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Gagneur A, Gutnick D, Berthiaume P, Diana A, Rollnick S, Saha P. From vaccine hesitancy to vaccine motivation: A motivational interviewing based approach to vaccine counselling. Hum Vaccin Immunother 2024; 20:2391625. [PMID: 39187772 DOI: 10.1080/21645515.2024.2391625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/30/2024] [Accepted: 08/09/2024] [Indexed: 08/28/2024] Open
Abstract
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.
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Affiliation(s)
- Arnaud Gagneur
- Department of Pediatrics, Université de Sherbrooke, Quebec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Quebec, Canada
| | - Damara Gutnick
- Department of Epidemiology & Population Health, The Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Alessandro Diana
- IUMFE - Institute of Primary care Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Paediatric Center, Grangettes Hirslanden Clinic, Geneva, Switzerland
| | | | - Prantik Saha
- Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY, USA
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Charmasson A, Ecollan M, Jaury P, Partouche H, Frachon A, Pinot J. Perceived impact of discussions with a healthcare professional on patients' decision regarding COVID-19 vaccine. Hum Vaccin Immunother 2024; 20:2307735. [PMID: 38346925 PMCID: PMC10863372 DOI: 10.1080/21645515.2024.2307735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/17/2024] [Indexed: 02/15/2024] Open
Abstract
There is evidence that advice from Healthcare Professionals (HCPs) plays an important role in patients' decision to get vaccinated, but the extent to which patients perceive this impact is unclear. The aim of this study was to assess the perceived impact of a discussion with a HCP on participants' decision to be vaccinated against COVID-19. A cross-sectional survey was conducted among adults who consulted a general practitioner (GP) or a pharmacist in Ile-de-France, France, after COVID-19 vaccines became available (October-November 2021 period). A total of 344 participants were included, 65.2% of whom reported having had a discussion about COVID-19 vaccines with a HCP. Overall, 55% of participants were advised to be vaccinated by their HCP. Most of the discussions took place with a GP (n = 203, 48.9%). According to 52.5% of participants, the discussion had a positive impact, i.e. it was perceived as encouraging vaccination. The latter reported that, among HCPs, GPs had the greatest number of discussions with a positive impact on the decision to be vaccinated against COVID-19 (93.1%). In the study population, the COVID-19 vaccine hesitancy rate, according to the WHO definition, was high (38.1%), although the COVID-19 vaccine coverage rate was 87.1%. Vaccine hesitant participants were more likely to report a discussion that had a perceived negative impact on their decision to get vaccinated (20.0%) than non-hesitant participants (5.8%, p = .004).
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Affiliation(s)
- Alric Charmasson
- Department of General Practice, Université Paris Cité, Paris, France
| | - Marie Ecollan
- Department of General Practice, Université Paris Cité, Paris, France
| | - Philippe Jaury
- Department of General Practice, Université Paris Cité, Paris, France
| | - Henri Partouche
- Department of General Practice, Université Paris Cité, Paris, France
| | - Adèle Frachon
- Department of General Practice, Université Paris Cité, Paris, France
| | - Juliette Pinot
- Department of General Practice, Université Paris Cité, Paris, France
- INSERM, IAME, Université Paris Cité and Université Sorbonne Paris Nord, Paris, France
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Chen AMH, Anthony A, Balogun A, Pereira R, Cole JW. The Impact of Motivational Interviewing and MOTIVE Tool Use by Pharmacists on Vaccine Acceptance. PHARMACY 2024; 12:114. [PMID: 39195843 PMCID: PMC11360627 DOI: 10.3390/pharmacy12040114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/01/2024] [Accepted: 07/17/2024] [Indexed: 08/29/2024] Open
Abstract
Vaccines have played a significant role in reducing infectious disease burden. However, vaccine hesitancy remains a persistent challenge in public health, including for pharmacists who often interact with patients regarding vaccines. Thus, this study assesses the impact of motivational interviewing (MI) training and the MI-based vaccine hesitancy discussion tools (MOTIVE) on pharmacists' management of vaccine hesitancy. Pharmacists in eight Midwestern pharmacy practices who completed MI and MOTIVE training and engaged with vaccine-hesitant patients participated in this study. The pharmacist participants completed post-encounter surveys identifying the vaccine discussed, the tool utilized, and the outcome of the conversation. Descriptive results from 362 encounters indicated that the primary reasons for hesitancy were safety (39%), care coordination (31.5%), and efficacy (30.4%). Post encounter, 35.4% of patients received vaccines, 26% planned to, 25.1% considered it, and 13.5% were uninterested. The findings highlight the importance of patient-centered communication, such as MI, between patients and pharmacists to identify and address reasons for vaccine hesitancy. Pharmacists, equipped with conversation tools such as the MOTIVE tools, may effectively influence vaccine acceptance. Future research should evaluate the utility of MI and the MOTIVE tools in other settings and regions.
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Affiliation(s)
- Aleda M. H. Chen
- School of Pharmacy, Cedarville University, 251 N. Main St., Cedarville, OH 45314, USA; (A.A.); (A.B.); (R.P.); (J.W.C.)
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Li Y, Lee KC, Bressington D, Liao Q, He M, Law KK, Leung AYM, Molassiotis A, Li M. A Theory and Evidence-Based Artificial Intelligence-Driven Motivational Digital Assistant to Decrease Vaccine Hesitancy: Intervention Development and Validation. Vaccines (Basel) 2024; 12:708. [PMID: 39066346 PMCID: PMC11281439 DOI: 10.3390/vaccines12070708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 06/13/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
Vaccine hesitancy is one of the top ten threats to global health. Artificial intelligence-driven chatbots and motivational interviewing skills show promise in addressing vaccine hesitancy. This study aimed to develop and validate an artificial intelligence-driven motivational digital assistant in decreasing COVID-19 vaccine hesitancy among Hong Kong adults. The intervention development and validation were guided by the Medical Research Council's framework with four major steps: logic model development based on theory and qualitative interviews (n = 15), digital assistant development, expert evaluation (n = 5), and a pilot test (n = 12). The Vaccine Hesitancy Matrix model and qualitative findings guided the development of the intervention logic model and content with five web-based modules. An artificial intelligence-driven chatbot tailored to each module was embedded in the website to motivate vaccination intention using motivational interviewing skills. The content validity index from expert evaluation was 0.85. The pilot test showed significant improvements in vaccine-related health literacy (p = 0.021) and vaccine confidence (p = 0.027). This digital assistant is effective in improving COVID-19 vaccine literacy and confidence through valid educational content and motivational conversations. The intervention is ready for testing in a randomized controlled trial and has high potential to be a useful toolkit for addressing ambivalence and facilitating informed decision making regarding vaccination.
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Affiliation(s)
- Yan Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China; (Y.L.); (K.-C.L.); (M.H.); (K.-K.L.); (A.Y.M.L.)
| | - Kit-Ching Lee
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China; (Y.L.); (K.-C.L.); (M.H.); (K.-K.L.); (A.Y.M.L.)
| | | | - Qiuyan Liao
- School of Public Health, The University of Hong Kong, Hong Kong 999077, China;
| | - Mengting He
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China; (Y.L.); (K.-C.L.); (M.H.); (K.-K.L.); (A.Y.M.L.)
| | - Ka-Kit Law
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China; (Y.L.); (K.-C.L.); (M.H.); (K.-K.L.); (A.Y.M.L.)
| | - Angela Y. M. Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China; (Y.L.); (K.-C.L.); (M.H.); (K.-K.L.); (A.Y.M.L.)
- Research Institute for Smart Aging (RISA), The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Alex Molassiotis
- College of Arts, Humanities and Education, University of Derby, Derby DE22 1GB, UK;
| | - Mengqi Li
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China; (Y.L.); (K.-C.L.); (M.H.); (K.-K.L.); (A.Y.M.L.)
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Hoffman E, Kahan T, Auerbach E, Brody H, Abramson NN, Haiken S, Shields D, Elyasi A, Ifrah S, Frenkel-Schick A, Zyskind I, Knoll M, Carmody E. Peer education as a strategy to promote vaccine acceptance: A randomized controlled trial within New York community healthcare practices. Vaccine 2024:S0264-410X(24)00654-6. [PMID: 38862308 DOI: 10.1016/j.vaccine.2024.05.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Effective strategies are needed to improve vaccine acceptance. This study sought to determine if a peer-led vaccine education intervention embedded within community medical practices increases parental acceptance of pediatric pneumococcal conjugate vaccination. METHODS From March 2022-July 2023, we conducted a randomized trial at three pediatric health practices in predominantly Hasidic Jewish neighborhoods in New York, where vaccine deferral is common. Parents of children up to 18 months due/overdue for routine pneumococcal vaccination were randomized (1:1) to receive routine care alone or routine care plus a peer educational intervention. Peer educators trained in motivational interviewing and vaccine science provided counseling at enrollment and follow-up telephone engagement in the intervention arm at day 30 and 60. Primary outcome was child's pneumococcal immunization status by allocation arm expressed as at least one dose received between enrollment and 90 days post-enrollment. RESULTS 144 parent-child dyads were eligible for outcome analysis. Participants in the group receiving routine care along with peer-led vaccine counseling were significantly more likely to have their child receive at least 1 vaccine dose between enrollment and 90 days compared to the group who received routine care alone (28.4 % vs 12.9 %, risk ratio [RR] 2.21, confidence interval [CI] 1.09-4.49, p = 0.022). The effect of peer education was greatest in dyads with children less than 1 year old at enrollment (34 % vs 12.7 %, RR 2.67, CI (1.22-5.86), p = 0.009). CONCLUSIONS Peer vaccine education can increase vaccine acceptance compared to routine care alone and may be particularly valuable in decreasing vaccination delays for younger infants. (Funded by EGL Charitable Foundation, ClinicalTrials.gov NCT05875779).
