines are bad), you are unlikely to help them.

“Costs” are Vacccine Hesitancy: 84% of pediatricians think it is more painful to bring kids back repetitively for a “spread out schedule” increases a child’s fear which potentiates pain.

Interventions with #VaccineHesitant parents should focus on how patients ACTUALLY think, not based on how WE think they think. Our “conventional wisdom” about what works to help move parents feel safer is often wrong.

Some strategies:
1. Focus on facts, not myths. (Avoid making the myth more familiar.
2. If you DO have to mention the myth, explicitly state that it is false.
3. Keep it simple.
4. Replace the false belief with new factual information.
#VaccinesAreSafe

Avoid the “lecture trap” - responding to a concern by dumping a bunch of data about one aspect of a vaccine.

Why is this bad?
1. Puts parents off because it implies that they do not know what they are talking about.
2. May bring up new concerns.

Instead, brief motivational interviewing can help: 1. start with open-ended question (“Having concerns is understandable, would you mind sharing with me what your concerns are?”)

2. Acknowledge concern/empathize and ask for permission to share more information. (“That does sound scary! I have looked into this. Would you mind me sharing how I have come to think about it?”)
#VaccineHesitancy
#AskForPermission

3. Share brief facts addressing concern - focus on facts and the disease, pivot away from the myth/false belief.
(“To address your specific vaccine, that false myth is from... but I think it is important to focus on why we get this vaccine in the first place.”)

4. Follow with a personal, strong recommendation but allow the parents to make the decision. (“If she we’re my daughter, I would not hesitate...but, ultimately, the decision is yours. What do you think?”)
#VaccineHesitancy
#AutonomyIsImportant