Motivational interviewing: A powerful tool to address vaccine hesitancy

From vaccine hesitancy to vaccine motivation: A motivational interviewing based approach to vaccine counselling

The COVID-19 pandemic highlighted Vaccine Hesitancy (VH) as an accelerating global phenomenon that must be addressed. According to the WHO, thirty to fifty percent of the world's population are VH. Motivational Interviewing (MI) is an evidence-based communication style demonstrated to significantly reduce VH. MI guides people toward change through the expression of empathy and by respecting an individual's autonomy. Healthcare providers (HCPs) are the primary implementors of vaccine policies and the most trusted advisors and influencers of vaccination intention at the individual patient level. Training HCPs in MI is one of the most effective strategies to overcome VH. Many countries are currently implementing HCP training programs and population-based MI interventions to improve vaccine uptake. MI conversations are 'the heart' of vaccine decision-making processes. Understanding individual patient-level drivers of hesitancy allows clinicians to efficiently provide tailored, accurate information that reinforces a person's own motivation and confidence in their own decision. This paper describes a 4-step practical framework designed to support HCPs in their dialogue with vaccine-hesitant patients. (1) Engaging to establish a trustful relationship and safety to freely express opinions, beliefs, and knowledge gaps; (2) Understanding what matters most to the individual; (3) Offering Information to co-build accurate knowledge in order to guide the individual toward vaccine intention (4) Clarifying and Accepting to validate an individual's decision-making autonomy. We believe that our pragmatic approach can contribute to greater acceptability of COVID-19 and other vaccines, and enable rapid deployment of practical MI skills across care systems.

From both sides of the needle: Understanding effective interventions for facilitating non-national immunization program vaccine decision making in China

Vaccination decisions are influenced by various psychological and practical factors. In China, non-National Immunization Program (non-NIP) vaccines, which are voluntary and self-paid, add uncertainty and autonomy to the decision-making process. Effective communication between providers and recipients is crucial but understudied. This study aims to integrate their perspectives, identify strategies for facilitating vaccination decisions, and analyze their mechanisms. From July to December 2023, semi-structured interviews were conducted with 17 caregivers and 12 vaccination providers across five Chinese provinces. Participants shared their experiences and decision-making processes regarding non-NIP vaccines. The Behaviour Change Wheel framework guided the analysis, utilizing iterative coding and directed content analysis. Thirteen Behavior Change Techniques were identified, with feedback, monitoring, and environmental restructuring being the most common. Key intervention functions included Persuasion, Education, and Training. We further mapped how these interventions influence non-NIP vaccine decisions. Capability was enhanced through education and effective communication, providing necessary knowledge and skills. Opportunity was increased via infrastructural improvements and societal support, making vaccines more accessible and endorsed by the community. Motivation was driven by clear communication of vaccination benefits and risks, reinforced by societal norms through public health messaging. By understanding the mechanisms influencing vaccination behaviors and interacting with stakeholders, tailored strategies can be developed. Healthcare providers can enhance service accessibility and offer evidence-based guidance with reminders, monitoring, and incentives to ensure compliance. For recipients, reliable information, sustained engagement, timely communication, and motivational opportunities are essential. A multi-dimensional approach involving multiple stakeholders is crucial for promoting non-NIP vaccine uptake.

Building a way forward: Enabling community voices to forge the path toward successful immunization for all

Community engagement is vital to the development of people-centered, successful vaccination programs. The diverse Vaccination Acceptance Research Network (VARN) community brings together interdisciplinary professionals from across the immunization ecosystem who play a crucial role in vaccination acceptance, demand, and delivery. Over the course of the VARN2023 conference, researchers and practitioners alike shared ideas and experiences focused on strategies and approaches to building trust between communities and health systems to increase equity in vaccination. Health professionals and community members must have equal value in the design and delivery of community-centered immunization services, while key vaccination decision-makers must also consider community experiences, concerns, and expertise in program design and policymaking. Therefore, strategies for community engagement and cultivating trust with communities are crucial for the success of any immunization program. Furthermore, health workers need additional skills, support, and resources to effectively communicate complex information about immunization, including effective strategies for countering misinformation. This article summarizes three skills-building sessions offered at the VARN2023 conference, focused on human-centered design, motivational interviewing, and engaging with journalists to leverage the voices of communities. These sessions offered practical, evidence-based tools for use across geographic and social settings that can be used by practitioners, researchers, and other stakeholders to increase vaccination demand and uptake in their communities.

[Vaccine hesitancy in postpandemic times-A guide for physicians]

The coronavirus disease 2019 (COVID-19) pandemic emphasized the importance of vaccinations for the prevention of life-threatening diseases and for avoiding the overburdening of the healthcare system. Despite the clear advantage of vaccinations, increasing vaccine hesitancy has been observed worldwide, especially among young people who are potential future parents. Vaccine hesitancy describes the delayed or lack of willingness to utilize recommended vaccinations and represents a substantial challenge for public health. This article analyzes the causes of vaccine hesitancy in the postpandemic period and discusses factors that could make communication successful. The role of artificial intelligence and structured evidence-based discussion techniques, such as the empathetic refutation interview, are emphasized. The aim is to provide practice-oriented recommendations to be able to provide physicians with tools that can help in the education counselling with insecure patients and can promote the acceptance of vaccinations.

HIV Denial in the COVID Era

Though scientific consensus regarding HIV causation of AIDS was reached decades ago, denial of this conclusion remains. The popularity of such denial has waxed and waned over the years, ebbing as evidence supporting HIV causation mounted, building again as the internet facilitated connection between denial groups and the general public, and waning following media attention to the death of a prominent denier and her child and data showing the cost of human life in South Africa. Decades removed from these phenomena, HIV denial is experiencing another resurgence, coupled to mounting distrust of public health, pharmaceutical companies, and mainstream medicine. This paper examines the history and current state of HIV denial in the context of the COVID pandemic and its consequences. An understanding of the effect of this phenomenon and evidence-based ways to counter it are lacking. Community-based interventions and motivational interviewing may serve to contain such misinformation in high-risk communities.

Association of the belief in conspiracy narratives with vaccination status and recommendation behaviours of German physicians

Vaccine hesitancy has been identified as one of the top ten threats to global health by the World Health Organization (WHO). The belief in conspiracy narratives is repeatedly discussed as a major driver of vaccine hesitancy among the general population. However, there is a lack of research investigating the role of the belief in conspiracy narratives in vaccination decisions and recommendation behaviours of physicians. This is particularly relevant as physicians are one of the major and trusted sources of information for patients' vaccination decisions. This study therefore investigated the association between believing in COVID-19-related conspiracy narratives and physicians' own COVID-19 vaccination status and their recommendation behavior for COVID-19 and other vaccines (e.g., HPV or flu). In a cross-sectional survey among German physicians (N = 602, April 2022) two conspiracy narratives were assessed, stating that the coronavirus is a hoax or that it is human-made. Additional control variables included trust in health institutions, the rejection of complementary and alternative medicine (CAM), the 5C psychological antecedents of vaccination (confidence, complacency, constraints, calculation, and collective responsibility) and demographic variables. Hierarchical regressions indicated that greater belief in the conspiracy narrative claiming that the coronavirus is a hoax was associated with lower COVID-19 vaccination uptake and fewer COVID-19 vaccination recommendations among physicians. The results for recommendation behavior remain robust even when controlling for other variables. Contrary to our assumption, believing that the coronavirus is human-made was not related to vaccination status nor vaccine recommendation behavior. In conclusion, believing in conspiracy narratives that question the existence and thus also the danger of the virus is an important independent predictor of vaccine hesitancy among physicians that should be addressed in future public health interventions.

Integrating Science Media Literacy, Motivational Interviewing, and Neuromarketing Science to Increase Vaccine Education Confidence among U.S. Extension Professionals

This article presents an Integrative Model of Sustainable Health Decision-Making and a toolkit to equip U.S. Extension professionals with knowledge and skills to engage in adult immunization education. The objective was to reduce mistrust and increase willingness and confidence toward delivering vaccination education. The model was developed through an explanatory parallel mixed methods design. Data collection included a needs assessment survey, interviews, workshops, and Neuromarketing message testing. The resulting toolkit was pilot tested before final delivery. Four key needs were identified: tailoring trainings based on Extension roles, prioritizing preserving community trust and professional credibility, establishing connections with medical experts, and strengthening Science Media Literacy skills to counter misinformation and communicate emerging science. Correlations among constructs supported an integrated model focused on a professional development core of Science Media Literacy, Motivational Interviewing, and Neuromarketing Science that strengthens communication relationships between priority populations and trusted partners. The model and work described in this article can serve as a general framework for engaging key influencers in communities in communication education intended to promote sustainable well-being, such as increasing vaccine uptake.

