How to have better conversations about vaccines
An international study suggests that empathetic correction of misinformation can significantly improve patients’ attitudes towards vaccination. Lead author Dr Dawn Holford explains how it works.
- 5 March 2024
- 5 min read
- by Linda Geddes
How have doctors traditionally talked to patients about vaccines, and why are new approaches needed?
Vaccine uptake rates vary across countries, but in the UK right now we are dealing with insufficiently high rates of uptake, and measles outbreaks in various areas. This is quite alarming, given that we previously had a measles-free status. Low rates of uptake are also a growing concern in other countries, including the European countries where my collaborators work.
"Although we expected people to generally respond more positively to an empathetic approach, it was surprising how much greater the preference for this style of communication was among those who expressed concerns about vaccination."
– Dr Dawn Holford
For a long time, the prevailing wisdom has been that people are not taking vaccines because they do not have access to information that would enable them to make an informed decision, so we need to give them that information. This is still important, but unfortunately there is now a lot of misinformation alongside the reliable information, which makes it difficult for people to make those informed decisions. So, what isn't needed is more information, but rather the ability for people to have a conversation about their concerns, and build trust in what they are being recommended.
You and your colleagues have developed an approach called Empathetic Refutational Interviewing. How does it work?
What we've done is to integrate and consolidate different strategies that have previously been examined across different disciplines into a coherent approach that could be communicated to frontline health care professionals to help them to build those bridges with patients. We're trying to help them find ways to engage in a productive conversation about vaccines.
We advise starting this conversation by using open questions to identify what is really bothering a patient, so that the rest of the conversation can be tailored towards those concerns.
The next step involves an expression of empathy for the patient's position, which we know is a critical component of having a productive dialogue with someone.
The health care provider can then deliver a "tailored refutation", which means trying to correct any misconceptions in a way that doesn't feel too threatening, rather than jumping in and saying "No, you're wrong." For instance, they might say, "I know you're worried about this. How about we think about vaccines in a different sort of way; what about thinking of the protection they provide against the medical consequences you're worried about?"
The final component involves delivering the facts that address the concerns that this person has. These facts are important, but by putting them towards the end of the conversation, you can better target what that person's concerns are, after maybe removing the block that's preventing them from wanting to engage with the idea of vaccinations.
Have you read?
You recently tested the effectiveness of this approach on more than 2,500 vaccine-hesitant patients in the UK and US. What did you discover?
We saw a very big effect when it came to how much people supported what the doctor was saying to them. Although we expected people to generally respond more positively to an empathetic approach, it was surprising how much greater the preference for this style of communication was among those who expressed concerns about vaccination.
People trusted the doctor more and they were more open to having that conversation, in comparison with the control condition where they were just given information saying, "This is safe, it is effective, and this is what you need to know."
What else needs to be done to validate this kind of approach?
We are quite confident that this is a better approach for face-to-face interactions, rather than just going in with the facts, but we need to investigate how easy it will be for health care professionals to adopt this into their practice. Based on the workshops we've done in the UK so far, it looks promising.
One question we often get asked is, "Will this conversation take a long time?" I think the answer is that it doesn't take as long as people necessarily think. But also, let's say it usually takes five minutes to go over the vaccine information sheet with a patient; if that person isn't in a position to listen, you've wasted five minutes of your time. But if you spend those five minutes taking time to build a rapport, figure out the roots of that patient's attitude, and diagnose what is the tailored information that you need to provide, you can more effectively deliver the relevant information, which might only take two minutes. So, you've spent seven effective minutes, versus five wasted ones.
Do you think this approach could also work in other parts of the world, such as countries in the Global South?
Although our target is health care professionals, I think this suite of tools could also be used in general conversations with friends and family, and I think it could work wherever you are in the world. But I think that there are also lessons that the Global South can teach us about community outreach and engagement. We probably have a lot to learn from each other.
Dr Dawn Holford is a behavioural science researcher at the University of Bristol, UK, who investigates vaccine confidence and the development of interventions to combat misinformation. Her study, "The Empathetic Refutational Interview to tackle vaccine misconceptions: four randomised experiments" is published in Health Psychology.
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