Motivational Interview Training Improves Self-efficacy of GP Interns in Vaccination Consultations: A Study Using the Pro-VC-Be to Measure Vaccine Confidence Determinants

"MI [motivational interviewing] can be applicable to different types of HCPs, in face-to-face or distance learning, and in different cultural contexts..."

Immunisation-specific motivational interviewing (MI), a patient-centred communication style used to encourage internal motivation for attitudinal and behavioural change, can provide healthcare professionals (HCPs) with the skills and practice required to respond to patients' vaccine-related doubts and concerns. The Motivac study tested the feasibility and effectiveness of an immunisation-specific MI training via videoconference for GP interns in southeastern France. The objective of this paper is to compare the evolution of psychosocial determinants of vaccine confidence and behaviours in these interns before and after this training using the validated Health Professionals Vaccine Confidence and Behaviors (Pro-VC-Be) questionnaire (see Related Summaries, below).

French GP interns participated in a virtual 3-day MI-workshop during the latter portion of the 2020/2021 academic year. The first 2 days of the workshop (March 2021), which 45 interns completed, focused on the philosophy and principles of MI and its fundamental skills; interns then had 2 months to apply their newly acquired MI skills within their daily practice before returning for the final day of the workshop (May 2021). During this final 3-hour session, 35 of the remaining interns shared their experiences and challenges encountered with vaccine-hesitant patients within supervised group feedback discussions.

The researchers used the validated Pro-VC-Be questionnaire (as a complementary instrument to the Motivational Interviewing Skills in Immunization (MISI) questionnaire, a tool specifically validated to assess the acquisition of skills from MI training) to measure the evolution of the psychosocial determinants of their vaccine confidence and behaviours. Eight of the 10 psychosocial determinants (dimensions) identified in the Pro-VC-Be were measured: perceived risks of vaccines, complacency, perceived benefit/risk balance of vaccines, collective responsibility, commitment to vaccination, perceived self-efficacy in addressing vaccination concerns, trust in authorities, and openness to patients' concerns regarding vaccination. Scores before and after workshop trainings were compared.

Participants' scores for commitment to vaccination (+10.5 ± 20.5, P = .001), perceived self-efficacy (+36.0 ± 25.8, P < .0001) [equivalent to a 100% increase], openness to patients (+18.7 ± 17.0, P < .0001) [equivalent to a 39% increase], and trust in authorities (+9.5 ± 17.2, P = 0.01) significantly increased after the training sessions. The effect sizes of the 4 score improvements were moderate to large, with self-efficacy and openness to patients having the largest effect sizes (P = .83 and 0.78, respectively). "The persistence of these effects two months after the first training session suggests the prolonged impact that immunization-specific MI educational strategies among GP interns."

The researchers explain that one of the mechanisms behind the impacts of MI educational strategies on behavioural change is the acquirement of therapeutic skills of accurate empathy, non-judgment, and the ability to listen to the patient and respect her or his autonomy. These skills facilitate establishing a relationship of trust between HCPs and patients based on mutual respect and understanding. This relationship allows patients to feel valued and have the autonomy to seek out resources related to their own behavioural changes regarding vaccination without HCPs imposing these changes onto them.

In conclusion: "Incorporating immunization-specific MI-training in the curriculum for GP interns, and other HCPs, could improve several necessary skills for patient interactions, such as increased empathy, active listening, more openness to patients, and feeling more comfortable evoking the subject of vaccination, all of which could subsequently improve HCP-patient relationships and be useful for vaccination and other healthcare services."