COVID-19 and influenza vaccine-hesitancy subgroups

Health communicators are faced with the challenge that people can hesitate vaccines for different reasons. Our aim was to identify and describe the qualities of distinct COVID-19 and influenza vaccine-hesitancy subgroups to facilitate the development of tailored vaccine-hesitancy communication. In two studies, we used agglomerative hierarchical cluster analysis to identify COVID-19 (N = 554) and influenza (N = 539) vaccine-hesitancy subgroups in the general population based on nine vaccine hesitancy-related variables (intent to get vaccinated, perceived vaccine safety, perceived vaccine efficacy, perceived disease threat, perceived vaccination responsibility, perceived vaccination convenience, distrust in authorities, conspiracy mentality, and reliance on anecdotal testimonies). We identified and described six distinct COVID-19 vaccine-hesitancy subgroups (the Vaccination Positive, the Ambivalent, the Fearing Skeptic, the Unconvinced, the Constrained Skeptic, and the Vaccination Opponent), and three influenza vaccine-hesitancy subgroups (the Vaccination Positive, the Complacent, and the Vaccination Opponent), with different levels of hesitancy. We discuss the implications of the results for health communicators. Our results shed light on the (dis)similarities between people who hesitate COVID-19 and influenza vaccines and suggest that there is greater variety in hesitancy concerning COVID-19 vaccinations than influenza vaccinations. These findings can be used to design and test tailored vaccination messages.

Healthcare professionals' perceptions of challenges in vaccine communication and training needs: a qualitative study

BACKGROUND

Healthcare professionals (HCPs) can play an important role in encouraging patients and their caregivers to be vaccinated. The objective of this qualitative study was to investigate HCPs' perspectives on challenges in vaccine communication and unmet training needs in this domain.

METHODS

Semi-structured interviews were conducted with 41 HCPs (mainly nurses and physicians) with vaccination roles (23 in England; 18 in France), gathering information on: (1) HCPs' approach to vaccine conversations with patients; (2) Challenges of communicating about vaccines; (3) Vaccine-related training and learning resources available to HCPs, and; (4) HCPs' training needs around vaccine communication.

RESULTS

HCPs described a range of communication experiences that indicated insufficient time, information, and skills to confidently navigate difficult conversations with vaccine-hesitant patients. Communication skills were especially important to avoid conflict that could potentially damage the patient-provider relationship. Some HCPs interviewed had received communication training, but for most, this training was not specific to vaccination. Although general communication skills were transferable to vaccine conversations, most HCPs welcomed specific training and informational resources to support countering patients' misconceptions or misinformation about vaccines.

CONCLUSIONS

HCPs would benefit from training tailored to address vaccine communication with patients, and this should be part of a systemic approach that also provides time and space to have effective vaccine conversations.

Development of Promising Interventions to Improve Human Papillomavirus Vaccination in a School-Based Program in Quebec, Canada: Results From a Formative Evaluation Using a Mixed Methods Design

BACKGROUND

Despite the availability of school-based human papillomavirus (HPV) vaccination programs, disparities in vaccine coverage persist. Barriers to HPV vaccine acceptance and uptake include parental attitudes, knowledge, beliefs, and system-level barriers. A total of 3 interventions were developed to address these barriers: an in-person presentation by school nurses, an email reminder with a web-based information and decision aid tool, and a telephone reminder using motivational interviewing (MI) techniques.

OBJECTIVE

Here we report on the development and formative evaluation of interventions to improve HPV vaccine acceptance and uptake among grade 4 students' parents in Quebec, Canada.

METHODS

In the summer of 2019, we conducted a formative evaluation of the interventions to assess the interventions' relevance, content, and format and to identify any unmet needs. We conducted 3 focus group discussions with parents of grade 3 students and nurses. Interviews were recorded, transcribed, and analyzed for thematic content using NVivo software (Lumivero). Nurses received training on MI techniques and we evaluated the effect on nurses' knowledge and skills using a pre-post questionnaire. Descriptive quantitative analyses were carried out on data from questionnaires relating to the training. Comparisons were made using the proportions of the results. Finally, we developed a patient decision aid using an iterative, user-centered design process. The iterative refinement process involved feedback from parents, nurses, and experts to ensure the tool's relevance and effectiveness. The evaluation protocol and data collection tools were approved by the CHU (Centre Hospitalier Universitaire) de Québec Research Ethics Committee (MP-20-2019-4655, May 16, 2019).

RESULTS

The data collection was conducted from April 2019 to March 2021. Following feedback (n=28) from the 3 focus group discussions in June 2019, several changes were made to the in-person presentation intervention. Experts (n=27) and school nurses (n=29) recruited for the project appreciated the visual and simplified information on vaccination in it. The results of the MI training for school nurses conducted in August 2019 demonstrated an increase in the skills and knowledge of nurses (n=29). School nurses who took the web-based course (n=24) filled out a pretest and posttest questionnaire to evaluate their learning. The rating increased by 19% between the pretest and posttest questionnaires. Several changes were made between the first draft of the web-based decision-aid tool and the final version during the summer of 2019 after an expert consultation of experts (n=3), focus group participants (n=28), and parents in the iterative process (n=5). More information about HPV and vaccines was added, and users could click if more detail is desired.

CONCLUSIONS

We developed and pilot-tested 3 interventions using an iterative process. The interventions were perceived as potentially effective to increase parents' knowledge and positive attitudes toward HPV vaccination, and ultimately, vaccine acceptance. Future research will assess the effectiveness of these interventions on a larger scale.

Healthcare Professionals' Perspectives on HPV Recommendations: Themes of Interest to Different Population Groups and Strategies for Approaching Them

As a flagship of the Europe's Beating Cancer Plan, the European Commission supports EU member states' efforts to strengthen and expand the routine vaccination of girls and boys against human papillomavirus (HPV). Populations across Europe have grown in diversity, and health systems must adapt to meet the specific needs of increasing diversity. Healthcare professionals (HCPs) must strive to communicate HPV vaccine information in a culturally sensitive manner and address specific concerns related to cultural beliefs, trust in health systems and perceived risks. The objectives of this exploratory study are to identify which themes are most frequently raised during the recommendation of vaccination to minors based on the characteristics of the population (religion, region of origin, gender, level of education and language proficiency) and to collect strategies to improve communication with a diverse population. A survey was distributed through various European public health institutions to HCPs in the region and their networks. The survey included multi-response questions (themes addressed during vaccination recommendation based on population characteristics) and open-ended questions (own qualitative comments and strategies). The most common issues that arise during vaccine recommendation are a lack of knowledge, followed by misinformation. Differences were detected according to the population characteristics. Suggested strategies to improve HPV vaccine recommendation focused on the following aspects: affordability; sexuality and gender; communication platforms; multilingualism; quality of care; school collaboration. HCPs report differences according to the characteristics of the population receiving the recommendation. Personalisation of the recommendations would help to optimise the decision-making process for some groups.

"You can push these conversations, but don't push your patient away": healthcare learner perspectives on virtual simulation games as an educational approach to address vaccine hesitancy

Background

Vaccine hesitancy is a significant threat to public health. Healthcare providers (HCPs) can address hesitancy during routine patient conversations; however, few multidisciplinary education tools exist for HCPs to learn to engage in vaccine discussion especially considering new vaccine technologies such as mRNA vaccines. The objectives of this study were to explore HCP learners' experiences with COVID-19 vaccine communication, and qualitatively evaluate an online learning module composed of virtual simulation games (VSGs) which utilize the PrOTCT Framework for HCP vaccine communication.

Methods

Three virtual focus groups were conducted from December 2022 to January 2023 with Canadian healthcare learners in nursing (N = 6), pharmacy (N = 9), and medicine (N = 7) who participated in a larger study measuring the effectiveness of the VSGs. Using a pragmatic approach, a qualitative thematic analysis was conducted using NVivo to identify themes and subthemes.

