Building Trust in the Moment (Est. 4 min read)

One of the few proven ways to move parents from vaccine hesitancy to vaccine confidence is motivational interviewing. In this method, health care providers first figure out what might spark a person to make a change. Then, they strengthen that motivation by tapping into the reasons the person has already given. When it comes to COVID-19 immunization, a motivational interviewing approach helps us spot the mindsets that are driving a parent’s decision-making. That helps us to provide them with information that responds to their concerns.

Even though this method is called an interview, it shouldn’t feel formal or one-sided. The ideas is to purposefully guide a conversation through different stages. All along the way, we are continuing to build the relationship.

A motivational interview doesn’t always follow a strict sequence or a straight line. That said, the examples below are presented in one sequence that might unfold naturally.

Questions to Draw Out Vaccine Motivations

When we draw out the thoughts of a parent or caregiver, we uncover their own commitments and values. Their own beliefs are much more powerful motivators than any opinion or fact we can offer. Also, a family’s own values offer a very different starting point than the vaccine itself.

Asking carefully worded questions can get families talking about their priorities for their children’s health. Here are some suggestions:

“When it comes to the COVID-19 pandemic and your child, what has been important to you?”

“What do you think about the advantages of vaccination in general?”

Ways to Affirm Families’ Commitments to Their Children’s Health

Affirmations are a key part of motivational interviewing. Highlight the values that families hold. Say something about the positive side of any actions they have already taken. Affirmations show that you notice what’s strong, not just what’s “wrong.” This can dispel family’s fears of being judged or criticized.

For affirmations to work, they must be genuine and connect to what the family has shared. Depending on the context, these examples might help you affirm families:

“I can see that the health and safety of your children are important to you.”

“You already have a lot of knowledge.”

“I don’t think you’re off-base to be concerned; that makes total sense to me.”

Ways to Recap What Families Have Shared

Reflective listening summarizes what you are taking from what families have shared. If you are new to this practice, it may feel awkward or artificial at first. Keep trying! It is important because it allows the family to build on or correct your understanding.

There are two types of reflective statements. Simple reflections restate what they have just said, almost word for word. Complex reflections state what you think they mean.

Simple reflection: “It sounds like you have read articles about the relationships between vaccines and long-term side effects.”

Complex reflection: “What matters most to you is that your child is as healthy as possible.”

Opening Lines for Sharing Vaccine Information

Before offering facts, ask for permission. When we gain our conversation partner’s permission before sharing information, we gain a willing learner. Try these questions to elicit a family’s agreement to hear you out:

“If you’d like, I could add to what you know by sharing what I’ve learned. Would that be okay?”

“Are you interested in hearing more about what I’ve learned as I’ve studied this issue?”

If the answer is “no,” respect the boundary. Remember that the goal is to build a positive, trusting relationship. Don’t ask why they didn’t agree. Instead, re-engage the family by asking about what they have been reading or hearing about vaccination.

If the answer is “yes,” offer information that strengthens their vaccine motivations or responds to their concerns. (See our resource, “Moving Mindsets: Techniques for Building Vaccine Confidence,” for suggested directions.)

Questions for Checking Reactions to New Vaccine Information

Once you have shared new vaccine information, double-check to see what the family has understood and what they will do with the information.

Try these questions to invite families to think aloud as they process what you have shared:

“I hope that made sense. Do you have questions or other reactions you’d like to share?”

“How does this new information land with you?”

Closing—or Returning to—the “Interview Loop”

If your interaction has led to the family feeling more confident than before, they may say they are now willing to accept the vaccine. (Well done!) Help them take the next step. Do what you can to make it as easy and convenient as possible.

If they express another concern or say that they ready yet, it can help to ask for permission to share more information or make other messaging moves that build confidence.