By Dawn Holford, University of Bristol, UK, Linda Karlsson, University of Turku, Finland, Frederike Taubert, Erfurt University, Germany, Emma C. Anderson, University of Bristol, UK, Virginia C. Gould, University of Bristol, UK
Correcting misconceptions about vaccination
Vaccination is one of the most successful tools of public health—they have been estimated to save 6 lives every minute. But vaccines have also faced public resistance, with persistent disinformation undermining public trust in vaccination, and posing a challenge for health workers with vaccination roles. How do health workers keep up with the flood of false narratives about vaccines? What can they say to patients who cite these narratives as reasons not to vaccinate themselves or their children?
While it can be tempting to respond by citing the facts, correcting misconceptions about vaccines—which are often fuelled by disinformation—is not as simple as sharing more factual information. Take the example of a long-debunked myth about vaccines and autism: despite decades of research and extensive evidence that there is no link between the two, health workers continue to encounter this concern among parents. Myths like this are “sticky” because they play on people’s underlying fears, using strong narratives that appear intuitive at first glance. They can also be weaponised by those with political agendas to keep these myths circulating in public.
So, what can health workers say to someone who holds a misconception about vaccines? It starts with understanding what motivates someone’s beliefs. Let’s imagine two parents, Tina and Tom. Both share a concern that their children’s immune system will not cope with all the recommended vaccinations. This is another common misconception: the fact is that vaccines are only a tiny dose compared to the real disease. For Tom, the concern is motivated by his fear of adverse effects each vaccine might trigger. For Tina, the concern is motivated by her preference for her child to have strong “natural” resistance to disease. These deeper drivers of the surface concern are known in psychology as “attitude roots”, and they can motivate people to cling to their misconceptions in the face of factual correction.
Often, we have a natural impulse to directly correct misconceptions we hear from others. However, research shows that when we first validate people’s attitude roots, they are more receptive to corrections of vaccine myths, which can increase their acceptance of vaccines. So, to address Tom’s concern, we might want to first reassure him that it’s normal to want to protect his child. In contrast, to address Tina’s concern, it could be better to begin by acknowledging that it is generally good to avoid unnecessary medication. After connecting with them and building trust, we can continue with addressing their misconceptions and sharing more information about vaccination.
How can we prepare health workers for vaccine conversations?
The best way to address vaccine misconceptions is through tailored, dialogue-based approaches. When people are able to speak to health workers whom they trust for medical advice, this can be highly effective at raising vaccine uptake. An example of such an approach is the Empathetic Refutational Interview, a four-step framework to structure vaccine conversations using evidence-based techniques described above to build trust and address misconceptions while respecting people’s attitude roots. It was created by the JITSUVAX project and builds on other dialogue-based approaches, such as Motivational Interviewing.
However, engaging in respectful dialogue with patients about vaccination is not always easy. Health workers may worry about provoking conflict during the discussion. Many health workers do not receive training to prepare them for such conversations. In fact, where health workers receive training or guidance for this important role, it tends to rely on an information-based approach of providing facts to patients—which can actually be counterproductive. The JITSUVAX project interviewed health workers who described their need for specific support and strategies they can use to deal with patients’ vaccine misconceptions.
The JITSUVAX project developed tools to support health workers to use the Empathetic Refutational Interview for vaccine conversations:
- Web resources to help health workers understand 11 attitude roots that underlie vaccine misconceptions.
- Guidance on using the Empathetic Refutational Interview to improve vaccine conversations.
- Training for health workers in the Empathetic Refutational Interview.
We have run workshops with health workers in countries across Europe, who reported strong and lasting improvements after attending training in their skills and confidence for vaccine conversations. In Romania, health workers trained in the Empathetic Refutational Interview and Motivational Interviewing saw a larger increase in the number of vaccination appointments booked after their consultations, compared to untrained health workers.
Our experience mirrors findings from the World Health Organization that communication skills training for health workers helps build their confidence in having vaccine conversations and is a worthwhile investment.
Practical recommendations
For practitioners:
- As a health worker, you hold a unique position of trust when it comes to medical advice. Recognise that your conversations can make the key difference in patients’ vaccine decisions.
- Understanding your patients’ attitude roots can help you in the conversation. You might think of this as diagnosing the situation to know how to approach the patient’s concerns. Techniques to help with this diagnostic step include asking questions that are open (e.g., “What information would support your decision?”) instead of closed (“Can I give you some information?”) and practising active listening by reflecting what the patient says.
- There are effective, evidence-based ways to correct vaccination myths while maintaining rapport. Seek out training in these techniques to support your confidence and skills to approach vaccine conversations.
- You may be concerned that dialogue with patients takes more time than you have in a consultation. Communication approaches like the Empathetic Refutational Interview, provide techniques to maximise the conversation even if you only have a few minutes. It is better to build trust and lay the groundwork for future discussions than deliver information that will not be well-received.
- Keep practising the communication skills and techniques you learn – these tend to improve the more you use them.