Results

A total of 22 HCP learners participated in this study and three key themes were identified. Across all three disciplines, participants expressed that (1) their prior education lacked training on how to hold vaccine conversations, resulting in uncomfortable personal experiences with patients; (2) the VSGs increased their confidence in holding vaccine conversations by providing novel tools and skills; and (3) participants also provided feedback to improve the VSGs which was implemented and supported the dissemination to all HCP professions.

Conclusion

Although HCPs are a trusted source of vaccine information, participants in this study felt they received little training on how to engage in challenging conversations regarding COVID-19 vaccines. The introduction of the PrOTCT Framework and presumptive statements provided novel strategies for HCP to initiate vaccine conversations, especially considering new vaccine technologies and participants appreciated the emphasis on coping strategies and resilience. It is essential that HCP are provided both opportunities to practice managing these conversations, and tools and skills to succeed at an early point in their careers to prepare them for future roles in vaccine advocacy, delivery, and promotion.

Reviving health mediation during the COVID-19 crisis and beyond: an implementation study in deprived neighbourhoods of Marseille, France

Introduction

In 2020, during France's COVID-19 response, healthcare professionals from a hospital and an association initiated health mediation interventions in Marseille's vulnerable neighbourhoods, funded by the regional health authorities. This mixed method research evaluates the CORHESAN program that lasted until June 2022.

Methods

We examined CORHESAN documents and reports, conducted interviews, and analysed activity data, comparing it to the COVID-19 hotspots identified on a weekly basis at the neighbourhood level, using generalised linear mixed models (GLMMs).

Results

CORHESAN was implemented by a team of up to nine health mediators, six private nurses hired on an ad hoc basis, supervised by a general coordinator and two part-time medical and nursing coordinators. Multiple partnerships were established with shelters, associations, social-housing landlords and local institutions. The team accompanied 6,253 people affected by COVID-19 or contact in the practical implementation of their isolation and contact tracing. Of the 5,180 nasopharyngeal samples for RT-PCR and 1,875 for antigenic testing: 12% were taken at home and 27% in partner facilities in the targeted neighbourhoods; 32% were taken from symptomatic patients and 30% in the context of contact tracing; and 40% were positive. Multiple awareness sessions on prevention methods and distributions of personal protection kits and self-diagnostic tests were conducted in the streets, in shelters, in associations or at home. A total of 5,929 doses of COVID-19 vaccine were administered in a walk-in vaccination centre, at temporary street vaccination posts, during operations at partner facilities, or during home-visits to patients with limited autonomy. GLMMs showed that the intervention significantly targeted its testing interventions in neighbourhoods with socioeconomic disadvantage and/or past under-testing (adjusted odds ratio (aOR), 2.75 [1.50-5.00]) and those with high hotspot level (aOR for level-3 versus level-0, 1.83 [1.24-2.71]).

Discussion

The pandemic emphasised the potential of health mediation interventions to address health disparities. Building on this, a new program began in July 2022, aiming at enhancing cancer screening and vaccinations in deprived areas of Marseille. Evaluations are ongoing to assess its activities and impact, and provide evidence to future implementation initiatives.

Do pregnant persons want influenza vaccines? Knowledge, attitudes, perceptions, and practices toward influenza vaccines in 8 low- and middle-income countries

BACKGROUND

While vaccination is the most effective way to prevent influenza infection and adverse outcomes, and despite WHO recommendations to vaccinate pregnant persons, access to seasonal influenza vaccines remains low. We explored knowledge, attitudes, and practices of pregnant persons about seasonal influenza vaccines to inform actions to improve vaccine uptake among this priority population.

METHODS

We pooled individual-level data from cross-sectional surveys assessing pregnant persons' attitudes toward seasonal influenza vaccines in eight low- and middle-income countries during 2018-2019. The eight countries used a standard protocol and questionnaire to measure attitudes and intents toward influenza vaccination. We stratified by country-level (presence/absence of a national influenza vaccination program, country income group, geographic region) and individual-level factors.

FINDINGS

Our analysis included 8,556 pregnant persons from eight low- and middle-income countries with and without seasonal influenza vaccination programs. Most pregnant persons (6,323, 74%) were willing to receive influenza vaccine if it was offered for free. Willingness differed by presence of an existing influenza vaccination program; acceptance was higher in countries without influenza vaccination programs (2,383, 89%) than in those with such programs (3,940, 67%, p < 0.001).

INTERPRETATION

Most pregnant persons in middle-income countries, regardless of influenza vaccination program status, were willing to be vaccinated against influenza if the vaccine was provided free of charge. National investments in influenza vaccination programs may be well-received by pregnant persons, leading to averted illness both in pregnant persons themselves and in their newborn babies.

FUNDING

US Centers for Disease Control and Prevention.

Motivating COVID-19 Vaccination through Persuasive Communication: A Systematic Review of Randomized Controlled Trials

Vaccination is a vital defense against COVID-19 infections and outbreaks, yet vaccine hesitancy poses a significant threat to pandemic response and recovery. We conducted a systematic review of published randomized controlled trials (N = 47) assessing the persuasive effects of COVID-19 communication on COVID-19 vaccine acceptance. Individual vs. collective appeals and gain vs. loss frames are among the most frequently assessed message features, but they generally do not make a difference in persuasion. Normative messages that highlight higher (vs. lower) prevalence of vaccine acceptance are more persuasive. Message sources overall have limited impact on COVID-19 vaccine acceptance, but sources that have a shared identity with the message receivers tend to be persuasive. More engaging message channels such as interactive chatbots and videos are promising communication tools but are generally under-utilized and under-studied. Compared to no communication or irrelevant communication, COVID-19 vaccine messages generally have a small advantage in increasing COVID-19 vaccine acceptance. Messages that include 1) vaccine safety and/or efficacy information; 2) collective appeals combined with embarrassment appeals; and 3) political leaders' vaccine endorsement are among the most effective messaging strategies. There is no evidence of any backfire effects of COVID-19 vaccine messages. We discuss the implications of our findings for persuasive message design in pandemic vaccine communication.

Proneness to false memory generation predicts pseudoscientific belief endorsement

Among cognitive factors that can influence the endorsement of pseudoscientific beliefs, our study focuses on proneness to false memory generation. In this preregistered study, we presented 170 fluent English speakers residing in the USA with a misinformation task aimed at generating false memories. In this task, they first completed an event encoding stage, in which two events were narrated through sequentially presented pictures. One day later, they read a series of sentences relating the same events but which included several inaccurate descriptions aimed at producing a misinformation effect. Finally, we measured the influence of the misinformation manipulation over false memory generation. After completing the misinformation task, participants responded to a questionnaire measuring pseudoscientific beliefs. Our results showed a positive correlation between pseudoscience endorsement and false memory rates, which indicates that the latter might be a key factor influencing susceptibility to pseudoscience. To our knowledge, this is the first study showing a link between the tendency to believe in pseudoscience and variability regarding proneness to develop false memories. Practical implications for the design of new interventions to effectively reduce pseudoscientific beliefs and their negative impact on our society are discussed.

A World without Measles and Rubella: Addressing the Challenge of Vaccine Hesitancy

The worldwide elimination of measles and rubella is feasible, but not without overcoming the substantial challenge of vaccine hesitancy. This challenge is complicated by the spread of misinformation and disinformation fueled by rapidly progressing technologies and evolving forms of online communication. The recent COVID-19 pandemic has only added further complexity to this challenge. However, considerable progress has been made in understanding the scope of the problem and the complex factors that influence vaccine hesitancy. Our understanding of evidence-based strategies for addressing vaccine hesitancy has grown significantly, including evidence for effective communication and behavioral interventions. In this article, we review measles and rubella vaccines and vaccine hesitancy. We then provide an overview of evidence-based strategies for addressing vaccine hesitancy, including communication strategies and behavioral interventions. This article is relevant to healthcare professionals, health system leaders, public health professionals, policymakers, community leaders, and any individuals who have a role in addressing vaccine hesitancy in their communities. Finally, we review future directions and major areas of research need.

Child and adolescent COVID-19 vaccination coverage by educational setting, United States

OBJECTIVES

The COVID-19 pandemic changed the setting of education for many children in the U.S. Understanding COVID-19 vaccination coverage by educational setting is important for developing targeted messages, increasing parents' confidence in COVID-19 vaccines, and protecting all children from severe effects of COVID-19 infection.

