Talking with Concerned Parents about Immunization

This 8-page article, published in the journal Zero to Three from the United States (US)-based National Center for Infants, Toddlers, and Families, explores communication between health professionals and parents who are hesitant about vaccinating their children. It is based on the observation that these clinical conversations can be frustrating: Parents bring to the table personal models of decision making and experiences of risk that may differ from those of their health care providers. They may also feel confused by what the authors describe as the vast amount of information available through the popular media, websites, public health agencies, and medical professional organisations. In this article, the authors suggest that parents' trust toward health care providers is a key to addressing parent worries about vaccines. Suggestions for understanding the bases of parent concerns and supporting parents' decision making are provided.

The article begins with a brief history of public concerns about vaccines, particularly in the US context. Next, the authors explain that concerned parents are not all alike. They cite recent research that explores the attitudes and vaccination behaviour with varying concerns about vaccination. For instance, parents may feel confident about vaccination in general, reluctant and unsure about one or all vaccines, or completely nonconfident. The authors then describe recent research about risk perception and health communication that can help health providers understand parent concerns. During clinical interactions, as explained here, different psychological models of decision making may collide: Many health care providers in the US use biomedical approaches that are anchored in scientific research about potential risks and benefits related to vaccination and disease. They tend to use population-based studies of disease and illness when considering the "best interest" of individual patients, and communicate risk through numbers or verbal quantifiers ("rarely"). In contrast, as the authors argue, parent models of decision making may indeed involve Western biomedical models of health and disease; however, they may, instead or in addition, involve homoeopathic/alternative medicine models. Furthermore, parents seek information to inform their decision not only from their health care provider but also from sources in the media and social contact. The authors explore some heuristics (experience-based techniques that help in problem solving, learning, and discovery) to explain why some parents perceive an extremely rare side effect as more important in decision making than providers feel is warranted.

The next section outlines some provider strategies for talking with parents, beginning with a hypothetical conversation between a health provider and a worried parent. The authors recommend the paediatric "Medical Home" model, when applied to vaccination, as a foundation for building trust because of the value placed on culturally sensitive, family-centred continuity of care with a provider. [Editor's note: see Wikipedia for more on this model.] This approach suggests the importance of multiple contacts across time between provider and family and provider-specific interpersonal skills and communication style. For instance: Conversations about vaccination should start early in the provider-parent relationship (e.g., during pregnancy); providers should not "rush to reassurance" when a parent expresses concerns about vaccine safety; providers should take time to thoroughly understand parents' concerns before they provide any science-based information; and providers should stay up to date with anti-vaccine books, popular press articles, websites, blogs, television depictions of vaccine controversies, etc.

In offering final thoughts about the non-confrontational approach to immunisation reluctance they have outlined, the authors note that "[i]t is clear that improved communication is needed on multiple fronts: at the individual dyadic (provider-parent) and community levels (e.g., coordinated public health campaigns on state and national levels) and on the information highway (e.g., parent-friendly scientific information on the Internet)."

To request a copy of this article via email, please contact Lynne Sturm at lsturm@iupui.edu