The Empathetic Refutational Interview to Tackle Vaccine Misconceptions: Four Randomized Experiments

"...provides a guide for more productive vaccine conversations."

Communication with trusted healthcare professionals (HCPs) can be effective at dealing with patients' (and caregivers') concerns and encouraging them to be vaccinated. Countering misconceptions about vaccines is crucial to ensure patients make informed decisions based on factual information. However, to effectively address misinformed beliefs about vaccination, communicators must go beyond simply refuting beliefs by showing an understanding of people's underlying motivations for their beliefs. This paper describes and assesses an approach toward such conversations, the Empathetic Refutational Interview (ERI), that involves taking into account individuals' possible psychological motivations and responding with empathy - even while correcting their misconceptions.

The researchers conducted four experiments in 2022 with participants in the United Kingdom who were predominantly negative or on the fence about vaccination (n = 2,545) to test four steps for tailoring an HCP's response to a vaccine-hesitant individual:

1. Elicit concerns: The interview commences by inviting the patient to share their thoughts about vaccination. This step draws from motivational interviewing, an approach involving active listening. Probing patients' motivations can help identify a patient's attitude roots: a necessary step to tailor one's response in subsequent steps.
2. Affirm: The next ERI step is an expression of empathy for the patient's position, demonstrated by providing an affirmation of the patient's concerns that is tailored to acknowledge their motivations to reject vaccination. An affirmation allows the HCP to show they understand and care about the patient's concern, which can build trust even between individuals who hold opposing views.
3. Offer a tailored refutation: The refutation process is important because explaining why a misconception is wrong and replacing it with facts is more effective at revising people's incorrect beliefs than simply telling them the facts. Refutations should thus be tailored to the misconception and to the motivation - that is, attitude root(s). On top of tailoring, refuting health misinformation in an empathetic way may be judged as more reliable and satisfying than refuting it directly and factually. For instance, "I see your point. Perhaps we could consider this information" is a more receptive formulation than "That's not correct. It is necessary to consider this information."
4. Provide factual information about vaccines - often facts that are known to be effective at increasing vaccine acceptance in mass communication studies.

Each of the steps was tested against active control conditions, with participants randomised to conditions. The study was conducted online; as part of the process, participants read a scenario that featured an online forum discussion between a regular forum user who was against vaccines and a medical professional.

Overall, compared to controls, the researchers found that observing steps of the ERI produced small effects on increasing vaccine acceptance and lowering support for antivaccination arguments. An HCP who affirmed participants' concerns generated significantly more support for their refutations and subsequent information, with large effects compared to controls. In addition, participants found tailored refutations (compared to control responses) more compelling, and they displayed more trust and openness toward the HCP giving them.

In conclusion, the "findings are promising as a proof of concept conducted in controlled settings. The ERI still needs to be tested in real healthcare contexts, to evaluate its impact on actual vaccine uptake as well as how to successfully implement it in a clinical setting where HCPs may experience competing demands and time pressures....Further studies to field test the ERI are underway as part of a wider international program to support HCPs in addressing vaccine misconceptions (https://sks.to/jitsuvax)."