Provider Communication and Parental Vaccine Acceptance
Provider Communication and Parental Vaccine Acceptance
Objectives. We investigated how provider vaccine communication behaviors influence parental vaccination acceptance and visit experience.
Methods. In a cross-sectional observational study, we videotaped provider–parent vaccine discussions (n = 111). We coded visits for the format providers used for initiating the vaccine discussion (participatory vs presumptive), parental verbal resistance to vaccines after provider initiation (yes vs no), and provider pursuit of recommendations in the face of parental resistance (pursuit vs mitigated or no pursuit). Main outcomes were parental verbal acceptance of recommended vaccines at visit's end (all vs ≥ 1 refusal) and parental visit experience (highly vs lower rated).
Results. In multivariable models, participatory (vs presumptive) initiation formats were associated with decreased odds of accepting all vaccines at visit's end (adjusted odds ratio [AOR] = 0.04; 95% confidence interval [CI] = 0.01, 0.15) and increased odds of a highly rated visit experience (AOR = 17.3; 95% CI = 1.5, 200.3).
Conclusions. In the context of 2 general communication formats used by providers to initiate vaccine discussions, there appears to be an inverse relationship between parental acceptance of vaccines and visit experience. Further exploration of this inverse relationship in longitudinal studies is needed.
Parental refusal or delay of childhood vaccines is a growing public health concern. It is an important contributor to underimmunization and raises the risk of a child developing and transmitting vaccine-preventable disease. However, little is known about how to increase vaccine acceptance among vaccine-hesitant parents.
Evidence suggests that improving provider–parent communication about vaccines may increase parental vaccine acceptance. Provider–parent communication is a key factor in parental decision making about childhood vaccines and presents opportunities for improvement. Although some general communication guidelines have been disseminated for providers to use with vaccine-hesitant parents, improvement efforts have been complicated by minimal data on the effectiveness of specific vaccine communication strategies.
We previously identified 2 provider communication behaviors that appear to influence parental vaccine decision making. When providers used participatory formats to initiate vaccine discussions (e.g., "What do you want to do about shots?"), parents were more likely to voice initial resistance to vaccines (e.g., "I don't want him vaccinated today") than when providers used presumptive formats (e.g., "Well we have to do some shots"). In addition, if patients voiced resistance, providers' pursuit of their original vaccine recommendations (e.g., "He really needs these shots") changed nearly half of parents' vaccination decisions.
However, important questions remain. First, how is provider initiation format associated with parental vaccination acceptance at visit's end? It is unclear whether provider initiation format is associated with the more clinically relevant end outcome of parental vaccination acceptance at visit's end. Furthermore, if there is an association between provider initiation format and parental vaccination acceptance, how much of this association is explained by parents' initial verbal resistance to vaccines during the discussion and by providers' pursuit of vaccine recommendations despite parental verbal resistance? For instance, if providers pursue their original vaccine recommendations, initial resistance may independently predict parental vaccine decisions at visits' end and mediate the relationship between provider initiation format and parental vaccination acceptance.
Second, how do these communication behaviors influence other pertinent outcomes, such as parents' ratings of their visit experience? Patient experience is a widely recognized quality-of-care indicator, reflecting the Institute of Medicine's health care quality aim of patient centeredness and being linked to annual reimbursement payments by the Centers for Medicare and Medicaid Services. There is concern that providers' use of presumptive formats to initiate vaccine discussions, despite precipitating less verbal resistance from parents during visits, may negatively affect parents' experiences. This, in turn, may result in decreased vaccine uptake over time.
We sought to (1) determine the relationship between provider initiation format and parental vaccine acceptance at visit's end and whether parental verbal resistance during the vaccine discussion or provider pursuit mediated this relationship, and (2) determine the association of provider initiation and pursuit behaviors with parental visit experience. We hypothesized that participatory formats would be associated with decreased parental acceptance of vaccines at visit's end but a highly rated parental visit experience and that parental verbal resistance would both predict decreased parental acceptance of vaccines and mediate the association of provider initiation format and parental vaccine acceptance.
