The science behind the strategies

Explore evidence-based communication scenarios for overcoming vaccine hesitancy

The scenarios we recommend are rooted in evidence-based communication strategies that have been adapted to support vaccination uptake.

Review these strategies and corresponding sample scenarios to discover techniques and specific dialogue for approaching the vaccine conversation confidently and effectively.

“A strong recommendation from a health care provider is the single most important factor in determining whether or not someone gets vaccinated.”13

—Centers for Disease Control and Prevention

Strategies in action

Adopt a presumptive approach:

Opening the vaccine conversation with a statement rather than a question leads to more parents accepting vaccinations for their children.8,34,35

The science of persuasion

When it comes to improving vaccination rates, using presumptive language is recommended over a participatory approach.34 State that the child will receive vaccines as though you presume the parents are ready to accept recommended vaccines for their child during that visit.8

Use reflective listening:

Allow patients to express their beliefs. After they share, try to interpret the meaning behind their answer and ask them to clarify if you’ve understood them correctly.36

“I’d like to delay my child’s vaccinations. Can we save this for her next appointment?”

Patient:

“I’d like to delay my child’s vaccinations. Can we save this for her next appointment?”

HCP:

“I’m hearing that you’d like an alternative vaccination schedule. Could you help me understand why?”

Patient:

“It just seems like a lot all at once, and I’m not sure if it’s safe.”

HCP:

“The CDC-recommended vaccination schedule is designed to help protect children before they are exposed to vaccine-preventable diseases.17

It’s based on many factors, including how your child’s immune system responds to vaccines at various ages, and how likely your child is to be exposed to a particular disease.17

Delaying vaccines could leave your child vulnerable to disease and may lead to serious complications.17

I feel confident in this schedule, which is recommended by the Advisory Committee on Immunization Practices (ACIP) and approved by the CDC, the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), etc.” 18

The science of persuasion

Tell parents the bottom-line meaning or the “gist” of a message to help them remember and take action on the information you provided. Messages with gists are expected to be more compelling to parents than those that simply state facts verbatim.35,37

Make affirmations:

Create a comfortable environment where patients may be more open to change. Reassure them by validating their motivations and good intentions to do what’s best for their child.36

“I’ve heard a lot of conflicting information, and I don’t know what to believe.”

Patient:

“I’ve heard a lot of conflicting information, and I don’t know what to believe.”

HCP:

“I understand that you just want to make the best decision for your child. It can be hard when you’re unsure which information is true and which isn’t. Is there anything specific that I can help clear up?”

Patient:

“Well, my best friend read something on social media and now she doesn’t want to vaccinate her family.”

HCP:

“It’s good that you have someone you trust who can share their personal choices like that. I hope you can also trust me to help with your vaccination decision.

Vaccinations are an important part of your child’s health.20 So important that I make sure my family and I are all vaccinated.”

The science of persuasion

Providers who share their own personal stories may stand a better chance of connecting with vaccine-hesitant parents. Parents likely want to hear that you vaccinate your children, or about other personal experiences you have with vaccination.38

Ask open-ended questions:

Invite patients to actively participate in the conversation and elaborate on their beliefs.36

“I didn’t know he needed 3 shots today. That seems like a lot!”

Patient:

“I didn’t know he needed 3 shots today. That seems like a lot!”

HCP:

“I’m sorry we didn’t talk about this more during our last visit. What worries you about vaccinating today?”

Patient:

“Well, they don’t all seem necessary to me. I didn’t get some of these vaccines and I was fine.”

HCP:

“I see why you would think that. But vaccines are an important part of helping to protect the health of our children.23

We’re lucky. Unlike our parents, we don’t have to stay up at night worrying about diseases like polio.23,29 That’s because the majority of kids are vaccinated.33,a

Vaccines do often cause mild side effects that go away quickly on their own and yes, serious side effects can occur…but they are rare.12

When a vaccine is delayed, children are vulnerable to certain diseases that they may encounter.12

There are no data to show that spacing out vaccines is safer or more effective than following the CDC recommendations.”12

The science of persuasion

Social norms play a key role in parents’ decision-making process.14,39 Remind parents that most children are vaccinated to reinforce that it’s a social norm.40

aNote: Providing childhood vaccination data from your own practice or geographic area may make this statement more impactful.

Elicit permission:

Ask if it’s okay to talk about vaccines and provide any facts they may want to know. Then, ask how they feel knowing that information.41

“What about vaccine side effects.”

Patient:

“I’m not sure I want my child to get those shots. I’m a little concerned about the side effects.”

HCP:

“That’s understandable. Can you tell me what concerns you the most?”

Patient:

“Well, I’ve heard they can be dangerous.”

HCP:

“Vaccines can cause side effects that are usually mild and go away quickly on their own, such as a low-grade fever, headache and/or pain, swelling, or redness where the shot was given.19

Serious side effects are extremely rare, but could include severe allergic reaction. Signs of a severe allergic reaction could be difficulty breathing, swelling of face and throat, and/or a bad rash on the body. Does that help address your concerns?”19

Patient:

“I’m still not sure.”

HCP:

“Okay. I’ll give you some information to read and we can reschedule a visit in 2-3 days to discuss any questions or concerns you might still have. Does that sound good?”

The science of persuasion

Show parents you understand their concerns by providing them with both the benefits and risks of vaccines. Some parents may feel adequately informed about the benefits, but underinformed about the risks.42,43,44 It can be helpful to acknowledge that parents ask for all the information because they want to do what’s best for their child.

Social determinants of health (SDOH) play a key role in vaccine hesitancy45

Learn how you can adapt conversations to better support your patient population.

Explore other scenarios and strategies for overcoming vaccine hesitancy.