STUDY DESIGN/METHODS

Using data from the Household Pulse Survey (n = 25,173) collected from December 9-19, 2022, January 4-16, 2023, and February 1-13, 2023, this study assessed factors associated with COVID-19 vaccination and reasons for non-vaccination among school-aged children 5-11 and adolescents 12-17 by educational setting.

RESULTS

Among children 5-11 years, COVID-19 vaccination coverage was higher among those who received in-person instruction (53.7%) compared to those who were homeschooled (32.5%). Furthermore, among adolescents 12-17 years, COVID-19 vaccination coverage was higher among those who received in-person instruction (73.5%) or virtual/online instruction (70.1%) compared to those who were homeschooled (51.0%). Children and adolescents were more likely to be vaccinated if the parental respondent had been vaccinated compared to those who had not. Among children and adolescents who were homeschooled, main reasons for non-vaccination were concern about side effects (45.4-51.6%), lack of trust in COVID-19 vaccines (45.0-50.9%), and lack of trust in the government (32.7-39.2%).

CONCLUSIONS

Children and adolescents who were home-schooled during the pandemic had lower vaccination coverage than those who attended school in person, and adolescents who were home-schooled had lower vaccination coverage than those who received virtual instruction. Based on the reasons for non-vaccination identified in this study, increasing parental confidence in vaccines, and reducing barriers to access are important for supporting COVID-19 vaccination for school-age children.

Causes and Effects of COVID-19 Vaccine Hesitancy Among Pregnant Women and its Association with Adverse Maternal, Placental, and Perinatal Outcomes

Populations identified to be severely affected by COVID-19, such as pregnant patients, require special consideration in vaccine counseling, access, and provider education. Maternal infection with COVID-19 poses a significant risk to the maternal-fetal dyad with known adverse placenta destruction [1-5]. Despite the widespread access and availability of vaccinations, vaccine hesitancy continues to persist and is highly prevalent in pregnant populations [6-9]. Addressing the multitude of social ecological factors surrounding vaccine hesitancy can aid in providing holistic counseling [10]. However, such factors are foremost shaped by maternal concern over possible fetal effects from vaccination. While changes in policy can help foster vaccine access and acceptance, increasing global provider education and incorporation of motivational interviewing skills are the first steps towards increasing maternal acceptance.

Community Partnership to Co-Develop an Intervention to Promote Equitable Uptake of the COVID-19 Vaccine Among Pediatric Populations

Objective

To describe the process of engaging community, caregiver, and youth partners in codeveloping an intervention to promote equitable uptake of the COVID-19 vaccine in non-Hispanic Black (Black) and Hispanic youth who experience higher rates of COVID-19 transmission, morbidity, and mortality but were less likely to receive the COVID-19 vaccine.

Methods

A team of 11 Black and Hispanic community partners was assembled to codevelop intervention strategies with our interdisciplinary research team. We used a mixed-methods crowdsourcing approach with Black and Hispanic youth (n=15) and caregivers of Black and Hispanic youth (n=20) who had not yet been vaccinated against COVID-19, recruited from primary care clinics, to elicit perspectives on the acceptability of these intervention strategies.

Results

We codeveloped five strategies: (1) community-tailored handouts and posters, (2) videos featuring local youth, (3) family-centered language to offer vaccines in the primary care clinic, (4) communication-skills training for primary care providers, and (5) use of community health workers to counsel families about the vaccine. The majority (56-96.9%) of youth and caregivers rated each of these strategies as acceptable, especially because they addressed common concerns and facilitated shared decision-making.

Conclusions

Engaging community and family partners led to the co-development of culturally- and locally-tailored strategies to promote dialogue and shared decision-making about the COVID-19 vaccine. This process can be used to codevelop interventions to address other forms of public health disparities.

Policy Implications

Intervention strategies that promote dialogues with trusted healthcare providers and support shared decision-making are acceptable strategies to promote COVID-19 vaccine uptake among youth from historically underserved communities. Stakeholder-engaged methods may also help in the development of interventions to address other forms of health disparities.

Strategies for Improving Vaccine Communication and Uptake

Vaccines have led to a significant decrease in rates of vaccine-preventable diseases and have made a significant impact on the health of children. However, some parents express concerns about vaccine safety and the necessity of vaccines. The concerns of parents range from hesitancy about some immunizations to refusal of all vaccines. This clinical report provides information about the scope and impact of the problem, the facts surrounding common vaccination concerns, and the latest evidence regarding effective communication techniques for the vaccine conversation. After reading this clinical report, readers can expect to: Understand concepts and underlying determinants of vaccine uptake and vaccine hesitancy.Understand the relationship between vaccine hesitancy and costs of preventable medical care.Recognize and address specific concerns (eg, vaccine safety) with caregivers when hesitancy is present.

A Multi-Modality Intervention Improves Obesity Bias among Medical Students

Background: Obesity is linked to chronic diseases in adults and children. Its prevalence continues to grow in the United States, necessitating the need for healthcare provider training and presenting an opportunity for the education of future medical providers. Despite this need, effectively implementing obesity education into medical school curricula has been challenging. Anti-obesity bias amongst healthcare providers and trainees represents a significant obstacle to the care of patients with obesity. Obesity bias may affect up to 1/3 of medical students. Methods: This study describes the development and preliminary testing of a brief, 2.5 h multi-modality teaching intervention consisting of online, interactive, and independent learning modules for first-year medical students and a patient panel focused on obesity, obesity bias, and motivational interviewing. The participants took Crandall's anti-fat attitude (AFA) questionnaire before and after an online independent learning module on motivational interviewing and obesity bias. The AFA consists of three subscales ("dislike", "fear of fat", and "willpower"). Individual responses were measured using a nine-point Likert-type response format (0 = very strongly disagree; 9 = very strongly agree). An average composite score was calculated for each subscale. Results: Data were analyzed from 103 first-year medical students enrolled at a college of medicine in the southwestern United States in 2022. The AFA mean composite scores decreased significantly, indicating a decrease in explicit anti-obesity attitude bias after completing the online module. This decrease was present in all three domains of fear (4.63 vs. 3.72, p < 0.001), dislike (1.25 vs. 0.88, p < 0.001) and willpower (3.23 vs. 2.31, p < 0.001). Conclusions: Relatively brief educational interventions can positively impact students' anti-obesity attitudes.

Motivational interview training improves self-efficacy of GP interns in vaccination consultations: A study using the Pro-VC-Be to measure vaccine confidence determinants

Immunization-specific motivational interviewing (MI), a patient-centered communication style used to encourage internal motivation for attitudinal and behavioral change, can provide healthcare professionals (HCPs) with the skills and practice required to respond to patients' doubts and concerns related to vaccines. We sought to assess the impact of an MI-training of General Practitioner (GP) interns on the psychosocial determinants of their vaccine confidence and behaviors. French GP interns participated in a virtual three-day MI-workshop in southeastern France. We used the validated Pro-VC-Be questionnaire - before and after the MI-workshop spanning over three months - to measure the evolution of these determinants. Scores before and after workshop trainings were compared in pairs. Participants' scores for commitment to vaccination (+10.5 ± 20.5, P = .001), perceived self-efficacy (+36.0 ± 25.8, P < .0001), openness to patients (+18.7 ± 17.0, P < .0001), and trust in authorities (+9.5 ± 17.2, P = 0.01) significantly increased after the training sessions, but not the score for confidence in vaccines (+1.5 ± 11.9, P = .14). The effect sizes of the four score improvements were moderate to large, with self-efficacy and openness to patients having the largest effect sizes (P = .83 and 0.78, respectively). This study provides evidence that certain determinants of overall vaccine confidence in HCPs, reflected respectively in the openness to patients and self-efficacy scores of the Pro-VC-Be, improve after immunization MI-training workshops. Incorporating immunization-specific MI-training in the curriculum for HCPs could improve several necessary skills to improve HCP-patient relationships and be useful for vaccination and other healthcare services.