Abstract and Introduction
Abstract
Objectives. We investigated how provider vaccine communication behaviors influence parental vaccination acceptance and visit experience.
Methods. In a cross-sectional observational study, we videotaped provider–parent vaccine discussions (n = 111). We coded visits for the format providers used for initiating the vaccine discussion (participatory vs presumptive), parental verbal resistance to vaccines after provider initiation (yes vs no), and provider pursuit of recommendations in the face of parental resistance (pursuit vs mitigated or no pursuit). Main outcomes were parental verbal acceptance of recommended vaccines at visit's end (all vs ≥ 1 refusal) and parental visit experience (highly vs lower rated).
Results. In multivariable models, participatory (vs presumptive) initiation formats were associated with decreased odds of accepting all vaccines at visit's end (adjusted odds ratio [AOR] = 0.04; 95% confidence interval [CI] = 0.01, 0.15) and increased odds of a highly rated visit experience (AOR = 17.3; 95% CI = 1.5, 200.3).
Conclusions. In the context of 2 general communication formats used by providers to initiate vaccine discussions, there appears to be an inverse relationship between parental acceptance of vaccines and visit experience. Further exploration of this inverse relationship in longitudinal studies is needed.
Introduction
Parental refusal or delay of childhood vaccines is a growing public health concern. It is an important contributor to underimmunization and raises the risk of a child developing and transmitting vaccine-preventable disease. However, little is known about how to increase vaccine acceptance among vaccine-hesitant parents.
Evidence suggests that improving provider–parent communication about vaccines may increase parental vaccine acceptance. Provider–parent communication is a key factor in parental decision making about childhood vaccines and presents opportunities for improvement. Although some general communication guidelines have been disseminated for providers to use with vaccine-hesitant parents, improvement efforts have been complicated by minimal data on the effectiveness of specific vaccine communication strategies.
We previously identified 2 provider communication behaviors that appear to influence parental vaccine decision making. When providers used participatory formats to initiate vaccine discussions (e.g., "What do you want to do about shots?"), parents were more likely to voice initial resistance to vaccines (e.g., "I don't want him vaccinated today") than when providers used presumptive formats (e.g., "Well we have to do some shots"). In addition, if patients voiced resistance, providers' pursuit of their original vaccine recommendations (e.g., "He really needs these shots") changed nearly half of parents' vaccination decisions.
However, important questions remain. First, how is provider initiation format associated with parental vaccination acceptance at visit's end? It is unclear whether provider initiation format is associated with the more clinically relevant end outcome of parental vaccination acceptance at visit's end. Furthermore, if there is an association between provider initiation format and parental vaccination acceptance, how much of this association is explained by parents' initial verbal resistance to vaccines during the discussion and by providers' pursuit of vaccine recommendations despite parental verbal resistance? For instance, if providers pursue their original vaccine recommendations, initial resistance may independently predict parental vaccine decisions at visits' end and mediate the relationship between provider initiation format and parental vaccination acceptance.
Second, how do these communication behaviors influence other pertinent outcomes, such as parents' ratings of their visit experience? Patient experience is a widely recognized quality-of-care indicator, reflecting the Institute of Medicine's health care quality aim of patient centeredness and being linked to annual reimbursement payments by the Centers for Medicare and Medicaid Services. There is concern that providers' use of presumptive formats to initiate vaccine discussions, despite precipitating less verbal resistance from parents during visits, may negatively affect parents' experiences. This, in turn, may result in decreased vaccine uptake over time.
We sought to (1) determine the relationship between provider initiation format and parental vaccine acceptance at visit's end and whether parental verbal resistance during the vaccine discussion or provider pursuit mediated this relationship, and (2) determine the association of provider initiation and pursuit behaviors with parental visit experience. We hypothesized that participatory formats would be associated with decreased parental acceptance of vaccines at visit's end but a highly rated parental visit experience and that parental verbal resistance would both predict decreased parental acceptance of vaccines and mediate the association of provider initiation format and parental vaccine acceptance.
Source...