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Affiliation(s)
- Emily Hoffman
- Department of Medicine, Division of Infectious Diseases at NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
| | - Tamara Kahan
- NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA; Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Esther Auerbach
- Jewish Orthodox Women's Medical Association, 350 Roselle Avenue, Cedarhurst, NY 11516, USA
| | - Heidi Brody
- Jewish Orthodox Women's Medical Association, 350 Roselle Avenue, Cedarhurst, NY 11516, USA
| | - Natalie Nesha Abramson
- Jewish Orthodox Women's Medical Association, 350 Roselle Avenue, Cedarhurst, NY 11516, USA
| | - Sarah Haiken
- NYU Langone Vaccine Center, 660 First Avenue 5(th) floor, New York, NY 10016, USA; The Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Kalman Ya'akov Man Street, Jerusalem, Israel
| | - Danielle Shields
- NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Ailin Elyasi
- Renaissance School of Medicine, Stony Brook University, 101 Nicolls Road, Stony Brook, NY 11794, USA
| | - Sheindel Ifrah
- Jewish Orthodox Women's Medical Association, 350 Roselle Avenue, Cedarhurst, NY 11516, USA; Touro College of Osteopathic Medicine, 230 West 125(th) Street, 3(rd) floor, New York, NY 10027, USA
| | | | - Israel Zyskind
- Department of Pediatrics at NYU Grossman School of Medicine, 145 East 32nd Street, 14th floor, New York, NY 10016, USA
| | - Miriam Knoll
- Jewish Orthodox Women's Medical Association, 350 Roselle Avenue, Cedarhurst, NY 11516, USA
| | - Ellie Carmody
- Department of Medicine, Division of Infectious Diseases at NYU Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
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Gichuki J, Ngoye B, Wafula F. "I'll take them another day": A qualitative study exploring the socio-behavioral complexities of childhood vaccination in urban poor settlements. PLoS One 2024; 19:e0303215. [PMID: 38739597 PMCID: PMC11090334 DOI: 10.1371/journal.pone.0303215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 04/21/2024] [Indexed: 05/16/2024] Open
Abstract
Despite improvement over recent decades, childhood vaccination uptake remains a concern across countries. The World Health Organization observed that over 25 million children missed out on one or more vaccines in 2021, with urban poor and other marginalized groups being the most affected. Given the higher risk of disease transmission and vaccine-preventable diseases (VPD) outbreaks across densely populated urban slums, identifying effective interventions to improve childhood vaccination in this vulnerable population is crucial. This study explored the behavioral and social factors influencing childhood vaccination uptake in urban informal settlements in Nairobi, Kenya. A grounded theory approach was employed to develop a theoretical account of the socio-behavioral determinants of childhood vaccination. Five focus group discussions (FGDs) were conducted with purposively sampled caregivers of children under five years of age residing in informal settlements. The Theory of Planned Behavior guided the structuring of the FGD questions. An iterative process was used to analyze and identify emerging themes. Thirty-nine caregivers (median age 29 years) participated in the FGDs. From the analysis, four main thematic categories were derived. These included attitude factors such as perceived vaccine benefits, cultural beliefs, and emotional factors including parental love. Additionally, subjective norms, like fear of social judgment, and perceived behavioral control factors, such as self-control and gender-based influences, were identified. Furthermore, a number of practical factors, including the cost of vaccines and healthcare providers attitude, also affected the uptake of vaccination. Various social, behavioral, cultural, and contextual factors influence caregiver vaccination decisions in urban poor settings. Community-derived and context-specific approaches that address the complex interaction between socio-behavioral and other contextual factors need to be tested and applied to improve the timely uptake of childhood vaccinations among marginalized populations.
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Affiliation(s)
- Judy Gichuki
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
| | - Ben Ngoye
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
| | - Francis Wafula
- Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
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7
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Albrecht S, Grässli F, Cusini A, Brucher A, Goppel S, Betschon E, Möller JC, Ortner M, Ruetti M, Stocker R, Vuichard-Gysin D, Besold U, Risch L, Von Kietzell M, Schlegel M, Vernazza P, Kuster SP, Kahlert CR, Kohler P. SARS-CoV-2 immunity and reasons for non-vaccination among healthcare workers from eastern and northern Switzerland: results from a nested multicentre cross-sectional study. Swiss Med Wkly 2024; 154:3734. [PMID: 38689545 DOI: 10.57187/s.3734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
AIMS OF THE STUDY We aimed to assess the extent of SARS-CoV-2 humoral immunity elicited by previous infections and/or vaccination among healthcare workers, and to identify reasons why healthcare workers decided against vaccination. METHODS This nested cross-sectional study included volunteer healthcare workers from 14 healthcare institutions in German-speaking Switzerland. In January 2021, SARS-CoV-2 vaccines were available for healthcare workers. In May and June 2022, participants answered electronic questionnaires regarding baseline characteristics including SARS-CoV-2 vaccination status (with one or more vaccine doses defined as vaccinated) and previous SARS-CoV-2 infections. Unvaccinated participants indicated their reasons for non-vaccination. Participants underwent testing for SARS-CoV-2 anti-spike (anti-S) and anti-nucleocapsid (anti-N) antibodies. Antibody prevalence was described across age groups. In addition, we performed multivariable logistic regression to identify baseline characteristics independently associated with non-vaccination and described reasons for non-vaccination. RESULTS Among 22,438 eligible employees, 3,436 (15%) participated; the median age was 43.7 years (range 16-73), 2,794 (81.3%) were female, and 1,407 (47.7%) identified as nurses; 3,414 (99.4%) underwent serology testing, among whom 3,383 (99.0%) had detectable anti-S (3,357, 98.3%) antibodies, anti-N (2,396, 70.1%) antibodies, or both (2,370, 69.4%). A total of 296 (8.6%) healthcare workers were unvaccinated, whereas 3,140 (91.4%) were vaccinated. In multivariable analysis, age (adjusted OR [aOR] 1.02 per year, 95% CI 1.01-1.03), being a physician (aOR 3.22, 95% CI 1.75-5.92) or administrator (aOR 1.88, 95% CI 1.27-2.80), and having higher education (aOR 2.23, 95% CI 1.09-4.57) were positively associated with vaccine uptake, whereas working in non-acute care (aOR 0.58, 95% CI 0.34-0.97), active smoking (aOR 0.68, 95% CI 0.51-0.91), and taking prophylactic home remedies against SARS-CoV-2 (aOR 0.42, 95% CI 0.31-0.56) were negatively associated. Important reasons for non-vaccination were a belief that the vaccine might not have long-lasting immunity (267/291, 92.1%) and a preference for gaining naturally acquired instead of vaccine-induced immunity (241/289, 83.4%). CONCLUSIONS Almost all healthcare workers in our cohort had specific antibodies against SARS-CoV-2 from natural infection and/or from vaccination. Young healthcare workers and those working in non-acute settings were less likely to be vaccinated, whereas physicians and administrative staff showed higher vaccination uptake. Presumed ineffectiveness of the vaccine is an important reason for non-vaccination.
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Affiliation(s)
- Selina Albrecht
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Fabian Grässli
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Alexia Cusini
- Cantonal Hospital of Grisons, Division of Infectious Diseases, Chur, Switzerland
| | - Angela Brucher
- Psychiatry Services of the Canton of St. Gallen (South), Trübbach, Switzerland
| | - Stephan Goppel
- Psychiatry Services of the Canton of St. Gallen (North), Wil, Switzerland
| | | | - J Carsten Möller
- Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Manuela Ortner
- Rheintal Werdenberg Sarganserland Hospital Group, Grabs, Switzerland
| | - Markus Ruetti
- Fuerstenland Toggenburg Hospital Group, Wil, Switzerland
| | | | - Danielle Vuichard-Gysin
- Thurgau Hospital Group, Division of Infectious Diseases and Hospital Epidemiology, Muensterlingen, Switzerland
- Swiss National Centre for Infection Prevention (Swissnoso), Berne, Switzerland
| | - Ulrike Besold
- Geriatric Clinic St. Gallen, St. Gallen, Switzerland
| | - Lorenz Risch
- Labormedizinisches Zentrum Dr Risch Ostschweiz AG, Buchs, Switzerland
- Private Universität im Fürstentum Liechtenstein, Institut für Labormedizin, Triesen, Liechtenstein
- Center of Laboratory Medicine, University Institute of Clinical Chemistry, University of Berne, Inselspital, Berne, Switzerland
| | | | - Matthias Schlegel
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Pietro Vernazza
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Stefan P Kuster
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Christian R Kahlert
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
- Children's Hospital of Eastern Switzerland, Department of Infectious Diseases and Hospital Epidemiology, St. Gallen, Switzerland
| | - Philipp Kohler
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
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Moriarty KL, Oyenuga RO, Olafuyi O, Schwartz DA. Causes and Effects of COVID-19 Vaccine Hesitancy Among Pregnant Women and its Association with Adverse Maternal, Placental, and Perinatal Outcomes. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2024; 97:73-84. [PMID: 38559465 PMCID: PMC10964823 DOI: 10.59249/lpoq5146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
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.
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Affiliation(s)
- Kristen Lee Moriarty
- Department of Obstetrics & Gynecology, University
of Connecticut School of Medicine, Farmington, CT, USA
| | - Roselyn O. Oyenuga
- Department of Obstetrics & Gynecology, University
of Connecticut School of Medicine, Farmington, CT, USA
| | - Olatoyosi Olafuyi
- Department of Obstetrics & Gynecology, University
of Connecticut School of Medicine, Farmington, CT, USA
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9
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O'Leary ST, Opel DJ, Cataldi JR, Hackell JM. Strategies for Improving Vaccine Communication and Uptake. Pediatrics 2024; 153:e2023065483. [PMID: 38404211 DOI: 10.1542/peds.2023-065483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/27/2024] Open
Abstract
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.
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Affiliation(s)
- Sean T O'Leary
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, Colorado
| | - Douglas J Opel
- Treuman Katz Center for Pediatric Bioethics and Palliative Care, Seattle Children's Research Institute; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Jessica R Cataldi
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, Colorado
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College, Valhalla, New York
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Garrison A, Fressard L, Mitilian E, Gosselin V, Berthiaume P, Casanova L, Gagneur A, Verger P. Motivational interview training improves self-efficacy of GP interns in vaccination consultations: A study using the Pro-VC-Be to measure vaccine confidence determinants. Hum Vaccin Immunother 2023; 19:2163809. [PMID: 36703495 PMCID: PMC10012912 DOI: 10.1080/21645515.2022.2163809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
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.