Development of an eLearning intervention for enhancing health professionals' skills for addressing COVID-19 vaccine hesitancy

Like many countries, Greece has faced resistance to coronavirus disease 2019 (COVID-19) vaccination among residents for both the initial and booster doses. Supporting healthcare professionals with delivering brief advice on COVID-19 vaccination may assist with reaching national vaccination targets. We sought to rapidly develop, pilot test, and deploy an eLearning intervention on skills training on effective techniques for addressing COVID-19 vaccine hesitancy for primary health and social care professionals in Greece. A five-part, 1.5-h eLearning was produced in Greek which featured two behavior change techniques, Very Brief Advice (VBA) and Motivational Interviewing (MI) adapted for use in addressing COVID-19 vaccine hesitancy. Six-film-based case studies modeling the use of VBA and MI in the context of challenging scenarios typically seen in Greek health and social settings were produced for the eLearning. The CME was pilot tested using a pre-post design in a small convenience sample (n = 17) of health care professionals. Pilot study results found the training provided new knowledge (80%), improved provider skills (80%), and was useful to provider's clinical practice (90%). There was a mixed effect in provider capability, motivation, and opportunity. Ninety percent of providers strongly agreed or agreed that they planned to use the information and skills provided by the training in their clinical practice. This project has resulted in new training assets for use by health and social professional tailored to the nationally context in Greece including supporting uptake of booster doses of the COVID-19 vaccine.

Exploring Black Undergraduate Students' Communication and Biology Education Experiences about COVID-19 and COVID-19 Vaccines During the Pandemic

Effective communication about science is a core skill undergraduates should learn, but little research has explored how students communicate about culturally controversial science topics. In this study, we explored how Black undergraduate science students took on the role of science communicators in their communities during the COVID-19 pandemic. We interviewed 23 Black students about their experiences learning about COVID-19 vaccines and communicating about COVID-19 vaccines to their communities. We found that students' racial/ethnic and science backgrounds made them feel a responsibility to be effective communicators about COVID-19 vaccines as potential trusted messengers within their communities. However, students were using limited strategies when communicating and were unsure how to communicate about COVID-19 topics effectively to those who were vaccine-hesitant or doubted the severity of the pandemic. Finally, students described ways that their biology instructors could have helped them be more confident when communicating about COVID-19 vaccines with their communities. Findings suggest that biology instructors could teach science communication principles in addition to content knowledge about culturally controversial science topics in their undergraduate classes to build on students' developing science communication skills.

Disparities in child and adolescent COVID-19 vaccination coverage and parental intent toward vaccinations for their children and adolescents

INTRODUCTION

Despite recommendations for COVID-19 primary series completion and booster doses for children and adolescents, coverage has been less than optimal, particularly in some subpopulations. This study explored disparities in childhood/adolescent COVID-19 vaccination, parental intent to vaccinate their children and adolescents, and reasons for non-vaccination in the US.

METHODS

Using the U.S. Census Bureau's Household Pulse Survey (HPS), we analyzed households with children aged <18 years using data collected from September 14 to November 14, 2022 (n = 44,929). Child and adolescent COVID-19 vaccination coverage (≥1 dose, completed primary series, and booster vaccination) and parental intentions toward vaccination were assessed by sociodemographic characteristics. Factors associated with child and adolescent vaccination coverage were examined using multivariable regression models. Reasons for non-vaccination were assessed overall, by the child's age group and respondent's age group.

RESULTS

Overall, approximately half (50.1%) of children aged < 18 years were vaccinated against COVID-19 (≥1 dose). Completed primary series vaccination was 44.2% among all children aged <18 years. By age group, completed primary series was 13.2% among children <5 years, 43.9% among children 5-11 years, and 63.3% among adolescents 12-17 years. Booster vaccination among those who completed the primary series was 39.1% among children 5-11 years and 55.3% among adolescents 12-17 years. Vaccination coverage differed by race/ethnicity, educational attainment, household income, region, parental COVID-19 vaccination status, prior COVID-19 diagnosis, child's age group, and parental age group. Parental reluctance was highest for children aged <5 years (46.8%). Main reasons for non-vaccination among reluctant parents were concerns about side effects (53.3%), lack of trust in COVID-19 vaccines (48.7%), and the belief that children do not need a COVID-19 vaccine (38.8%).

CONCLUSION

Disparities in COVID-19 vaccination coverage among children and adolescents continue to exist. Further efforts are needed to increase COVID-19 primary series and booster vaccination and parental confidence in vaccines.

Lessons from COVID-19 for behavioural and communication interventions to enhance vaccine uptake

The Covid pandemic has yielded new insights into psychological vaccine acceptance factors. This knowledge serves as a basis for behavioral and communication interventions that can increase vaccination readiness for other diseases.

How Likes and Retweets Impacted Our Patients During the COVID-19 Pandemic

The growing dependence on social media for health-related information boomed during the COVID-19 pandemic, posing unprecedented challenges in navigating the vast amounts of information available right at our fingertips. Social media had a major impact on clinical decision-making affecting individuals, communities, and societies at large. In this review, we discuss the role of social media in amplifying information and misinformation as well as factors contributing to its reliance and prevalence. We review how medical providers have been impacted by this changing landscape, useful communication strategies to employ with in-office patient encounters, and how we can be active players in using social media as a tool for health promotion, correcting misinformation, and preparing for future pandemics.

Strategies for Working With Parents With Vaccination Hesitancy

The purpose of this article is to provide an overview of effective strategies for working with parents' vaccination hesitancy or refusal. An overview of historical and current trends in vaccination hesitancy and factors that contribute to and strategies for addressing vaccine hesitancy are discussed. This includes an emphasis on the critical role played by health care providers, as trusted advisors and a primary source of health care information, in encouraging vaccine acceptance. Legal and ethical implications are also considered. Vaccination hesitancy strategies are most effective if they are timely, multifaceted, and collaborative.

"Figuring stuff out myself" - a qualitative study on maternal vaccination in socially and ethnically diverse areas in England

BACKGROUND

Maternal vaccinations against Influenza, Pertussis, and Covid-19 are recommended in the UK, and vaccines against further infections may become available soon. However, many pregnant women, especially in socially and ethnically diverse areas, have low vaccine uptake. Qualitative studies on the reasons and possible solutions are needed that are inclusive of disadvantaged and minority ethnic groups. We therefore aimed to understand the complex interplay between structural and behavioural factors contributing to the low maternal vaccine uptake in socially and ethnically diverse areas in London in the Covid-19 context.

METHODS

In 2022, we conducted semi-structured interviews and a focus group discussion among a purposive sample of 38 pregnant/recently pregnant women and 20 health service providers, including 12 midwives. Participants were recruited in ethnically diverse London boroughs. We followed a critical realist paradigm and used a thematic analysis approach.

RESULTS

The sample included participants who took all, some or none of the maternal vaccines, with some participants unsure whether they had taken or been offered the vaccines. Decision-making was passive or active, with the expectation for pregnant women to do their 'own research'. Participants described various individual, social and contextual influences on their decision-making as they navigated the antenatal care system. Missing or conflicting information from providers meant knowledge gaps were sometimes filled with misinformation from unreliable sources that increased uncertainties and mistrust. Both pregnant women and providers described structural and organisational factors that hindered access to information and vaccinations, including lack of training, time and resources, and shortcomings of health information systems and apps. Some participants described factors that facilitated vaccination uptake and many made recommendations for improvements.

CONCLUSIONS

Our study showed how structural and organisational factors can compound uncertainties around maternal vaccination among socially and ethnically diverse populations. Results highlight the need for more reliable resources, streamlined workflows, improved electronic information systems and training in their use. Roles and responsibilities should be clarified with potential greater involvement of nurses and pharmacists in vaccine provision. Education and communication should consider individual (language/digital) skills and needs for information and reassurance. Further research is needed to co-produce solutions with service users and providers.

Psychological profiles of anti-vaccination argument endorsement

The proliferation of anti-vaccination arguments online can threaten immunisation programmes, including those targeting COVID-19. To effectively refute misinformed views about vaccination, communicators need to go beyond providing correct information and debunking of misconceptions, and must consider the underlying motivations of people who hold contrarian views. Drawing on a taxonomy of anti-vaccination arguments that identified 11 "attitude roots"-i.e., psychological attributes-that motivate an individual's vaccine-hesitant attitude, we assessed whether these attitude roots were identifiable in argument endorsements and responses to psychological construct measures corresponding to the presumed attitude roots. In two UK samples (total n = 1250), we found that participants exhibited monological belief patterns in their highly correlated endorsements of anti-vaccination arguments drawn from different attitude roots, and that psychological constructs representing the attitude roots significantly predicted argument endorsement strength and vaccine hesitancy. We identified four different latent anti-vaccination profiles amongst our participants' responses. We conclude that endorsement of anti-vaccination arguments meaningfully dovetails with attitude roots clustering around anti-scientific beliefs and partisan ideologies, but that the balance between those attitudes differs considerably between people. Communicators must be aware of those individual differences.