Safety concerns/general mistrust:

Lack of information:

All scenarios:

Learn more:

id12

Reference

  1. Centers for Disease Control and Prevention. Preparing for questions parents may ask about vaccines. Reviewed April 11, 2018.Accessed July 21, 2023. https://www.cdc.gov/vaccines/hcp/conversations/preparing-for-parent-vaccine-questions.html
id13

Reference

  1. Centers for Disease Control and Prevention. Educate the parent or patient. Reviewed May 7, 2019. Accessed July 5, 2023. https://www.cdc.gov/vaccines/hcp/admin/educating-patients.html
id14

Reference

  1. Brunson EK. The impact of social networks on parents’ vaccination decisions. Pediatrics. 2013;131(5):e1397-404. doi:10.1542/peds.2012-2452
id17

Reference

  1. Centers for Disease Control and Prevention. Reasons to follow CDC’s recommended immunization schedule. Reviewed February 25, 2020. Accessed July 7, 2023. https://www.cdc.gov/vaccines/parents/schedules/reasons-follow-schedule.html
id18

Reference

  1. Centers for Disease Control and Prevention. Child and adolescent immunization schedule by age. Reviewed April 27, 2023. Accessed July 7, 2023. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
id19

Reference

  1. US Department of Health and Human Services. Vaccine side effects. Reviewed May 6, 2022. Accessed July 7, 2023. https://www.hhs.gov/immunization/basics/safety/side-effects/index.html
id20

Reference

  1. US Department of Health and Human Services. Vaccine basics.Reviewed November 9, 2022. Accessed July 7, 2023. https://www.hhs.gov/immunization/basics/index.html
id23

Reference

  1. US Department of Health and Human Services. Five important reasons to vaccinate your child. Reviewed May 6, 2022. Accessed July 10, 2023. https://www.hhs.gov/immunization/get-vaccinated/for-parents/five-reasons/index.html
id29

Reference

  1. Talbird SE, Carrico J, La EM, et al. Impact of routine childhood immunization in reducing vaccine-preventable diseases in the United States. Pediatrics. 2022;150(3):e2021056013. doi:10.1542/peds.2021-056013
id33

Reference

  1. Centers for Disease Control and Prevention. Immunization. Reviewed June 13, 2023. Accessed July 20, 2023. https://www.cdc.gov/nchs/fastats/immunize.htm
id34

Reference

  1. Opel D, Heritage J, Taylor JA, et al. The architecture of provider parent vaccine discussions at health supervision visits. Pediatrics. 2013;132(6):1037-1046. doi:10.1542/peds.2013-20373
id35

Reference

  1. Brewer NT, Chapman GB, Rothman AJ, Leask J, Kempe A. Increasing vaccination: putting psychological science into action. Psychol Sci Public Interest. 2017;18(3):149-207. doi:10.1177/1529100618760521
id36

Reference

  1. Miller WR, Rollnick S. What is motivational interviewing? In: Miller WR and Rollnick S, eds. Motivational Interviewing: Helping People Change. 3rd ed. Guilford Publications; 2012:1-36.
id37

Reference

  1. Broniatowski DA, Hilyard KM, Dredze M. Effective vaccine communication during the Disneyland measles outbreak. Vaccine. 2016;34(28):3225-3228. doi:10.1016/j.vaccine.2016.04.044
id38

Reference

  1. Shelby A, Ernst K. Story and science: how providers and parents can utilize storytelling to combat anti-vaccine misinformation. Hum Vaccin Immunother. 2013;9(8):1795-1801. doi:10.4161/hv.24828
id39

Reference

  1. Brunson EK. How parents make decisions about their children’s vaccinations. Vaccine. 2013;31(46):5466-5470. doi:10.1016/j.vaccine.2013.08.104
id40

Reference

  1. Hill HA, Chen M, Elam-Evans LD, Yankey D, Singleton JA.Vaccination coverage by age 24 months among children born during 2018-2019 – National Immunization Survey-Child, United States, 2019-2021. MMWR Morb Mortal Wkly Rep. 2023;72(2):33-38. doi:10.15585/mmwr.mm7202a3
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Reference

  1. American Academy of Pediatrics. Communication strategies: motivational interviewing. Reviewed July 9, 2021. Accessed July 25, 2023. https://www.aap.org/en/patient-care/healthy-active-living-forfamilies/communicating-with-families/motivational-interviewing/
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Reference

  1. Glanz JM, Wagner NM, Narwaney KJ, et al. A mixed methods study of parental vaccine decision making and parent-provider trust. Acad Pediatr. 2013;13(5):481-488. doi:10.1016/j.acap.2013.05.030
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Reference

  1. Glanz JM, Kraus CR, Daley MF. Addressing parental vaccine concerns: engagement, balance, and timing. PLoS Biology. 2015;13(8):e1002227. doi:10.1371/journal.pbio.1002227
id44

Reference

  1. Olson O, Berry C, Kumar N. Addressing parental vaccine hesitancy towards childhood vaccines in the United States: a systematic literature review of communication interventions and strategies. Vaccines (Basel). 2020;8(4):590. doi:10.3390/vaccines8040590
id45

Reference

  1. Nguyen KH, Srivastav A, Lindley MC, et al. Parental vaccine hesitancy and association with childhood diphtheria, tetanus toxoid, and acellular pertussis; measles, mumps, and rubella; rotavirus; and combined 7-series vaccination. Am J Prev Med. 2022;62(3):367-376. doi:10.1016/j.amepre.2021.08.015
id8

Reference

  1. Centers for Disease Control and Prevention. Talking with parents about vaccines for infants. Reviewed April 11, 2018. Accessed August 16, 2023. https://www.cdc.gov/vaccines/hcp/conversations/talking-with-parents.html

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