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Affiliation(s)
- Amanda Garrison
- Faculté des Sciences Médicales et Paramédicales, Observatoire Régional de la Santé (ORS) PACA, Marseille, France
| | - Lisa Fressard
- Faculté des Sciences Médicales et Paramédicales, Observatoire Régional de la Santé (ORS) PACA, Marseille, France
| | - Eva Mitilian
- Faculté des Sciences Médicales et Paramédicales, Observatoire Régional de la Santé (ORS) PACA, Marseille, France.,Faculté des Sciences Médicales et Paramédicales, Département Universitaire de Médecine Générale (DUMG), Aix Marseille Université, Marseille, France
| | - Virginie Gosselin
- Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Ludovic Casanova
- Faculté des Sciences Médicales et Paramédicales, Observatoire Régional de la Santé (ORS) PACA, Marseille, France.,Faculté des Sciences Médicales et Paramédicales, Département Universitaire de Médecine Générale (DUMG), Aix Marseille Université, Marseille, France
| | - Arnaud Gagneur
- Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.,Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Pierre Verger
- Faculté des Sciences Médicales et Paramédicales, Observatoire Régional de la Santé (ORS) PACA, Marseille, France
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11
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Papadakis S, Anastasaki M, Gamaletsou M, Papagiannopoulou X, Aligizakis E, Lionis C. Development of an eLearning intervention for enhancing health professionals' skills for addressing COVID-19 vaccine hesitancy. Front Med (Lausanne) 2023; 10:1290288. [PMID: 38155659 PMCID: PMC10753786 DOI: 10.3389/fmed.2023.1290288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
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.
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12
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Scales D, Hurth L, Xi W, Gorman S, Radhakrishnan M, Windham S, Akunne A, Florman J, Leininger L, Gorman J. Addressing Antivaccine Sentiment on Public Social Media Forums Through Web-Based Conversations Based on Motivational Interviewing Techniques: Observational Study. JMIR INFODEMIOLOGY 2023; 3:e50138. [PMID: 37962940 PMCID: PMC10685291 DOI: 10.2196/50138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/16/2023] [Accepted: 09/30/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Health misinformation shared on social media can have negative health consequences; yet, there is a dearth of field research testing interventions to address health misinformation in real time, digitally, and in situ on social media. OBJECTIVE We describe a field study of a pilot program of "infodemiologists" trained with evidence-informed intervention techniques heavily influenced by principles of motivational interviewing. Here we provide a detailed description of the nature of infodemiologists' interventions on posts sharing misinformation about COVID-19 vaccines, present an initial evaluation framework for such field research, and use available engagement metrics to quantify the impact of these in-group messengers on the web-based threads on which they are intervening. METHODS We monitored Facebook (Meta Platforms, Inc) profiles of news organizations marketing to 3 geographic regions (Newark, New Jersey; Chicago, Illinois; and central Texas). Between December 2020 and April 2021, infodemiologists intervened in 145 Facebook news posts that generated comments containing either false or misleading information about vaccines or overt antivaccine sentiment. Engagement (emojis plus replies) data were collected on Facebook news posts, the initial comment containing misinformation (level 1 comment), and the infodemiologist's reply (level 2 reply comment). A comparison-group evaluation design was used, with numbers of replies, emoji reactions, and engagements for level 1 comments compared with the median metrics of matched comments using the Wilcoxon signed rank test. Level 2 reply comments (intervention) were also benchmarked against the corresponding metric of matched reply comments (control) using the Wilcoxon signed rank test (paired at the level 1 comment level). Infodemiologists' level 2 reply comments (intervention) and matched reply comments (control) were further compared using 3 Poisson regression models. RESULTS In total, 145 interventions were conducted on 132 Facebook news posts. The level 1 comments received a median of 3 replies, 3 reactions, and 7 engagements. The matched comments received a median of 1.5 (median of IQRs 3.75) engagements. Infodemiologists made 322 level 2 reply comments, precipitating 189 emoji reactions and a median of 0.5 (median of IQRs IQR 0) engagements. The matched reply comments received a median of 1 (median of IQRs 2.5) engagement. Compared to matched comments, level 1 comments received more replies, emoji reactions, and engagements. Compared to matched reply comments, level 2 reply comments received fewer and narrower ranges of replies, reactions, and engagements, except for the median comparison for replies. CONCLUSIONS Overall, empathy-first communication strategies based on motivational interviewing garnered less engagement relative to matched controls. One possible explanation is that our interventions quieted contentious, misinformation-laden threads about vaccines on social media. This work reinforces research on accuracy nudges and cyberbullying interventions that also reduce engagement. More research leveraging field studies of real-time interventions is needed, yet data transparency by technology platforms will be essential to facilitate such experiments.
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Affiliation(s)
- David Scales
- Weill Cornell Medicine, New York City, NY, United States
- Critica, Bronx, NY, United States
| | | | - Wenna Xi
- Weill Cornell Medicine, New York City, NY, United States
| | | | | | | | | | | | - Lindsey Leininger
- Tuck School of Business, Dartmouth College, Hannover, NH, United States
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13
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Sobierajski T, Rzymski P, Małecka I, Augustynowicz E. Trust in Physicians in the Context of HPV Vaccination of Children from the Perspective of Social Exchange Theory: A Representative Study of Polish Parents. Vaccines (Basel) 2023; 11:1618. [PMID: 37897019 PMCID: PMC10611301 DOI: 10.3390/vaccines11101618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/04/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
The vaccination of children against human papillomavirus (HPV) effectively prevents HPV infection and HPV-related cancers in women and men. However, HPV vaccination programs are met with vaccine hesitancy, which varies between countries. The coverage in Poland is low, although introducing nationally funded HPV vaccination for girls aged 12-13 in mid-2023 may increase it. The uptake of the HPV vaccine in adolescents is highly affected by parental decisions, which in turn can be influenced by interactions with the physician. The present representative study aimed to analyze the acceptance of the HPV vaccine among Polish parents (n = 360) and the level of trust in HPV vaccination in the pediatrician/general practitioner who takes care of their children aged 9-15 years. The data were gathered in September 2022 using computer-assisted telephone interviews. Most surveyed parents reported trusting their child's physician regarding vaccine recommendations (89.2%) and vaccinated their child with all or most of the vaccines recommended by a national vaccination guideline (94.7%). However, 13.3% declared themselves as moderate or strong vaccine opponents, a group characterized by high (83.4%) distrust in physicians. There was no difference in the awareness of HPV in groups varying in trusting the physicians, but parents who trusted them were more frequently aware of the HPV vaccine. Parental willingness to vaccinate their child against HPV was highly differentiated by the level of trust in the child's physician. The results highlight that trust in physicians is a critical factor shaping decisions for children's vaccination, stressing a continuous need to improve strategies to communicate with patients.
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Affiliation(s)
- Tomasz Sobierajski
- Center of Sociomedical Research, Faculty of Applied Social Sciences and Resocialization, University of Warsaw, 26/28 Krakowskie Przedmieście Str., 00-927 Warsaw, Poland
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland;
- Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), 60-806 Poznań, Poland
| | - Ilona Małecka
- Department of Preventive Medicine, Poznań University of Medical Sciences, 10 Fredry Str., 61-701 Poznań, Poland;
| | - Ewa Augustynowicz
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health NIH—National Research Center, 24 Chocimska Str., 00-791 Warsaw, Poland;
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Bocquier A, Bruel S, Michel M, Le Duc‐Banaszuk A, Bonnay S, Branchereau M, Chevreul K, Chyderiotis S, Gauchet A, Giraudeau B, Hagiu D, Mueller JE, Gagneux‐Brunon A, Thilly N. Co-development of a school-based and primary care-based multicomponent intervention to improve HPV vaccine coverage amongst French adolescents (the PrevHPV Study). Health Expect 2023; 26:1843-1853. [PMID: 37312280 PMCID: PMC10485335 DOI: 10.1111/hex.13778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 05/01/2023] [Accepted: 05/09/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Despite various efforts to improve human papillomavirus (HPV) vaccine coverage in France, it has always been lower than in most other high-income countries. The health authorities launched in 2018 the national PrevHPV research programme to (1) co-develop with stakeholders and (2) evaluate the impact of a multicomponent complex intervention aimed at improving HPV vaccine coverage amongst French adolescents. OBJECTIVE To describe the development process of the PrevHPV intervention using the GUIDance for rEporting of intervention Development framework as a guide. METHODS To develop the intervention, we used findings from (1) published evidence on effective strategies to improve vaccination uptake and on theoretical frameworks of health behaviour change; (2) primary data on target populations' knowledge, beliefs, attitudes, preferences, behaviours and practices as well as the facilitators and barriers to HPV vaccination collected as part of the PrevHPV Programme and (3) the advice of working groups involving stakeholders in a participatory approach. We paid attention to developing an intervention that would maximise reach, adoption, implementation and maintenance in real-world contexts. RESULTS We co-developed three components: (1) adolescents' and parents' education and motivation using eHealth tools (web conferences, videos, and a serious video game) and participatory learning at school; (2) general practitioners' e-learning training on HPV using motivational interviewing techniques and provision of a decision aid tool and (3) easier access to vaccination through vaccination days organised on participating middle schools' premises to propose free of charge initiation of the HPV vaccination. CONCLUSION We co-developed a multicomponent intervention that addresses a range of barriers and enablers of HPV vaccination. The next step is to build on the results of its evaluation to refine it before scaling it up if proven efficient. If so, it will add to the small number of multicomponent interventions aimed at improving HPV vaccination worldwide. PATIENT OR PUBLIC CONTRIBUTION The public (adolescents, their parents, school staff and health professionals) participated in the needs assessment using a mixed methods approach. The public was also involved in the components' development process to generate ideas about potential activities/tools, critically revise the successive versions of the tools and provide advice about the intervention practicalities, feasibility and maintenance.
