Navigating Vaccine Hesitancy: Strategies and Dynamics in Healthcare Professional-parent Communication

"Understanding the communication dynamics between vaccine-hesitant parents and healthcare professionals (HCPs) is vital for addressing parent concerns and promoting informed decision-making."

Communicating the risks and benefits of vaccination is a complex task. Nevertheless, healthcare professionals (HCPs) have only limited time to do this. In addition, the evidence suggests that HCPs do not receive adequate training in evidence-based risk communication strategies. This paper focuses on strategies used by HCPs to communicate with vaccine-hesitant parents. It draws on empirical evidence generated as part of the international project VAX-TRUST, with analysis focused solely on data collected in the Czech Republic (CR). With its mandatory vaccination system, the Czech system shows relatively high vaccination rates, though they have generally been in a slight but steady decline over time.

Between January 2022 and June 2022, 60 hours of observations were carried out in three different paediatric practices during vaccination-related visits, and 19 physicians and nurses were interviewed.

The study found that the dynamics between parents and HCPs and their willingness to invest time in the vaccination discussion are influenced by how HCPs categorise and label parents. They used the term "vaccine rejectors" to refer to the group of parents who are strictly confident in their position not to vaccinate. To invest time in discussion with those parents was perceived as pointless, counterproductive, and a time burden for the practice (that negatively affects other patients who cannot be cared for). In those cases, HCPs preferred to close the topic of vaccination in order to avoid eroding the trust and mutual relationship necessary for further cooperation.

Those findings suggest that HCPs actively use attitudes toward vaccination as an indicator of future collaboration patterns. HCPs recognised attitudes toward vaccination as factors potentially impacting other spheres of care. The ability to adjust appropriate communication arrangements and build long-term cooperation becomes essential in a healthcare system based on a long-term relationship between individual HCPs and parents, as is the case in the CR.

The "postponers/hesitant parents" were depicted as more open to discussion. In those cases, HCPs stressed the need to uncover parents' fears so they could address them adequately. The study identified two different strategies HCPs use to manage the fears of vaccine-hesitant parents:
 

• The communication of risks associated with vaccination (and lack thereof): HCPs used a variety of discursive practices to familiarise the unfamiliar risks of vaccine-preventable diseases: mobilising representations that are part of collective memory, incorporating personal experiences to materialise the presence of risk and the confidence in the safety of vaccines, and situating risk as embedded in everyday processes and integral to the uncertainty of the global world - e.g., a potential change in the epidemiological situation in the CR due to the refugee crisis induced by the war in Ukraine. For example, by sharing their personal experiences and drawing on their own moments of concern as parents, some HCPs made the potential risks of vaccine-preventable diseases visible. Simultaneously, they underscored their confidence in vaccines through narratives of vaccination decisions made for their own children.
• The conscious employment of medical procedures that may contribute to reducing vaccination fears: For example, HCPs referred to offering consultation with a neurologist to assure hesitant parents that the child's development can handle the vaccination. The interviewed HCPs primarily framed this procedure as an activity designed to minimise parental concerns, and thus increase the likelihood that they would vaccinate their child. 
   

Reflecting on the findings, the researchers point to available evidence suggesting that the perception of risk (associated both with vaccination and vaccine-preventable disease) represents one of the most important factors impacting vaccination decisions. The HCPs interviewed in this study highlighted that the argumentation used by vaccine-hesitant parents is often irrational and grounded in emotional responses, and they symbolically positioned themselves as rational authorities. However, at the same time, they actively used arguments that evoked strong feelings in their efforts to reframe the risk-benefit debate toward discussing the risks of the particular disease rather than the risks of the vaccines. These strategies were seen by HCPs as being complementary to information that embeds risks in statistical information and biomedical risk calculations. In these cases, HCPs used comprehensible (media or cultural) representations, personal experiences, and media coverage of cases of infection to place vaccine-preventable disease risk in frameworks that are easy for parents to understand and that make unfamiliar risks appear more familiar.

The results have several implications:
 

1. The study found that HCPs actively seek creative strategies to communicate risks. More research is needed to explore the contexts in which HCPs use this type of communication and its impact on vaccination attitudes, because existing evidence suggests that emotionally charged messages emphasising the risks of vaccine-preventable disease can have pitfalls.
2. The research shows that HCPs mainly focus on risk communication, specifically reframing risk and emphasising the risks associated with vaccine-preventable diseases. However, it is crucial to reflect on the importance of communication strategies that shift the focus from risks to the benefits and individual situation of the child, which may address the needs of some parents more effectively. 
3. The findings underscore the importance of further research on the organisation of immunisation services and its impact on communication patterns with vaccine-hesitant parents. In the CR, vaccination is provided within the context of a long-term relationship between HCPs and parents. HCPs viewed communication about vaccinations within this relationship as an aspect that may influence future care provision, and they adapted their strategies accordingly.