A Descriptive Study of Maternal Vaccination Uptake, Attitudes, and Beliefs in Pregnancy Among Persons Delivering at an Urban Safety Net Hospital

Objective

To estimate uptake of influenza, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap), and COVID-19 vaccines during pregnancy and describe vaccine attitudes and beliefs among predominantly racial and ethnic minority individuals delivering at a publicly funded hospital.

Methods

We collected survey and electronic medical record data for English-speaking postpartum individuals who delivered a live-born infant from July 7, 2022, through August 21, 2022, and agreed to participate in our study. The 58-item survey included questions about general vaccine attitudes and beliefs as well as vaccine-specific questions. We calculated rates of influenza, Tdap, and COVID-19 vaccinations and compared distributions of survey responses by number (no vaccines, one vaccine, or two or three of the recommended vaccines) and type of vaccines received during pregnancy.

Results

Of the 231 eligible individuals, 125 (54.1%) agreed to participate. Rates of influenza, Tdap, and COVID-19 vaccination were 18.4%, 48.0%, and 5.6% respectively. A total of 61 (48.8%) did not receive any recommended vaccines during pregnancy, 40 (32.0%) received one vaccine, and 24 (19.0%) received two or three vaccines. Approximately 66.1% of the no vaccine group, 81.6% of the one vaccine group, and 87.5% of the two or three vaccine group strongly agreed or agreed that they trusted the vaccine information provided by their obstetrician or midwife. While most (>69.2%) agreed that the vaccine-preventable diseases were dangerous for pregnant women, only 24.0%, 29.3%, and 40.3% agreed that they were worried about getting influenza, whooping cough, or COVID-19, respectively, while pregnant.

Discussion

Vaccine uptake in our population was low and may be due, in part, to low perceived susceptibility to vaccine-preventable diseases. Obstetricians and midwives were trusted sources of vaccine information, suggesting that enhanced communication strategies could be critical for addressing maternal vaccine hesitancy, particularly in communities of color justifiably affected by medical mistrust.

The role of emergency physicians in the fight against health misinformation: Implications for resident training

Emergency physicians on the frontlines of the COVID-19 pandemic are first-hand witnesses to the direct impact of health misinformation and disinformation on individual patients, communities, and public health at large. Therefore, emergency physicians naturally have a crucial role to play to steward factual information and combat health misinformation. Unfortunately, most physicians lack the communications and social media training needed to address health misinformation with patients and online, highlighting an obvious gap in emergency medicine training. We convened an expert panel of academic emergency physicians who have taught and conducted research about health misinformation at the Society for Academic Emergency Medicine (SAEM) Annual Meeting in New Orleans, LA, on May 13, 2022. The panelists represented geographically diverse institutions including Baystate Medical Center/Tufts University, Boston Medical Center, Northwestern University, Rush Medical College, and Stanford University. In this article, we describe the scope and impact of health misinformation, introduce methods for addressing misinformation in the clinical environment and online, acknowledge the challenges of tackling misinformation from our physician colleagues, demonstrate strategies for debunking and prebunking, and highlight implications for education and training in emergency medicine. Finally, we discuss several actionable interventions that define the role of the emergency physician in the management of health misinformation.

"I Want People to Be Able to Make an Informed Choice": How Quebec naturopaths discuss vaccination in their practice

Health care providers' recommendations can play an important role in individuals' vaccination decisions. Despite being one of the most popular complementary and alternative medicine (CAM), naturopathy is understudied in relation to vaccination decisions. We sought to address this gap through this study of vaccination perspectives of naturopathy practitioners in the province of Quebec, Canada. We conducted in-depth interviews with 30 naturopaths. Thematic analysis was conducted. Main themes were developed deductively (i.e., based on prior literature) and expanded through inductive coding of the data. Participants noted that they discuss vaccination in their practice, but only when clients asked questions or wanted advice. Naturopaths described refraining from explicitly recommending for or against vaccination. Instead, they focus on empowering their clients to make their own informed decision regarding vaccination. Most participants noted that they direct clients towards sources of information so that clients could decide for themselves, but some mentioned they discussed with clients what they considered to be risks associated with vaccination, as well as its benefits. These discussions were framed through a personalized and individual approach with clients.

Understanding barriers to vaccination against invasive meningococcal disease: a survey of the knowledge gap and potential solutions

INTRODUCTION

Invasive meningococcal disease (IMD) is a leading cause of life-threatening bacterial meningitis and septicemia. Evidence points to a knowledge gap among parents, teenagers, and healthcare providers (HCPs) regarding IMD and available vaccines, including those against the highly prevalent serogroup B.

AREAS COVERED

An online survey was conducted between March 27 and April 12, 2019, to gather insights into the knowledge that parents/guardians have about IMD vaccines. The children were aged 2 months-10 years in Australia, Brazil, Germany, Greece, Italy, and Spain, 5-20 years in the UK, and 16-23 years in the US. The findings were discussed in the context of the available literature and solutions were proposed to minimize the knowledge gap and the barriers to vaccination against IMD.

EXPERT OPINION

The survey demonstrated that parents have a good understanding of IMD but a limited understanding of the different serogroups and vaccines. The available literature highlighted multiple barriers to IMD vaccine uptake; these may be reduced through education of HCPs, clear recommendations to parents by HCPs, the use of technology, and disease-awareness initiatives that engage parents through physical and digital channels. Further studies are warranted to assess the impact of the COVID-19 pandemic on IMD vaccination.

Addressing Vaccine Hesitancy Among Students and Families: Interventions for School Nurses

Vaccine hesitance is a public health issue that school nurses often address in practice. It has become even more prevalent during the coronavirus disease 2019 (COVID-19) pandemic. Vaccine compliance among schoolchildren is essential to the health of an entire community, given that many pediatric illnesses are vaccine-preventable. School nurses are involved in the promotion of vaccines in a school district, as they provide health education to students and families and are responsible for vaccine surveillance. Promoting vaccine compliance as a matter of public health can be challenging for school nurses, especially if a community holds strong beliefs regarding the necessity of pediatric vaccines. This article reviews the history of vaccine mandates, addresses challenges associated with vaccine compliance, and provides interventions school nurses can use when providing care to students and families regarding vaccine hesitancy. In following the nursing process, a school nurse is able to identify students missing vaccine(s) and evaluate for hesitancy, before implementing interventions that provide education to students and families. Several cost-efficient and accessible interventions can facilitate effective education and promote vaccine compliance. School nurses can forge trusting relationships and engage in compassionate dialogue to support vaccine compliance in the school.

Drivers of COVID-19 Vaccine Intent Among Survivors of Adolescent and Young Adult Cancer: a Mixed Method Study

BACKGROUND

Survivors of adolescent and young adult (AYA) cancer are susceptible to severe COVID-19 outcomes due to their cancer history. Drivers of COVID-19 vaccine hesitancy and willingness are largely unexplored among AYA cancer survivors.

METHODS

We surveyed survivors of AYA cancer from October 2020-February 2021 who received services through an AYA cancer care program. Survey measures included vaccine hesitancy on a five-point Likert scale and an open-ended question on vaccine intent. Open-ended responses were content analyzed through two cycles of structured coding. Quantitative vaccine intent and qualitative drivers of intent were integrated during data analysis.

RESULTS

Of participants who responded to the open-ended vaccine intent question (N = 300), 39.0% reported COVID-19 vaccine hesitancy. Qualitative content analysis resulted in N = 517 codes and seven content categories. The most common content category associated with hesitancy included COVID-19 vaccine development, approval, and efficacy (34.5%; p value ≤ 0.001), as well as content areas including presence of misinformation about COVID-19 in the response (4.8%; p value = 0.04), the desire for more information about COVID-19/COVID-19 vaccine (6.0%; p value ≤ 0.001), and reference to political influence on participants' intent to get the vaccine (2.5%; p value = 0.005). The most common category associated with vaccine willingness was personal perceptions of COVID-19 vaccination including protecting oneself and others (36.6% of codes; p value ≤ 0.001), followed by pro-vaccine beliefs (8.3%; p value ≤ 0.001) and trust in science (3.9%; p value ≤ 0.001).