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Affiliation(s)
| | - Sébastien Bruel
- Department of General Practice, Jacques Lisfranc Faculty of MedicineSaint‐Etienne‐Lyon UniversitySaint‐EtienneFrance
- Health, Systemic, Process UR 4129 Research Unit, University Claude BernardUniversity of LyonLyonFrance
| | - Morgane Michel
- ECEVE UMR 1123, Université de Paris CitéParisFrance
- Assistance Publique‐Hôpitaux de Paris, Hôtel Dieu, URC Eco Ile‐de‐France/Hôpital Robert DebréUnité d'épidémiologie cliniqueParisFrance
| | | | | | - Marion Branchereau
- Centre Régional de Coordination des Dépistages des cancers‐Pays de la LoireAngersFrance
| | - Karine Chevreul
- ECEVE UMR 1123, Université de Paris CitéParisFrance
- Assistance Publique‐Hôpitaux de Paris, Hôtel Dieu, URC Eco Ile‐de‐France/Hôpital Robert DebréUnité d'épidémiologie cliniqueParisFrance
| | - Sandra Chyderiotis
- Emerging Disease Epidemiology Unit, Institut PasteurUniversité Paris CitéParisFrance
| | - Aurélie Gauchet
- LIP/PC2SUniversité Grenoble AlpesGrenobleFrance
- LIP/PC2SUniversité Savoie Mont BlancChambéryFrance
| | - Bruno Giraudeau
- SPHERE U1246, Université de Tours, Université de NantesINSERMToursFrance
- INSERM CIC 1415CHRU de ToursToursFrance
| | - Dragos‐Paul Hagiu
- Department of General Practice, Jacques Lisfranc Faculty of MedicineSaint‐Etienne‐Lyon UniversitySaint‐EtienneFrance
- CIC‐INSERM 1408, CHU deSaint‐EtienneFrance
| | - Judith E. Mueller
- Emerging Disease Epidemiology Unit, Institut PasteurUniversité Paris CitéParisFrance
- Univ. Rennes, EHESP, CNRS, Inserm, Arènes ‐ UMR 6051RSMS (Recherche sur les Services et Management en Santé) ‐ U 1309RennesFrance
| | - Amandine Gagneux‐Brunon
- Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, CIC INSERM 1408 VaccinologieCHU de Saint‐EtienneSaint‐EtienneFrance
| | - Nathalie Thilly
- APEMACUniversité de LorraineNancyFrance
- Département Méthodologie, Promotion, InvestigationUniversité de Lorraine, CHRU‐NancyNancyFrance
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15
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Verger P, Cogordan C, Fressard L, Gosselin V, Donato X, Biferi M, Verlomme V, Sonnier P, Meur H, Malfait P, Berthiaume P, Ramalli L, Gagneur A. A postpartum intervention for vaccination promotion by midwives using motivational interviews reduces mothers' vaccine hesitancy, south-eastern France, 2021 to 2022: a randomised controlled trial. Euro Surveill 2023; 28:2200819. [PMID: 37733238 PMCID: PMC10515496 DOI: 10.2807/1560-7917.es.2023.28.38.2200819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/17/2023] [Indexed: 09/22/2023] Open
Abstract
BackgroundDespite childhood vaccine mandates imposed in 2018 in France, parental vaccine hesitancy (VH) remains frequent. Interventions in Quebec, Canada, applying motivational interviewing (MI) techniques have successfully reduced parents' VH for childhood immunisations.AimTo determine whether MI intervention for mothers in maternity wards in the days after birth in France could significantly reduce VH, increase intentions to vaccinate (VI) their child at 2 months and reduce VH social inequalities.MethodsWe conducted a parallel-arm multicentre randomised controlled trial from November 2021 to April 2022 to compare impacts of MI performed by MI-trained midwives (intervention) vs a vaccination leaflet (control). We included 733 mothers from two maternity hospitals in south-eastern France, randomly assigned either arm. The validated Parents Attitudes about Childhood Vaccines questionnaire was used before and after MI or leaflet to assess mothers' VH (13 items, 0-100 score) and VI (1 item, 1-10 score). Difference-in-difference (D-I-D) models were used to estimate net impact of MI vs leaflet for the entire sample and stratified by VH and education level.ResultsMotivational interview intervention reduced mothers' VH score by 33% (p < 0.0001) and increased VI by 8% (p < 0.0001); the effect was largest for the highest initial VH levels. D-I-D analyses estimated net VH decrease at 5.8/100 points (p = 0.007) and net VI increase at 0.6/10 points (p = 0.005). Net VH decrease was highest for high initial VH levels and low education levels.ConclusionsOur results show positive effects of MI intervention, and means of its implementation should be investigated in France.
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Affiliation(s)
- Pierre Verger
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Chloé Cogordan
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Lisa Fressard
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | | | - Xavier Donato
- Maternity ward, Saint-Joseph Hospital, Marseille, France
| | | | | | - Pierre Sonnier
- Comité Régional d'Education pour la Santé Provence-Alpes-Côte-D'Azur, Marseille, France
| | - Hervé Meur
- Agence Régionale de Santé Provence-Alpes-Côte-D'Azur, Marseille, France
| | - Philippe Malfait
- Santé publique France (French National Public Health Agency), Marseille, France
| | | | - Lauriane Ramalli
- Santé publique France (French National Public Health Agency), Marseille, France
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16
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Cogordan C, Fressard L, Ramalli L, Rebaudet S, Malfait P, Dutrey-Kaiser A, Attalah Y, Roy D, Berthiaume P, Gagneur A, Verger P. Motivational interview-based health mediator interventions increase intent to vaccinate among disadvantaged individuals. Hum Vaccin Immunother 2023; 19:2261687. [PMID: 37772602 PMCID: PMC10543359 DOI: 10.1080/21645515.2023.2261687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
Coverage for recommended COVID-19 and diphtheria-tetanus-poliomyelitis (DTP) booster shots is often inadequate, especially among disadvantaged populations. To help health mediators (HMs) involved in outreach programs deal with the problems of vaccine hesitancy (VH) in these groups, we trained them in motivational interviewing (MI). We evaluated the effectiveness of this training among HMs on their MI knowledge and skills (objective 1) and among the interviewees on their vaccination readiness (VR) and intention to get vaccinated or accept a booster against COVID-19 and/or DTP (objective 2). Two MI specialists trained 16 HMs in a two-day workshop in May 2022. The validated MISI questionnaire evaluated HMs' acquisition of MI knowledge and skills (objective 1). Trained HMs offered an MI-based intervention on vaccination to people in disadvantaged neighborhoods of Marseille (France). Those who consented completed a questionnaire before and after the interview to measure VR with the 7C scale and intentions regarding vaccination/booster against COVID-19 and DTP (objective 2). The training resulted in HMs acquiring good MI skills (knowledge, application, self-confidence in using it). HMs enrolled 324 interviewees, 96% of whom completed both questionnaires. VR increased by 6%, and intentions to get vaccinated or update COVID-19 and DTP vaccination increased by 74% and 52% respectively. Nearly all interviewees were very satisfied with the interview, although 21% still had questions about vaccination. HMs assimilated MI principles well. MI use in outreach programs appears to show promise in improving vaccine confidence and intentions among disadvantaged people.
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Affiliation(s)
- Chloé Cogordan
- Southeastern Health Regional Observatory, ORS PACA, Marseille, France
| | - Lisa Fressard
- Southeastern Health Regional Observatory, ORS PACA, Marseille, France
| | - Lauriane Ramalli
- Santé publique France (French National Public Health Agency), Marseille, France
| | - Stanislas Rebaudet
- Hôpital Européen, Marseille, France
- UMR1252 SESSTIM, Aix-Marseille University, Inserm, IRD, ISSPAM, Marseille, France
| | - Philippe Malfait
- Santé publique France (French National Public Health Agency), Marseille, France
| | | | | | - David Roy
- Centre de recherche du CHUS, Sherbrooke, QC, Canada
| | | | - Arnaud Gagneur
- Centre de recherche du CHUS, Sherbrooke, QC, Canada
- Department of Pediatrics, Sherbrooke University, Sherbrooke, QC, Canada
| | - Pierre Verger
- Southeastern Health Regional Observatory, ORS PACA, Marseille, France
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17
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Opel DJ. Clinician Communication to Address Vaccine Hesitancy. Pediatr Clin North Am 2023; 70:309-319. [PMID: 36841598 DOI: 10.1016/j.pcl.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
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.
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Affiliation(s)
- Douglas J Opel
- Department of Pediatrics, University of Washington School of Medicine, Center for Clinical and Translational Research, Seattle Children's Research Institute, M/S: JMB-6, 1900 Ninth Avenue, Seattle, WA 98101, USA.
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18
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Mercadante AR, Chen AMH, Chu V, Wong JC, Law AV. Examining General Vaccine Acceptance and COVID-19 Vaccine Intention: Comparison across Pharmacies in California and Ohio. PHARMACY 2023; 11:pharmacy11020046. [PMID: 36961023 PMCID: PMC10037570 DOI: 10.3390/pharmacy11020046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 03/02/2023] Open
Abstract
Given the complexities surrounding vaccine acceptance of COVID-19 and other vaccines, it is important to determine the underlying health beliefs of patients in order to bridge gaps and promote vaccine confidence. With pharmacies as key hubs for vaccinations and vaccine conversations, examining patient perspectives through the lens of community pharmacy may provide a targeted insight into their patient populations. The primary objectives of this study were to measure COVID-19 vaccine intention and compare vaccine acceptance at pharmacies and clinics between California and Ohio. The secondary objectives included subgroup comparisons of vaccine intention and vaccine acceptance based on demographic characteristics. A previously validated survey instrument (5C survey tool) was administered at pharmacy sites in California and Ohio to examine respondents' vaccine acceptance (confidence, complacency, constrains, calculation, and collective responsibility). Additional items were added to capture flu and COVID-19 vaccine intention. Reliability and confirmatory factor analysis were completed for the 13-item 5C. Comparisons were made between sites and within different demographic groups. Good reliability (Cronbach's alpha = 0.768) was found, with nearly all items loading on their hypothesized domains. Respondents from Ohio had significantly higher complacency and constraints domain scores. Highest acceptance was revealed in females, individuals with a Master's degree or higher, and individuals with the intention to receive a flu vaccine. The adapted 5C is a reasonable tool to measure vaccine intention in English-speaking populations in the US. Certain demographic groups may have lower vaccine acceptance; pharmacists could consider implementing a tool, such as the 5C tool, to identify low acceptance. Given that the 5C tool gathers information on different domains of vaccine acceptance, healthcare professionals could utilize these results to improve trust and vaccine confidence in their patient populations; focused conversations concerning any of the respective domains could best address individual concerns and barriers about vaccinations, notably the COVID-19 and flu vaccines.
