4. WHAT ARE WE TRYING TO ACHIEVE?

In this section, let's think about what you are trying to achieve in a conversation with someone who is Covid vaccine hesitant.

A PATIENT-CENTRED APPROACH

It's common for health professionals to feel their role here is to convince patients to take the vaccine, and perhaps correct any misunderstandings about the vaccine. Success would then be the patient changing their mind and accepting the vaccine.

This approach is understandable, but can often backfire and set up confrontation and lack of trust. Conversations aimed mainly at changing minds or correcting misinformation can become very doctor-centred, can seem disrespectful of patients' concerns and values [whether you think they are rational or not], and risk breakdown of rapport and trust. 

Accurate information is crucial of course, but as we have seen, people make decisions about whether or not to have a vaccine based on so much more than simple information. All sorts of things influence peoples' choices, from their trust of institutions and health professionals, previous experiences and access, to perceptions of risk, friends and family opinions, and what they have read or seen. 

Best practice and motivational interviewing techniques suggest that it is often more fruitful to adopt a more patient-centred approach, starting with listening to and respecting the patient's concerns :

Having listened respectfully to the patient's concerns, you are then in a good position to find out how you might be able to help them make the right decision for them. 

MOTIVATIONAL INTERVIEWING (MI) - IN A NUTSHELL

MI is an interviewing technique that aims to reinforce the motivation and commitment of the person being interviewed. It is less about the health care professional talking to the patient/caregiver and more about working with them. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion (Rollnick et al, 2008). 

 The great strength of motivational interviewing is that it does not seek to persuade or coerce patients into having the vaccine. It offers a different approach, where the practitioner comes “alongside” the patient, tries to understand their views, and offers rather than imposes information that might help them weigh up the risks and benefits for themselves, and make a decision that makes sense to them. 

It is absolutely not a technique for making people do what they might not otherwise want to do. Rather, the patient is encouraged to examine the pros and cons of change and to make an informed decision that they think could lead to improvement in their health and wellbeing. 

 Motivational interviewing has been the subject of over 1600 randomised controlled trials (Stephen Rollnick, personal communication). Recently this has been explored in the vaccine hesitancy field (Gagneur, 2020) and one recent study in a paediatric setting found an increase in vaccine uptake as a result (Gagneur, 2018).

References

• Gagneur 2020: Gagneur A. Motivational interviewing: A powerful tool to address vaccine hesitancy. Can Commun Dis Rep 2020;46(4):93–7. https://doi.org/10.14745/ccdr.v46i04a06
• Gagneur et al 2018: Gagneur A, Lemaître T, Gosselin V, Farrands A, Carrier N, Petit G, Valiquette L, De Wals P. A postpartum vaccination promotion intervention using motivational interviewing techniques improves short-term vaccine coverage: PromoVac study. BMC Public Health 2018 Jun;18(1):811. DOI PubMed
• Rollnick S, Miller WR, Butler CC. Motivational interviewing in health care: helping patients change behavior. New York: The Guilford Press; 2008.
• Easton, G   Re: Covid-19 vaccination hesitancy’, 12 June 2021, https://www.bmj.com/content/373/bmj.n1138/rr-35

Professor Stephen Rollnick, co-developer of motivational interviewing technique