CONCLUSIONS

Common drivers of COVID-19 vaccine hesitancy among survivors of AYA cancer include concern about vaccine side effects and approval process, and misinformation. Cancer survivors COVID-19 vaccine uptake could be improved by focusing communication on drivers of willingness, motivational interviewing, and physician recommendations.

Clinician Communication to Address Vaccine Hesitancy

There are several factors that influence childhood vaccine uptake. Pediatric clinicians play a particularly influential role in parent vaccine decision-making. It is critical therefore that pediatric clinicians have a "communication toolbox"--a set of effective, evidence-based communication strategies to facilitate uptake of childhood vaccines--that they can use in conversations with parents about vaccines. In this article, recent advances in our understanding of what constitutes effective clinician vaccine communication with parents are discussed.

The Good Talk! A Serious Game to Boost People's Competence to Have Open Conversations About COVID-19: Protocol for a Randomized Controlled Trial

BACKGROUND

Vaccine hesitancy is one of the many factors impeding efforts to control the COVID-19 pandemic. Exacerbated by the COVID-19 infodemic, misinformation has undermined public trust in vaccination, led to greater polarization, and resulted in a high social cost where close social relationships have experienced conflict or disagreements about the public health response.

OBJECTIVE

The purpose of this paper is to describe the theory behind the development of a digital behavioral science intervention-The Good Talk!-designed to target vaccine-hesitant individuals through their close contacts (eg, family, friends, and colleagues) and to describe the methodology of a research study to evaluate its efficacy.

METHODS

The Good Talk! uses an educational serious game approach to boost the skills and competences of vaccine advocates to have open conversations about COVID-19 with their close contacts who are vaccine hesitant. The game teaches vaccine advocates evidence-based open conversation skills to help them speak with individuals who have opposing points of view or who may ascribe to nonscientifically supported beliefs while retaining trust, identifying common ground, and fostering acceptance and respect of divergent views. The game is currently under development and will be available on the web, free to access for participants worldwide, and accompanied by a promotional campaign to recruit participants through social media channels. This protocol describes the methodology for a randomized controlled trial that will compare participants who play The Good Talk! game with a control group that plays the widely known noneducational game Tetris. The study will evaluate a participant's open conversation skills, self-efficacy, and behavioral intentions to have an open conversation with a vaccine-hesitant individual both before and after game play.

RESULTS

Recruitment will commence in early 2023 and will cease once 450 participants complete the study (225 per group). The primary outcome is improvement in open conversation skills. Secondary outcomes are self-efficacy and behavioral intentions to have an open conversation with a vaccine-hesitant individual. Exploratory analyses will examine the effect of the game on implementation intentions as well as potential covariates or subgroup differences based on sociodemographic information or previous experiences with COVID-19 vaccination conversations.

CONCLUSIONS

The outcome of the project is to promote more open conversations regarding COVID-19 vaccination. We hope that our approach will encourage more governments and public health experts to engage in their mission to reach their citizens directly with digital health solutions and to consider such interventions as an important tool in infodemic management.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/40753.

Willingness to vaccinate children against COVID-19 declined during the pandemic

OBJECTIVES

To document the level of vaccine hesitancy in caregivers' of children younger than 12 years of age over the course of the pandemic in Pediatric Emergency Departments (ED). Study design Ongoing multicenter, cross-sectional survey of caregivers presenting to 19 pediatric EDs in the USA, Canada, Israel, and Switzerland during first months of the pandemic (phase1), when vaccines were approved for adults (phase2) and most recently when vaccines were approved for children (phase3).

RESULTS

Willingness to vaccinate rate declined over the study period (59.7%, 56.1% and 52.1% in the three phases). Caregivers who are fully vaccinated, who have higher education, and those worried their child had COVID-19 upon arrival to the ED, were more likely to plan to vaccinate in all three phases. Mothers were less likely to vaccinate early in the pandemic, but this hesitancy attenuated in later phases. Older caregivers were more willing to vaccinate, and caregivers of older children were less likely to vaccinate their children in phase 3. During the last phase, willingness to vaccinate was lowest in those who had a primary care provider but did not rely on their advice for medical decisions (34%). Those with no primary care provider and those who do and rely on their medical advice, had similar rates of willingness to vaccinate (55.1% and 52.1%, respectively).

CONCLUSIONS

COVID-19 vaccine hesitancy is widespread and growing over time, and public health measures should further try to leverage identified factors associated with hesitancy in order to enhance vaccination rates among children.

COVID-19 vaccine compliance in adolescents with attention-deficit/hyperactivity disorder

OBJECTIVE

To compare the rate of the administration of the Pfizer-BioNTech COVID-19 vaccinations between adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) and non-ADHD subjects.

METHOD

A retrospective chart review was performed on all adolescents aged 12-17 years registered at a central district in Israel from January 1st 2021 to October 31st 2021.

RESULTS

Of the 46,544 subjects included in the study, 8241 (17.7%) were diagnosed with ADHD. Of them, 3% were PCR-COVID-19 positive. Among the patients with ADHD, the older adolescents were more likely to be vaccinated: 48.8% of those aged 12-15 years were vaccinated versus 59.6% of patients aged 16-17 years. The ultra-orthodox Jewish and Arab adolescents in the ADHD group were far less likely to be vaccinated (22.9% and 34.6%, respectively), compared to the adolescents with ADHD in the general population (60.5%). Girls were also somewhat more likely to be vaccinated.

CONCLUSIONS

Adolescents diagnosed with ADHD had a higher COVID-19 vaccination rate compared to their non-ADHD counterparts. The vaccine uptake was lower amongst Arab and ultra-orthodox Jewish populations.

Parental Decision Making Regarding COVID-19 Vaccines for Children under Age 5: Does Decision Self-Efficacy Play a Role?

BACKGROUND

COVID-19 vaccines are now available under Emergency Use Authorization for children ages 6 months to 5 years. We examined parents' intentions to vaccinate their children under the age of 5 years and assessed whether their confidence in making an informed decision about vaccination (decision self-efficacy) was associated with these intentions.

METHOD

We conducted a cross-sectional online survey of U.S. parents between 23 March and 5 April 2022. We examined associations between parental intention to vaccinate their young children (

RESULTS

Of the 591 parents in this sample, 49% indicated that they intended to vaccinate their child(ren), 29% reported that they would not, and 21% were undecided. In bivariate analyses, race/ethnicity, health insurance, flu vaccination in the past 12 months, and parental COVID-19 vaccination status were significantly related to parental intention to vaccinate their child(ren). In the multivariable analyses, which controlled for these factors, parents who intended to vaccinate their child(ren) had greater confidence in their ability to make informed decisions about COVID-19 vaccinations compared to those who were unsure about vaccination. Each one standard deviation in the Decision Self-Efficacy score was associated with a 39% increase in intention to vaccinate one's child versus being unsure about vaccination (AOR 1.39, 95% CI 1.09, 1.77).

CONCLUSIONS

Parents who are unsure about vaccinating their children against COVID-19 may benefit from interventions designed to increase their ability to obtain, understand, and utilize information to make informed decisions.

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Key Words

• SARS-CoV-2 (COVID-19)
• decision self-efficacy
• health behaviors
• parents
• vaccination
• vaccine confidence

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MESH Headings Collapse

Grants

• U54MD007601 NIH HHS
• U54 MD007601 NIMHD NIH HHS

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Affiliation(s)

Jennifer D. Allen Department of Community Health, Tufts University School of Arts and Sciences, 574 Boston Ave, Medford, MA 02155, USA
Masako Matsunaga Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA
Eunjung Lim Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA
Gregory D. Zimet Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, Suite 1001, Indianapolis, IN 46202, USA
Kimberly H. Nguyen Department of Public Health and Community Medicine, Tufts University Medical School, 136 Harrison Ave, Boston, MA 02111, USA
Holly B. Fontenot Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, 2528 McCarthy Mall, Webster Hall, Honolulu, HI 96822, USA

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What impact does the attitude toward COVID-19 vaccination have on physicians as vaccine providers? A cross sectional study from the German outpatient sector

BACKGROUND

COVID-19 vaccination is recognized as a key component in addressing the COVID-19 pandemic. Physicians' attitudes toward vaccination are known to play a defining role in the management and dissemination of medical advice to patients. In Germany, outpatient practitioners are predominantly responsible for the dissemination of vaccines.