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Affiliation(s)
- Amanda R Mercadante
- College of Pharmacy, Western University of Health Sciences, 309 E 2nd St, Pomona, CA 91766, USA
| | - Aleda M H Chen
- School of Pharmacy, Cedarville University, 251 N. Main St., Cedarville, OH 45314, USA
| | - Vivian Chu
- College of Pharmacy, Western University of Health Sciences, 309 E 2nd St, Pomona, CA 91766, USA
| | - Jason C Wong
- College of Pharmacy, Western University of Health Sciences, 309 E 2nd St, Pomona, CA 91766, USA
| | - Anandi V Law
- College of Pharmacy, Western University of Health Sciences, 309 E 2nd St, Pomona, CA 91766, USA
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19
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Regan AK, Fiddian-Green A. Protecting pregnant people & infants against influenza: A landscape review of influenza vaccine hesitancy during pregnancy and strategies for vaccine promotion. Hum Vaccin Immunother 2022; 18:2156229. [PMID: 36535646 PMCID: PMC10019833 DOI: 10.1080/21645515.2022.2156229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
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.
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Affiliation(s)
- Annette K. Regan
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Alice Fiddian-Green
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
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Betsch C, Schmid P, Verger P, Lewandowsky S, Soveri A, Hertwig R, Fasce A, Holford D, De Raeve P, Gagneur A, Vuolanto P, Correia T, Tavoschi L, Declich S, Marceca M, Linos A, Karnaki P, Karlsson L, Garrison A. A call for immediate action to increase COVID-19 vaccination uptake to prepare for the third pandemic winter. Nat Commun 2022; 13:7511. [PMID: 36473855 PMCID: PMC9726862 DOI: 10.1038/s41467-022-34995-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Cornelia Betsch
- University of Erfurt, Erfurt, Germany.
- Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.
| | - Philipp Schmid
- University of Erfurt, Erfurt, Germany
- Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Pierre Verger
- Faculty of Medicine, Southeastern Regional Health Observatory, Marseille, France
| | | | | | - Ralph Hertwig
- Max Planck Institute for Human Development, Berlin, Germany
| | | | - Dawn Holford
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Paul De Raeve
- European Federation of Nurses Associations, Brussels, Belgium
| | - Arnaud Gagneur
- Faculté de Médecine et des Sciences de la Santé, University of Sherbrooke, Sherbrooke, QC, Canada
| | | | - Tiago Correia
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Lara Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Silvia Declich
- Istituto Superiore di Sanità, Italian National Institute of Health, Rome, Italy
| | - Maurizio Marceca
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | | | | | - Amanda Garrison
- Faculty of Medicine, Southeastern Regional Health Observatory, Marseille, France
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21
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Bussink-Voorend D, Hautvast JLA, Vandeberg L, Visser O, Hulscher MEJL. A systematic literature review to clarify the concept of vaccine hesitancy. Nat Hum Behav 2022; 6:1634-1648. [PMID: 35995837 DOI: 10.1038/s41562-022-01431-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 07/13/2022] [Indexed: 11/25/2022]
Abstract
Vaccine hesitancy (VH) is considered a top-10 global health threat. The concept of VH has been described and applied inconsistently. This systematic review aims to clarify VH by analysing how it is operationalized. We searched PubMed, Embase and PsycINFO databases on 14 January 2022. We selected 422 studies containing operationalizations of VH for inclusion. One limitation is that studies of lower quality were not excluded. Our qualitative analysis reveals that VH is conceptualized as involving (1) cognitions or affect, (2) behaviour and (3) decision making. A wide variety of methods have been used to measure VH. Our findings indicate the varied and confusing use of the term VH, leading to an impracticable concept. We propose that VH should be defined as a state of indecisiveness regarding a vaccination decision.
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Affiliation(s)
- Daphne Bussink-Voorend
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands.
| | - Jeannine L A Hautvast
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands
| | - Lisa Vandeberg
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Olga Visser
- Radboud University Medical Center, Radboud Institute for Health Sciences, Primary and Community Care, Nijmegen, the Netherlands
| | - Marlies E J L Hulscher
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
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22
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Mitilian E, Gosselin V, Casanova L, Fressard L, Berthiaume P, Verger P, Gagneur A. Assessment of training of general practice interns in motivational interviews about vaccination. Hum Vaccin Immunother 2022; 18:2114253. [PMID: 36494997 PMCID: PMC9746523 DOI: 10.1080/21645515.2022.2114253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
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.
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Affiliation(s)
- Eva Mitilian
- Aix Marseille Univ, DUMG, département universitaire de médecine générale, Marseille, France,ORS PACA. Southeastern Health Regional Observatory, Faculty of Medicine, Marseille, France,CONTACT Eva Mitilian Aix Marseille Univ, DUMG, département universitaire de médecine générale, 40, rue Saint-Bruno, Marseille13004
| | - Virginie Gosselin
- Centre de Recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Ludovic Casanova
- Aix Marseille Univ, DUMG, département universitaire de médecine générale, Marseille, France,ORS PACA. Southeastern Health Regional Observatory, Faculty of Medicine, Marseille, France
| | - Lisa Fressard
- ORS PACA. Southeastern Health Regional Observatory, Faculty of Medicine, Marseille, France
| | | | - Pierre Verger
- ORS PACA. Southeastern Health Regional Observatory, Faculty of Medicine, Marseille, France
| | - Arnaud Gagneur
- Centre de Recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada,Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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23
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Olusanya OA, White B, Malik F, Hester KA, Davis RL, Bednarczyk RA, Shaban-Nejad A. Healthcare professionals' perceptions and recommendations regarding adolescent vaccinations in Georgia and Tennessee during the COVID-19 pandemic: A qualitative research. PLoS One 2022; 17:e0277748. [PMID: 36399477 PMCID: PMC9674128 DOI: 10.1371/journal.pone.0277748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Despite its benefits, HPV vaccine uptake has been historically lower than other recommended adolescent vaccines in the United States (US). While hesitancy and misinformation have threatened vaccinations for many years, the adverse impacts from COVID-19 pandemic on preventive services have been far-reaching. OBJECTIVES To explore the perceptions and experiences of adolescent healthcare providers regarding routine vaccination services during the COVID-19 pandemic. METHODOLOGY Between December 2020 and May 2021, in-depth qualitative interviews were conducted via Zoom video conferencing among a purposively selected, diverse group of adolescent healthcare providers (n = 16) within 5 healthcare practices in the US southeastern states of Georgia and Tennessee. Audio recordings were transcribed verbatim and analyzed using a rapid qualitative analysis framework. Our analysis was guided by the grounded theory and inductive approach. RESULTS Participants reported that patient-provider communications; effective use of presumptive languaging; provider's continuing education/training; periodic reminders/recall messages; provider's personal conviction on vaccine safety/efficacy; early initiation of HPV vaccination series at 9 years; community partnerships with community health navigators/vaccine champions/vaccine advocates; use of standardized forms/prewritten scripts/standard operating protocols for patient-provider interactions; and vaccine promotion through social media, brochures/posters/pamphlets as well as outreaches to schools and churches served as facilitators to adolescent HPV vaccine uptake. Preventive adolescent services were adversely impacted by the COVID-19 pandemic at all practices. Participants highlighted an initial decrease in patients due to the pandemic, while some practices avoided the distribution of vaccine informational materials due to sanitary concerns. CONCLUSION As part of a larger study, we provided contextual information to refine an intervention package currently being developed to improve adolescent preventive care provision in healthcare practices. Our results could inform the implementation of comprehensive intervention strategies that improve HPV vaccination rates. Additionally, lessons learned (e.g. optimizing patient- provider interactions) could be adopted to expand COVID-19 vaccine acceptance on a sizable scale.
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Affiliation(s)
- Olufunto A. Olusanya
- Department of Pediatrics, Center for Biomedical Informatics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- * E-mail: (OAO); (AS-N)
| | - Brianna White
- Department of Pediatrics, Center for Biomedical Informatics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Fauzia Malik
- Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Kyra A. Hester
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Robert L. Davis
- Department of Pediatrics, Center for Biomedical Informatics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Robert A. Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Arash Shaban-Nejad
- Department of Pediatrics, Center for Biomedical Informatics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- * E-mail: (OAO); (AS-N)
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24
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Garrison A, Fressard L, Karlsson L, Soveri A, Fasce A, Lewandowsky S, Schmid P, Gagneur A, Dubé E, Verger P. Measuring psychosocial determinants of vaccination behavior in healthcare professionals: validation of the Pro-VC-Be short-form questionnaire. Expert Rev Vaccines 2022; 21:1505-1514. [PMID: 35938710 DOI: 10.1080/14760584.2022.2108800] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Vaccine confidence among health care professionals (HCPs) is a key determinant of vaccination behaviors. We validate a short-form version of the 31-item Pro-VC-Be (Health Professionals Vaccine Confidence and Behaviors) questionnaire that measures HCPs' confidence in and commitment to vaccination. RESEARCH DESIGN AND METHODS A cross-sectional survey among 2,696 HCPs established a long-form tool to measure 10 dimensions of psychosocial determinants of vaccination behaviors. Confirmatory factor analysis (CFA) models tested the construct validity of 69,984 combinations of items in a 10-item short form tool. The criterion validity of this tool was tested with four behavioral and attitudinal outcomes using weighted modified Poisson regressions. An immunization resource score was constructed from summing the responses of the dimensions that can influence HCPs' pro-vaccination behaviors: vaccine confidence, proactive efficacy, and trust in authorities. RESULTS The short-form tool showed good construct validity in CFA analyses (RMSEA = 0.035 [0.024; 0.045]; CFI = 0.956; TLI = 0.918; SRMR 0.027) and comparable criterion validity to the long-form tool. The immunization resource score showed excellent criterion validity. CONCLUSIONS The Pro-VC-Be short-form showed good construct validity and criterion validity similar to the long-form and can therefore be used to measure determinants of vaccination behaviors among HCPs.
