Motivational Interviewing: A Powerful Tool to Address Vaccine Hesitancy

"MI is a person-centred communication style used to enhance internal motivation for attitudinal change by exploring and solving inherent ambivalences..."

Trying to convince parents/caregivers to accept vaccination for their child by simply providing the facts may backfire and exacerbate vaccine hesitancy. An alternative is motivational interviewing (MI), which aims to support decision making by eliciting and strengthening a person's motivation to change their behaviour based on their own arguments for change. This short article outlines the MI technique and provides both evidence of its impact and guidance based on PromoVac, an educational intervention that has been implemented in maternity wards across the province of Quebec, Canada (see Related Summaries, below).

The MI approach aims to inform parents/caregivers about vaccinations, according to their specific needs and their individual level of knowledge, with respectful acceptance of their beliefs. It is based on 3 main components/best practices:

1. The spirit to cultivate a culture of partnership and empathy: (i) partnership - achieving equality, strengthening collaboration; (ii) acceptance - fostering a positive, empathic attitude that reinforces autonomy; (iii) evocation - having the individual verbalise the change; and (iv) compassion/altruism - acting in a caring way.
2. The processes to foster engagement in the relationship and target the goal of the intervention: (i) engaging - strengthen the link, show empathy and interest; (ii) focusing - define and focus the discussion on the target of change; (iii) evoking - outline reasons and abilities to change, talk about change to boost the confidence to change; and (iv) planning - ask: How will the individual get there?
3. The skills that enable healthcare providers to understand and address the parent/caregiver's real concerns: asking open-ended questions, using reflective listening, and affirming and reiterating statements back to the interviewee (see Table 2 in the paper).

Table 3 shows a case example of how vaccine education between a healthcare provider and a parent could occur with the traditional versus MI approach. This illustration highlights the fact that targeting concerns and tailoring information are the most prominent distinguishing features of this approach compared to other types of interventions in the field of vaccination promotion. Using MI techniques, healthcare professionals help individuals explore their own ambivalence, find their own arguments for change, and make their own informed decision about vaccinating their child. A study cited here found that most parents/caregivers did not actively process the information provided on benefits and drawbacks prior to deciding whether to have their child vaccinated. Thus, a parent's attitude towards vaccination and high vaccination intention may be susceptible to counterarguments. By eliciting and exploring a parent's personal reasons for vaccination, the MI approach is designed to enhance his or her personal motivation to vaccinate via a robust decision-making process.

Evidence for the effectiveness of MI on vaccine hesitancy:

• A regional pilot study found that the PromoVac strategy led to a 15% increase in mothers' intention to vaccinate, a 7% increase in infants' vaccine coverage at 7 months, and a 9% greater chance of a complete immunisation status among children 2 years or younger if their parents received the intervention in the maternity ward.
• A provincial randomised controlled trial found that vaccine hesitancy scores were reduced by 40%. Vaccine-hesitant mothers benefited the most from the intervention, with 97% reporting that they were satisfied with the intervention and would recommend it to all parents.
• Preliminary results of an evaluation of the 2018 implementation of PromoVac in all maternity wards in Quebec through a provincial public health programme called EMMIE (Entretien Motivationnel en Maternité pour l'Immunisation des Enfants) indicated an increase of 11% in vaccination intention and a decrease of 30% in vaccine hesitancy.

As noted here, MI is a short intervention that "could easily be integrated into the usual vaccination consultation once health care practitioners are trained." Cited here are several workshop/academic training materials on applying MI to immunisation that could assist healthcare providers in integrating MI into their daily practice.

This is the third of a series of articles produced by the Canadian Vaccination Evidence Resource and Exchange Centre (CANVax). This centre includes a group of multidisciplinary professionals that identify and create resources that are designed to foster vaccine uptake.