METHOD

Using a cross-sectional online survey, 932 outpatient general practitioners, gynecologists, and pediatricians in Germany were asked in fall, 2021, about their attitude toward COVID-19 vaccination and - among others - their communication in vaccine discussions, their assessment of vaccine safety, and reporting of suspected adverse events. Physicians were divided into two groups along their attitudes toward COVID-19 vaccination. In addition, multivariate linear regression models were constructed to assess differences in communication strategies.

RESULTS

92 % of physicians had a positive or very positive attitude toward COVID-19 vaccination. Own vaccination status, practice-based vaccination delivery, and estimated vaccination coverage among patients were significantly associated with the attitude toward vaccination. Confidence in vaccine safety was significantly lower among physicians with negative attitudes. There were no differences between the two groups in self-assessment of the ability to detect suspected adverse events, but there were differences in the observing and reporting of adverse events. For the linear regression models, we found that a more negative attitude toward COVID-19 vaccination was significantly associated with increased acceptance of patient refusal of COVID-19 vaccination and empathic behavior for patient concerns. In contrast, willingness to engage in a detailed persuasion consultation was significantly lower. Pediatricians showed significantly higher empathy for patient-side concerns compared to general practitioners, whereas gynecologists showed less empathy than general practitioners.

DISCUSSION

The physician's attitude toward COVID-19 vaccination influences the physician's practices as a vaccine provider. However, when providing medical advice and healthcare, the physician should focus on the actual needs of the patient.

Misinformation, infighting, backlash, and an 'endless' recovery; policymakers recount challenges and mitigating measures after a vaccine scare in the Philippines

Background

Vaccine scares undermine longstanding global health achievements. Remarkably little data has documented the lived experiences of policymakers working amidst vaccine scares and navigating their fallout. As a result, chances and challenges of large-scale national recuperation efforts are poorly understood.

Objective

This study aims to explore the perspectives of policymakers involved in ongoing efforts to boost vaccine confidence in the Philippines following a 2017 Dengvaxia scare and the current COVID-19 pandemic.

Methods

Between August and November 2020, we conducted 19 semi-structured narrative interviews with purposively selected policymakers from governmental agencies and non-governmental organizations in the Philippines. Interviews were conducted online, transcribed, and analyzed following the tenets of reflexive thematic analysis.

Results

We present results as an emerging model that draws on a chronology conveyed by policymakers in their own words. The Dengvaxia scare proved ‘a decisive wedge’ that splintered Filipino society and pitted governmental agencies against one another. The scare stoked distorted vaccination narratives, which were ‘accelerated rapidly’ via social media, and ignited feelings of uncertainty among policymakers of how to convey clear, accurate health messaging and how to prevent drops in care-seeking more broadly.

Conclusions

Efforts to regain trust placed exceptional burdens on an already-strained health system. Respondent-driven recommendations on how to reinforce vaccine confidence and improve vaccination rollout include: developing clear vaccine messages, fostering healthcare providers’ and policymakers’ communication skills, and rebuilding trust within, toward and across governmental agencies. Further research on how to build enabling environments and rebuild trust in and across institutions remains paramount.

Protecting pregnant people & infants against influenza: A landscape review of influenza vaccine hesitancy during pregnancy and strategies for vaccine promotion

Before COVID-19, influenza vaccines were the most widely recommended vaccine during pregnancy worldwide. In response to immunization during pregnancy, maternal antibodies offer protection against potentially life-threatening disease in both pregnant people and their infants up to six months of age. Despite this, influenza vaccine hesitancy is common, with few countries reporting immunization rates in pregnant people above 50%. In this review, we highlight individual, institutional, and social factors associated with influenza vaccine hesitancy during pregnancy. In addition, we present an overview of the evidence evaluating interventions to address influenza vaccine hesitancy during pregnancy. While some studies have indicated promising results, no single intervention has consistently effectively increased influenza vaccine uptake during pregnancy. Using a social-ecological model of health framework, future strategies addressing multiple levels of vaccine hesitancy will be needed to realize the potential health benefits of prenatal immunization programs.

Assessment of training of general practice interns in motivational interviews about vaccination

The effectiveness of motivational interviewing (MI) for reducing vaccine hesitancy (VH) has been demonstrated in Quebec. We conducted a study to evaluate the acquisition of MI skills after MI training via videoconferencing for interns training as general practitioners (GPs) in southeastern France. A vaccination-specific MI training workshop was offered to interns in 2021, consisting of two separate Zoom videoconference sessions. Participants completed the Motivational Interviewing Skills in Immunization questionnaire before and after the training to measure skills acquisition. We used pairwise exact Wilcoxon-Pratt signed rank tests for the analysis. Among 45 GP interns enrolled in the first MI session, 34 (75.6%) attended both sessions and completed the questionnaire at 3 different time points. After the first session, MI knowledge scores improved significantly (+21.1 ± 21.6; P < .0001), as did application of MI skills (+36.8 ± 36.7; P < .0001), and MI practice confidence (+21.2 ± 11.1; P < .0001). The second MI session maintained the skills developed after the first session without further improvement. Participant satisfaction was high. This is the first study in France assessing the impact of a vaccination-specific MI training for GP interns. It shows a substantial improvement in knowledge, application of MI skills, and self-confidence in the practice of MI. GP interns were highly satisfied with the training despite the videoconference format. These promising results will allow the integration of MI training in GP medical curricula in order to prepare future GPs for communication in the field of vaccination.

"I don't think there's a point for me to discuss it with my patients": exploring health care providers' views and behaviours regarding COVID-19 vaccination

BACKGROUND

Health care providers' knowledge and attitudes about vaccines are important determinants of their own vaccine uptake, their intention to recommend vaccines, and their patients' vaccine uptake. This qualitative study' objective was to better understand health care providers' vaccination decisions, their views on barriers to COVID-19 vaccine acceptance and proposed solutions, their opinions on vaccine policies, and their perceived role in discussing COVID-19 vaccination with patients.

METHODS

Semi-structured interviews on perceptions of COVID-19 vaccines were conducted with Canadian health care providers (N = 14) in spring 2021. A qualitative thematic analysis using NVivo was conducted.

RESULTS

Participants had positive attitudes toward vaccination and were vaccinated against COVID-19 or intended to do so once eligible (two delayed their first dose). Only two were actively promoting COVID-19 vaccination to their patients; others either avoided discussing the topic or only provided answers when asked questions. Participants' proposed solutions to enhance COVID-19 vaccine uptake in the public were in relation to access to vaccination services, information in multiple languages, and community outreach. Most participants were in favor of mandatory vaccination policies and had mixed views on the potential impact of the Canadian vaccine-injury support program.

CONCLUSIONS

While health care providers are recognized as a key source of information regarding vaccines, participants in our study did not consider it their role to provide advice on COVID-19 vaccination. This is a missed opportunity that could be avoided by ensuring health care providers have the tools and training to feel confident in engaging in vaccine discussions with their patients.

Understanding Influenza and SARS-CoV-2 Vaccine Hesitancy in Racial and Ethnic Minority Caregivers

(1) Background: We compared influenza and SARS-CoV-2 vaccine hesitancy levels in Black, Hispanic, and White parents/caregivers and identified barriers and facilitators to vaccine acceptance. (2) Methods: This was a mixed methods study. A cross-sectional survey of ED caregivers presenting with children 6mo−18yo compared vaccine hesitancy levels among diverse caregivers. Six focus groups of survey participants, stratified by caregiver race/ethnicity and caregiver intent to receive SARS-CoV-2 vaccine, assessed facilitators and barriers of vaccination, with thematic coding using the Consolidated Framework for Implementation Research (CFIR). (3) Results: Surveys (n = 589) revealed Black caregivers had significantly higher vaccine hesitancy rates than White caregivers for pediatric influenza (42% versus 21%) and SARS-CoV-2 (63% versus 36%; both p < 0.05). Hispanic caregivers were more hesitant than White caregivers (37% flu and 58% SARS-CoV-2), but this was not significant. Qualitative analysis (n = 23 caregivers) identified barriers including vaccine side effects, lack of necessity, inadequate data/science, and distrust. Facilitators included vaccine convenience, fear of illness, and desire to protect others. (4) Conclusions: Minority caregivers reported higher levels of vaccine hesitancy for influenza and SARS-CoV-2. We identified vaccine facilitators and barriers inclusive of Black and Hispanic caregivers, which may guide interventions designed to equitably improve acceptance of pediatric vaccines.