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Affiliation(s)
- Amanda Garrison
- Faculty of Medicine, ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Lisa Fressard
- Faculty of Medicine, ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Linda Karlsson
- Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Anna Soveri
- Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Angelo Fasce
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Stephan Lewandowsky
- School of Psychological Science, University of Bristol, Bristol, UK.,School of Psychological Science, University of Western Australia, Perth, Australia
| | - Philipp Schmid
- Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Arnaud Gagneur
- Department of Pediatrics, Centre de Recherche du CHUS, Sherbrooke, Quebec, Canada.,Département de Pédiatrie, Université de Sherbrooke-Campus de la Santé, Sherbrooke, Quebec, Canada
| | - Eve Dubé
- Department of Anthropology, Laval University, Quebec City, Quebec, Canada
| | - Pierre Verger
- Faculty of Medicine, ORS PACA, Southeastern Health Regional Observatory, Marseille, France.,Faculty of Medicine, Aix-Marseille University, Marseille, France
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25
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Kassianos G, Puig-Barberà J, Dinse H, Teufel M, Türeci Ö, Pather S. Addressing COVID-19 vaccine hesitancy. Drugs Context 2022; 11:2021-12-3. [PMID: 35814493 PMCID: PMC9225513 DOI: 10.7573/dic.2021-12-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/13/2022] [Indexed: 11/24/2022] Open
Abstract
Immunization programmes have been globally recognized as one of the most successful medical interventions against infectious diseases. Despite the proven efficacy and safety profiles of coronavirus disease 2019 (COVID-19) vaccines, there are still a substantial number of people who express vaccine hesitancy. Factors that influence vaccine decision-making are heterogenous, complex, and context specific and may be caused or amplified by uncontrolled online information or misinformation. With respect to COVID-19, the recent emergence of novel variants of concern that give rise to milder disease also drives vaccine hesitancy. Healthcare professionals remain one of the most trusted groups to advise and provide information to those ambivalent about COVID-19 vaccination and should be equipped with adequate resources and information as well as practical guidance to empower them to effectively discuss concerns. This article seeks to summarize the currently available information to address the most common concerns regarding COVID-19 vaccination.
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Affiliation(s)
- George Kassianos
- Royal College of General Practitioners, London, UK
- The British Global and Travel Health Association, London, UK
| | - Joan Puig-Barberà
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, Valencia, Spain
| | - Hannah Dinse
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, Essen, Germany
| | - Martin Teufel
- University of Duisburg-Essen, Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, Essen, Germany
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26
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Verger P, Fressard L, Soveri A, Dauby N, Fasce A, Karlsson L, Lewandoswky S, Schmid P, Dube E, Gagneur A. An instrument to measure psychosocial determinants of health care professionals' vaccination behavior: Validation of the Pro-VC-Be questionnaire. Expert Rev Vaccines 2022; 21:693-709. [PMID: 35238274 DOI: 10.1080/14760584.2022.2046467] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The lack of validated instruments assessing vaccine hesitancy/confidence among health care professionals (HCPs) for themselves, and their patients led us to develop and validate the Pro-VC-Be instrument to measure vaccine confidence and other psychosocial determinants of HCPs' vaccination behavior among diverse HCPs in different countries. METHODS Cross-sectional survey in October-November 2020 among 1,249 GPs in France, 432 GPs in French-speaking parts of Belgium, and 1,055 nurses in Quebec (Canada), all participating in general population immunization. Exploratory and confirmatory factor analyses evaluated the instrument's construct validity. We used HCPs' self-reported vaccine recommendations to patients, general immunization activity, self-vaccination, and future COVID-19 vaccine acceptance to test criterion validity. RESULTS The final results indicated a 6-factor structure with good fit: vaccine confidence (combining complacency, perceived vaccine risks, perceived benefit-risk balance, perceived collective responsibility), trust in authorities, perceived constraints, proactive efficacy (combining commitment to vaccination and self-efficacy), reluctant trust, and openness to patients. The instrument showed good convergent and criterion validity and adequate discriminant validity. CONCLUSIONS This study found that the Pro-VC-Be is a valid instrument for measuring psychosocial determinants of HCPs' vaccination behaviors in different settings. Its validation is currently underway in Europe among various HCPs in different languages.
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Affiliation(s)
- Pierre Verger
- ORS PACA, Southeastern Health Regional Observatory, Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Lisa Fressard
- ORS PACA, Southeastern Health Regional Observatory, Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Anna Soveri
- Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Nicolas Dauby
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Centre for Environmental Health and Occupational Health, School of Public health, Université Libre de Bruxelles (ULB), Brussel, Belgium.,Institute for Medical Immunology, Université Libre de Bruxelles (ULB), Brussel, Belgium
| | - Angelo Fasce
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Linda Karlsson
- Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Stephan Lewandoswky
- School of Psychological Science, University of Bristol, Bristol, United Kingdom.,School of Psychological Science, University of Western Australia, Perth, Australia
| | - Philipp Schmid
- Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Eve Dube
- Département d'Anthropologie, Faculté des Sciences Sociales, Université Laval, Quebec, Canada.,Institut National de la Santé Publique du Québec, Quebec, Canada.,Centre de Recherche du CHU de Québec, Université Laval, Quebec, Canada
| | - Arnaud Gagneur
- Department of Pediatrics, Centre de Recherche du CHUS, Sherbrooke, Canada.,Université de Sherbrooke-Campus de la Santé, Sherbrooke,Canada
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27
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Training Physicians in Motivational Communication to Address Influenza Vaccine Hesitation: A Proof-of-Concept Study. Vaccines (Basel) 2022; 10:vaccines10020143. [PMID: 35214603 PMCID: PMC8875187 DOI: 10.3390/vaccines10020143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Strategies to support health care professionals on how to address vaccine hesitancy are needed. Methods: We developed a 4-h Motivational Communication (MC) training program tailored to help physicians address hesitancy related to influenza vaccination among patients living with rheumatoid arthritis. Five MC competencies were evaluated at baseline and post-training with a standardized patient using the Motivational Interviewing Treatment Integrity [MITI] scale. Adherence to MC during clinical consultations and changes in vaccine intentions was measured as secondary outcomes. Results: Seven rheumatology physicians participated in the training. MITI scores increased in all participants, and 71% (n = 5) achieved thresholds of clinical competency (i.e., ≥3.5/5 at MITI global score and ≥3/5 on at least 3 individual competency score) post-training. Autonomy/support and empathy competencies reached competency thresholds (+2.4 ± 1.3 to +4.1 ± 0.7 and +2.1 ± 0.7 to +4.1 ± 0.7, respectively). Evocation and collaboration competencies improved but without reaching competency thresholds (+1.4 ± 0.8 to +3.1 ± 1.1; +1.4 ± 0.8 to +2.9 ± 1.1, respectively). Direction did not improve. Among 21 patient consultations post-training, 15 (71%) were MC-consistent. Of the 15 patients, 67% (10/15) intended to receive the influenza vaccine and 33% (5/15) received it. Conclusion: A brief MC training program targeting vaccine hesitancy increased MC competency among rheumatology physicians and promoted behavioral change among patients.
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Gilchrist CA, Chelimo C, Tatnell R, Atatoa Carr P, Camargo CA, Morton S, Grant CC. Vaccination information fathers receive during pregnancy and determinants of infant vaccination timeliness. Hum Vaccin Immunother 2021; 17:5214-5225. [PMID: 34797748 DOI: 10.1080/21645515.2021.1932212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The information fathers receive about infant vaccination may influence their decision to vaccinate. We describe fathers' sources of vaccination information and paternal determinants of timely infant vaccinations. Participants were from a child cohort study in New Zealand. The child cohort was established by enrolling pregnant women and their partners. During pregnancy, fathers (n = 4017) of the cohort children born 2009-2010 described information sources that encouraged or discouraged infant vaccination. The National Immunization Register provided infant vaccination data. Independent associations of the vaccination information received by fathers with the timeliness of their infant's vaccination were determined using multivariable logistic regression. Associations were described using adjusted odds ratios and 95% confidence intervals. One-third of fathers (1430/4017 [36%]) recalled receiving vaccination information, 64% of which encouraged vaccination. Most infants (2900/4017 [72%]) received all their vaccinations on time, however only 58% of Māori infants were vaccinated on time. Paternal determinants of vaccination timeliness were the father receiving discouraging or conflicting information about vaccination, father's ethnicity, father's vaccination hesitancy, and whether the mother received vaccination information. To improve vaccination uptake and timeliness, a vaccination conversation with mothers, fathers and whānau could be included in routine antenatal care, informing and supporting decision-making, and addressing concerns. Vaccination education should address present and historic distrust of the health system. Framing vaccination within a Māori model of health and including fathers and whānau in decision-making will address vaccination inequities in New Zealand.
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Affiliation(s)
- Catherine A Gilchrist
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Carol Chelimo
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Ryan Tatnell
- General Paediatrics, Starship Children's Health, Auckland, New Zealand
| | - Polly Atatoa Carr
- Growing up in New Zealand, The University of Auckland, Auckland, New Zealand.,National Institute of Demographic and Economic Analysis, University of Waikato, Hamilton, New Zealand
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Susan Morton
- Growing up in New Zealand, The University of Auckland, Auckland, New Zealand.,Centre for Longitudinal Research - He Ara Ki Mua, The University of Auckland, Auckland, New Zealand
| | - Cameron C Grant
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand.,General Paediatrics, Starship Children's Health, Auckland, New Zealand.,Centre for Longitudinal Research - He Ara Ki Mua, The University of Auckland, Auckland, New Zealand
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29
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Aksnes BN, Walldorf JA, Nkwenkeu SF, Zoma RL, Mirza I, Tarbangdo F, Fall S, Hien S, Ky C, Kambou L, Diallo AO, Aké FH, Hatcher C, Patel JC, Novak RT, Hyde TB, Medah I, Soeters HM, Jalloh MF. Vaccination information, motivations, and barriers in the context of meningococcal serogroup A conjugate vaccine introduction: A qualitative assessment among caregivers in Burkina Faso, 2018. Vaccine 2021; 39:6370-6377. [PMID: 34579975 PMCID: PMC8519392 DOI: 10.1016/j.vaccine.2021.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND In March 2017, Burkina Faso introduced meningococcal serogroup A conjugate vaccine (MACV) into the Expanded Programme on Immunization. MACV is administered to children aged 15-18 months, concomitantly with the second dose of measles-containing vaccine (MCV2). One year after MACV introduction, we assessed the sources and content of immunization information available to caregivers and explored motivations and barriers that influence their decision to seek MACV for their children. METHODS Twenty-four focus group discussions (FGDs) were conducted with caregivers of children eligible for MACV and MCV2. Data collection occurred in February-March 2018 in four purposively selected districts, each from a separate geographic region; within each district, caregivers were stratified into groups based on whether their children were unvaccinated or vaccinated with MACV. FGDs were recorded and transcribed. Transcripts were coded and analyzed using qualitative content analysis. RESULTS We identified many different sources and content of information about MACV and MCV2 available to caregivers. Healthcare workers were most commonly cited as the main sources of information; caregivers also received information from other caregivers in the community. Caregivers' motivations to seek MACV for their children were driven by personal awareness, engagements with trusted messengers, and perceived protective benefits of MACV against meningitis. Barriers to MACV and MCV2 uptake were linked to the unavailability of vaccines, immunization personnel not providing doses, knowledge gaps about the 15-18 month visit, practical constraints, past negative experiences, sociocultural influences, and misinformation, including misunderstanding about the need for MCV2. CONCLUSIONS MACV and MCV2 uptake may be enhanced by addressing vaccination barriers and effectively communicating vaccination information and benefits through trusted messengers such as healthcare workers and other caregivers in the community. Educating healthcare workers to avoid withholding vaccines, likely due to fear of wastage, may help reduce missed opportunities for vaccination.
