By Michelle Li
Published 1:20 EST, Thurs October 21st, 2021
Vaccines have played a vital role in the almost complete eradication of several infectious diseases, such as measles, chickenpox, and polio. However, in recent years, the contributions of vaccines to public health have been threatened by the spread of anti-vaccination sentiment and vaccine hesitancy. As defined by the World Health Organization (WHO), vaccine hesitancy is the “delay in acceptance or refusal of vaccines despite availability of vaccine services” (MacDonald, 2015). The recent anti-vaccine movement has led to increased vaccine hesitancy and decreased vaccine coverage. Its spread presents detrimental consequences for public health with the resurgence of diseases. Many factors have contributed to this rise in vaccine hesitancy, with mistrust in vaccines playing a crucial role. Different interventions, such as providing access to educational resources, have been suggested. One factor that may be overlooked when considering interventions is the language utilized by healthcare workers when interacting with vaccine hesitant parents, as the word choice of providers is connected to different rates of vaccine acceptance. Correspondingly, a change in the word choices of healthcare providers, if used effectively, may be utilized to increase rates of vaccine acceptance and coverage.
Presumptive Compared to Participatory Approaches
An examination led by Opel et al. (2013) found that there is a relationship between the approach of healthcare workers, particularly their word choice or language, and the parents’ acknowledgment or opposition to vaccination. In the study, vaccine discussions between providers and parents—both vaccine-hesitant and non-vaccine hesitant—were videotaped and analyzed. The parents had children aged 1 to 19 months old, and the Parent Attitudes about Childhood Vaccinations Survey was used to categorize parents as vaccine-hesitant (score of greater than or equal to 50) or non-vaccine hesitant based on their score. The investigation compared the effect of providers using presumptive methodologies against those that used participatory approaches on parents’ immunization choices. Providers with presumptive approaches used statements similar to “We have to do some shots,” while providers with participatory approaches used statements similar to “What do you want to do about these shots?”. In 74% of cases, healthcare workers implemented the presumptive strategy. In 26% of those cases, parents voiced resistance to immunization suggestions (Opel et al., 2013). Of those that resisted, there were significantly more vaccine-hesitant parents than non-vaccine hesitant parents. 50% of providers responded to the resistance by repeating their original stance through statements similar to “He really needs these shots,” and 47% of parents, who initially resisted, accepted the vaccine recommendations (Opel et al., 2013). When providers took on a participatory approach (26% of cases), 83% of parents resisted (Opel et al., 2013). These outcomes suggest that the type of approach used by healthcare providers influences the decision-making of parents regarding vaccination. Providers that introduce vaccines as requirements or the optimal decision are less likely to face parent resistance compared to those that give parents more of a choice—26% compared to 83%, respectively (Opel et al., 2013). In addition, almost 50% of those that initially showed resistance from the presumptive approach acknowledged immunization suggestions when pressed again with the provider’s original stance. The presumptive methodology uses language that assumes that the patient will consent to the vaccination, depicting vaccination as a routine technique that the healthcare provider recommends. On the other hand, the participatory approach removes the healthcare provider’s confidence in the vaccine, opening the situation to vaccine hesitancy-related sentiments. Conveying and emphasizing a provider’s confidence in vaccination influences the vaccination results of patients, as they will be more likely to feel confident about the vaccine if the provider does as well.
One explanation for the influence of presumptive approaches is the trust in the relationship between the healthcare provider and the patient. Provider-patient relationships have proven to play a vital role in combating vaccine hesitancy, specifically in countering the mistrust of vaccines. A study conducted by Gilkey et al. (2014) sought to measure confidence about adolescent vaccination (ages 13 to 17) in different populations of parents. Randomly selected parents who completed the 2010 National Immunization Survey-Teen were a part of the study. Participants rated their agreement to 8 vaccination belief statements—0 being strongly disagree and 10 being strongly agree. The study categorized the statements into factors: benefits of vaccination, harms of vaccination, and trust in healthcare providers. Data on subgroups and demographics—such as sex, race/ethnicity, and mother’s education—was also collected. Across these subgroups and demographics, the mean agreement rating for statements that fell under trust in healthcare providers was 9.0, while the mean agreement rating for those under benefits of vaccination was 8.5 (Gilkey, 2014). This aspect of the study showcases that parent confidence in vaccines is high when the trust patients have in healthcare providers is high. Therefore, approaches that emphasize that trust in the provider-patient relationship, namely presumptive approaches, may push parents to accept the recommendations of providers, thereby supporting the findings of the study by Opel et al. (2013).
While the word choices of healthcare providers alone will not resolve the issues of vaccine hesitancy, it can still influence the vaccine rate acceptance, as it capitalizes on the trust held between providers and patients, which has been shown to correlate positively with vaccine acceptance. A change in the language used by healthcare providers, in conjunction with existing interventions, can maximize the chances of persuading vaccine-hesitant parents, increasing vaccine coverage and protecting public health. Therefore, the language used by healthcare providers must not be overlooked when considering interventions involving vaccine-hesitant patients.
Michelle Li, Youth Medical Journal 2021
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