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Affiliation(s)
| | - Jenny A Walldorf
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | | | - Robert L Zoma
- Institut National de Statistique et Démographie, Ouagadougou, Burkina Faso
| | | | | | | | | | - Cesaire Ky
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | | | | | | | - Cynthia Hatcher
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Jaymin C Patel
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Ryan T Novak
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Terri B Hyde
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Isaïe Medah
- Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Heidi M Soeters
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
| | - Mohamed F Jalloh
- Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
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30
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Abstract
PURPOSE OF REVIEW We reviewed the literature about parental vaccine hesitancy, focusing on publications from October 2019 to April 2021 to describe patterns and causes of hesitancy and interventions to address hesitancy. RECENT FINDINGS Recent studies expand understanding of the prevalence of vaccine hesitancy globally and highlight associated individual and contextual factors. Common concerns underlying hesitancy include uncertainty about the need for vaccination and questions about vaccine safety and efficacy. Sociodemographic factors associated with parental vaccine hesitancy vary across locations and contexts. Studies about psychology of hesitancy and how parents respond to interventions highlight the role of cognitive biases, personal values, and vaccination as a social contract or norm. Evidence-based strategies to address vaccine hesitancy include presumptive or announcement approaches to vaccine recommendations, motivational interviewing, and use of immunization delivery strategies like standing orders and reminder/recall programs. A smaller number of studies support use of social media and digital applications to improve vaccination intent. Strengthening school vaccine mandates can improve vaccination rates, but policy decisions must consider local context. SUMMARY Vaccine hesitancy remains a challenge for child health. Future work must include more interventional studies to address hesitancy and regular global surveillance of parental vaccine hesitancy and vaccine content on social media.
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Affiliation(s)
- Jessica R Cataldi
- Department of Pediatrics, University of Colorado School of Medicine
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Sean T O'Leary
- Department of Pediatrics, University of Colorado School of Medicine
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
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31
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McGregor S, Goldman RD. Determinants of parental vaccine hesitancy. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:339-341. [PMID: 33980625 DOI: 10.46747/cfp.6705339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
QUESTION We engage parents on a daily basis in the office to discuss immunization for their children, and some of them are hesitant about vaccination. Discussing the importance of vaccines for the child and the public, and reviewing the safety of vaccines has not led to substantial increases in acceptance in our office. What factors influence a parent's views of vaccines, and how can we effectively address them in practice? ANSWER Despite medical acceptance of vaccines and widespread accessibility, many Canadian children do not receive all their vaccines, and parental hesitancy has increased in the past 30 years. Thus, family physicians play an important role in addressing concerns that parents might have about vaccines and in increasing vaccine uptake. Determinants of vaccine hesitancy are heterogeneous and multifactorial. Factors that affect vaccine decision making include the perceived risks of vaccines, the relationship between parents and health care providers, and the social norm of vaccination. Communication strategies such as motivational interviewing and using presumptive language are valuable tools to increase vaccine uptake in children with vaccine-hesitant parents.
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32
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Pires C. What Is the State-of-the-Art in Clinical Trials on Vaccine Hesitancy 2015-2020? Vaccines (Basel) 2021; 9:348. [PMID: 33916427 PMCID: PMC8065658 DOI: 10.3390/vaccines9040348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Vaccine hesitancy is related to a delay in acceptance or refusal of vaccination. AIM to perform a systematic review of clinical trials on vaccine hesitancy (2015-2020). METHODS a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria (PRISMA). Five databases were screened-PubMed, Cochrane Library, DOAJ, SciELO and b-on-which comprise multiple resources. KEYWORDS "Vaccine hesitancy" and ("randomized controlled trial" or "clinical trial"). INCLUSION CRITERIA trials about "vaccine hesitancy" enrolling patients and/or health professionals (2015-2020). EXCLUSION CRITERIA studies about other topics, repeated and qualitative studies, reviews and papers written in languages other than English, Portuguese, French or Spanish. RESULTS a total of 35 trials out of 90 were selected (19 PubMed, 14 Cochrane Library, 0 DOAJ, 0 SciELO and 2 b-on). Selected trials were classified into five topics: children/pediatric (n = 5); online or electronic information (n = 5); vaccination against a specific disease (n = 15) (e.g., influenza or COVID-2019); miscellaneous (n = 4); and educational strategies (n = 6). CONCLUSION the provision of online or electronic information (e.g., through virtual reality, social websites of experts, or apps), communication-based interventions and training of health professionals, residents or subjects seemed to improve vaccine hesitancy.
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Affiliation(s)
- Carla Pires
- Research Center for Biosciences and Health Technologies, CBIOS-Universidade Lusófona de Humanidades e Tecnologias-Escola de Ciências e Tecnologias da Saúde, Campo Grande 376, 1740-024 Lisboa, Portugal
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Castillo E, Patey A, MacDonald N. Vaccination in pregnancy: Challenges and evidence-based solutions. Best Pract Res Clin Obstet Gynaecol 2021; 76:83-95. [PMID: 34090801 DOI: 10.1016/j.bpobgyn.2021.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/09/2021] [Indexed: 01/31/2023]
Abstract
Vaccination in pregnancy (VIP) is dually beneficial - it protects the mother and the baby from tetanus, influenza, and pertussis. VIP uptake is low in many countries. Vaccine hesitancy, defined by the World Health Organization (WHO) as a "delay in acceptance or refusal of vaccination despite the availability of vaccination services" is one of WHO's ten threats to global health per 2019. According to extensive research, mostly from high-income countries (HIC) and limited to tetanus, influenza and pertussis vaccines, lack of provider recommendations, safety concerns, and limitations in access are the main barriers to VIP. Health care provider recommendation is the leading facilitator for VIP across various socioeconomic status groups. Data on strategies to overcome patient, provider, and system barriers to VIP are inconsistent, contradictory, or lacking. Patient-focused research on evidence-based strategies to overcome provider and system barriers is needed. Furthermore, VIP programs require embedded continuous quality improvement to ensure sustainability.
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Affiliation(s)
- Eliana Castillo
- Department of Medicine, University of Calgary, Canada; Department of Obstetrics and Gynaecology University of Calgary, Canada.
| | - Andrea Patey
- Centre for Implementation Research, Ottawa Hospital Research Institute, Canada; Faculty of Health Sciences, Queen's University, Canada
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Verger P, Dualé C, Scronias D, Lenzi N, Pulcini C, Launay O. Attitudes of hospital physicians toward childhood mandatory vaccines in France: A cross-sectional survey. Hum Vaccin Immunother 2021; 18:1870393. [PMID: 33616464 PMCID: PMC8920152 DOI: 10.1080/21645515.2020.1870393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Due to a decades-long crisis of confidence in vaccination, in 2017 France extended the number of mandatory early childhood vaccines from 3 to 11. Aims To describe the opinions of hospital staff physicians (HSPs) regarding this measure, quantify the proportion who would have preferred measures based on education, and study the factors associated with the latter opinion. Methods Cross-sectional nationwide survey with a standardized questionnaire in 2018–2019 among HSPs in 14 French public hospitals. The factors associated with HSPs’ preference for education and persuasion over mandatory vaccination were analyzed with simple and multiple Poisson regressions. Results The analyses included 1,795 HSPs (participation rate of 86%). Among them, 84% considered the extension of mandatory childhood vaccination essential given the epidemiological context at the time; in a later question, 40% would have preferred education and persuasion. Multiple regressions showed that the latter tended to be younger and less trustful of sources of information about vaccination. They were more likely to think that information on the rationale behind the national vaccination policy lacked clarity and that the extension of mandatory vaccines was not essential, even in the current epidemiologic situation. Conclusion Although most HSPs agreed that the extension of mandatory childhood vaccines was essential, some were ambivalent about its coercive philosophy. Further research is necessary to better understand the reasons of this ambivalence. A fraction did not understand the French vaccination strategy well. Efforts to explain its details to HSPs and an overhaul of their initial training on vaccination are still needed.
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Affiliation(s)
- Pierre Verger
- Research Department, Southeastern Health Regional Observatory (Observatoire Régional De La Santé Paca), Marseille, France.,INSERM, F-CRIN, Innovative Clinical Research Network in VACcinology (I-REIVAC), Paris, France
| | - Christian Dualé
- INSERM, F-CRIN, Innovative Clinical Research Network in VACcinology (I-REIVAC), Paris, France.,Centre Hospitalo-universitaire, Clermont-Ferrand, Centre d'Investigation Clinique, INSERM, Clermont-Ferrand, France
| | - Dimitri Scronias
- Faculté de Médecine Paris Descartes, Université de Paris, Paris, France.,INSERM, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Nezha Lenzi
- INSERM, F-CRIN, Innovative Clinical Research Network in VACcinology (I-REIVAC), Paris, France.,Faculté de Médecine Paris Descartes, Université de Paris, Paris, France.,INSERM, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Céline Pulcini
- PEMAC, équipe MICS, Université de Lorraine, Nancy, France.,Infectious Diseases Department, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Odile Launay
- INSERM, F-CRIN, Innovative Clinical Research Network in VACcinology (I-REIVAC), Paris, France.,Faculté de Médecine Paris Descartes, Université de Paris, Paris, France.,INSERM, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
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Attwell K, Betsch C, Dubé E, Sivelä J, Gagneur A, Suggs LS, Picot V, Thomson A. Increasing vaccine acceptance using evidence-based approaches and policies: Insights from research on behavioural and social determinants presented at the 7th Annual Vaccine Acceptance Meeting. Int J Infect Dis 2021; 105:188-193. [PMID: 33578012 DOI: 10.1016/j.ijid.2021.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In 2019, the World Health Organization (WHO) flagged vaccine hesitancy as one of the top 10 threats to global health. The drivers of and barriers to under-vaccination include logistics (access to and awareness of affordable vaccines), as well as a complex mix of psychological, social, political, and cultural factors. INCREASING VACCINE UPTAKE There is a need for effective strategies to increase vaccine uptake in various settings, based on the best available evidence. Fortunately, the field of vaccine acceptance research is growing rapidly with the development, implementation, and evaluation of diverse measurement tools, as well as interventions to address the challenging range of drivers of and barriers to vaccine acceptance. ANNUAL VACCINE ACCEPTANCE MEETINGS Since 2011, the Mérieux Foundation has hosted Annual Vaccine Acceptance Meetings in Annecy, France that have fostered an informal community of practice on vaccination confidence and vaccine uptake. Mutual learning and sharing of knowledge has resulted directly in multiple initiatives and research projects. This article reports the discussions from the 7th Annual Vaccine Acceptance Meeting held September 23-25, 2019. During this meeting, participants discussed emergent vaccine acceptance challenges and evidence-informed ways of addressing them in a programme that included sessions on vaccine mandates, vaccine acceptance and demand, training on vaccine acceptance, and frameworks for resilience of vaccination programmes.
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Affiliation(s)
- Katie Attwell
- School of Social Science, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia.
| | - Cornelia Betsch
- University of Erfurt, Nordhäuser Str. 63, 99089, Erfurt, Germany.
| | - Eve Dubé
- Centre de Recherche du CHU de Québec-Université Laval, 2400 D'Estimauville, Quebec, QC, G1E 7G9, Canada.
| | - Jonas Sivelä
- Infectious Disease Control and Vaccinations, Finnish Institute for Health and Welfare (THL), Mannerheimintie 166, Helsinki, Finland.
| | - Arnaud Gagneur
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada.
| | - L Suzanne Suggs
- BeCHANGE Research Group, Institute of Public Health, Faculty of Communication Sciences, Università della Svizzera Italiana, via G. Buffi 13, Lugano, Switzerland; Swiss School of Public Health (SSPH+), Zurich, Switzerland; Institute for Global Health Innovation, Imperial College London, London, UK.
| | - Valentina Picot
- Scientific Conferences and Public Health Initiatives, Fondation Mérieux, 17 Rue Bourgelat, 69002, Lyon, France.
| | - Angus Thomson
- Sanofi Pasteur, 14 Espace Henry Vallee, 69007, Lyon, France.
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Ethics of Vaccination in Childhood-A Framework Based on the Four Principles of Biomedical Ethics. Vaccines (Basel) 2021; 9:vaccines9020113. [PMID: 33540732 PMCID: PMC7913000 DOI: 10.3390/vaccines9020113] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 02/07/2023] Open
Abstract
Although vaccination is recognised as the top public health achievement of the twentieth century, unequivocal consensus about its beneficence does not exist among the general population. In countries with well-established immunisation programmes, vaccines are “victims of their own success”, because low incidences of diseases now prevented with vaccines diminished the experience of their historical burdens. Increasing number of vaccine-hesitant people in recent years threatens, or even effectively disables, herd immunity levels of the population and results in outbreaks of previously already controlled diseases. We aimed to apply a framework for ethical analysis of vaccination in childhood based on the four principles of biomedical ethics (respect for autonomy, nonmaleficence, beneficence and justice) to provide a comprehensive and applicable model on how to address the ethical aspects of vaccination at both individual and societal levels. We suggest finding an “ethical equilibrium”, which means that the degree of respect for parents’ autonomy is not constant, but variable; it shall depend on the level of established herd immunity and it is specific for every society. When the moral obligation of individuals to contribute to herd immunity is not fulfilled, mandatory vaccination policies are ethically justified, because states bear responsibility to protect herd immunity as a common good.
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Bouchez M, Ward JK, Bocquier A, Benamouzig D, Peretti-Watel P, Seror V, Verger P. Physicians’ decision processes about the HPV vaccine: A qualitative study. Vaccine 2021; 39:521-528. [DOI: 10.1016/j.vaccine.2020.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
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Abstract
Although vaccine acceptance and uptake are overall high among children in the United States, vaccine delays or refusals are a growing concern. Vaccine hesitancy is a challenge for the pediatric provider, given the diverse factors associated with hesitancy and the limited evidence on effective strategies for addressing vaccine hesitancy in the provider office. In this article, we review available evidence and approaches for vaccine communication, including the importance of using a whole-team approach, building trust, starting the conversation early, using a presumptive approach for vaccine recommendations, motivational interviewing with parents who have concerns for vaccines, and additional techniques for responding to parent questions. We also review organizational strategies to help create a culture of immunization in the practice, including evidence-based approaches for increasing vaccine uptake and efficiency. Although these communication approaches and organizational strategies are intended to reassure parents who are vaccine hesitant that all routine, universally recommended vaccines are safe and effective, they likely will take on increased significance as the development, implementation, and evaluation of coronavirus disease 2019 vaccines continue to unfold. [Pediatr Ann. 2020;49(12):e523-e531.].
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Vaccination Attitude and Communication in Early Settings: An Exploratory Study. Vaccines (Basel) 2020; 8:vaccines8040701. [PMID: 33233535 PMCID: PMC7712563 DOI: 10.3390/vaccines8040701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/14/2020] [Accepted: 11/19/2020] [Indexed: 01/06/2023] Open
Abstract
Background: This study assesses attitudes towards vaccination in mothers of new-born babies and explores its association with different exposures to communication. Methods: Data were collected through questionnaires administered by means of interviews. Results: Data highlighted that 20% of mothers showed an orientation towards vaccine hesitancy. As for the reasons behind the attitude to vaccine hesitancy, data showed that concern is a common feature. As for the different exposures to communication, 49% of mothers did not remember having received or looked for any information about vaccination during pregnancy and post-partum; 25% stated they received information from several healthcare and non-healthcare sources; 26% declared having received or looked for information by means of healthcare and non-healthcare sources, as well as having taken part in a specific meeting during antenatal classes or at birth centres. The attitude towards vaccine hesitancy tends to reduce as exposure to different communication increases. Conclusions: This study supports the hypothesis that participation in interactive meetings in small groups focused on vaccination during the prenatal course or at the birth point may act as an enabling factor contributing to a decrease in the tendency to experience vaccine hesitation.
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Affiliation(s)
- Pierre Verger
- Research department, Southeastern Health Regional Observatory , Marseille, France.,Aix Marseille University, IRD, AP-HM, SSA, VITROME , Marseille, France
| | - Eve Dubé
- Institut de santé publique du Québec, Centre de recherche du CHU de Québec - Université Laval , D'Estimauville, QC, Canada
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Sondagar C, Xu R, MacDonald NE, Dubé E. Vaccine acceptance: How to build and maintain trust in immunization. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2020; 46:155-159. [PMID: 32558811 PMCID: PMC7279131 DOI: 10.14745/ccdr.v46i05a09] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In Canada, over 80% of parents choose to vaccinate their children. Although this may appear positive, it is one of the lowest vaccination rates in the western world, and does not meet the 95% coverage rate needed to prevent outbreaks of vaccine-preventable diseases such as measles. A recent national immunization survey showed approximately 50% of parents are concerned about potential side-effects from vaccines, 25% believe that a vaccine can cause the disease it was meant to prevent, and 13% think alternative practices could eliminate the need for vaccines. In addition, vaccine hesitancy-defined by its determinants: confidence, complacency and convenience-is on rise. To address the complacency and trust (confidence) components of vaccine hesitancy, four best practices to optimize trust in vaccines and promote vaccine acceptance are presented. The first best practice is to understand the concerns; this is done at a population level via research and at individual level via motivational interviewing. The second best practice is to address these concerns by effectively presenting science-based information. This is done at a population level by communicating research and at an individual level by applying this research to the specific concerns, values and norms of the individual. Third, present immunization as a social norm, both in educational materials and in conversations. Finally, resilience is fostered by planning ahead (both at a population level and for individual practitioners) to manage events that can undermine trust and drive negative vaccine concerns, such as a new vaccine being added to the routine schedule or the emergence of an unexpected adverse event. Building and maintaining public trust in immunization takes time. Healthcare practitioners must keep in mind that while trust is a key element in vaccine acceptance, it is not the only element; convenience and access can also impact vaccine uptake. Nurturing trust is but one part of increasing vaccine acceptance and this brief will focus on strategies to build and nurture trust.
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Affiliation(s)
| | - Ruotian Xu
- Canadian Public Health Association, Ottawa, ON
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, NS
| | - Eve Dubé
- Quebec National Institute of Public Health, Québec, QC
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Gagneur A. Motivational interviewing: A powerful tool to address vaccine hesitancy. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2020; 46:93-97. [PMID: 32281992 PMCID: PMC7145430 DOI: 10.14745/ccdr.v46i04a06] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
According to the World Health Organization, vaccine hesitancy is among the top threats to global health and few effective strategies address this growing problem. In Canada, approximatively 20% of parents/caregivers are concerned about their children receiving vaccines. Trying to convince them by simply providing the facts about vaccination may backfire and make parents/caregivers even more hesitant. In this context, how can health care providers overcome the challenge of parental decision-making needs regarding vaccination of their children? Motivational interviewing aims to support decision making by eliciting and strengthening a person's motivation to change their behaviour based on their own arguments for change. This approach is based on three main components: the spirit to cultivate a culture of partnership and compassion; the processes to foster engagement in the relationship and focus the discussion on the target of change; and the skills that enable health care providers to understand and address the parent/caregiver's real concerns. With regard to immunization, the motivational interviewing approach aims to inform parents/caregivers about vaccinations, according to their specific needs and their individual level of knowledge, with respectful acceptance of their beliefs. The use of motivational interviewing calls for a respectful and empathetic discussion of vaccination and helps to build a strong relationship. Numerous studies in Canada, including multicentre randomized controlled trials, have proven the effectiveness of the motivational interviewing approach. Since 2018, the PromoVac strategy, an educational intervention based on the motivational interviewing approach, has been implemented as a new practice of care in maternity wards across the province of Quebec through the Entretien Motivationnel en Maternité pour l'Immunisation des Enfants (EMMIE) program.
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Affiliation(s)
- Arnaud Gagneur
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC
- Correspondence:
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Note from the editors: Don't stop thinking about tomorrow. Euro Surveill 2020; 25:2001091. [PMID: 31937393 PMCID: PMC6961261 DOI: 10.2807/1560-7917.es.2020.25.1.2001091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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