The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits
Open accessAbstract
OBJECTIVE: To characterize provider-parent vaccine communication and determine the influence of specific provider communication practices on parent resistance to vaccine recommendations. METHODS: We conducted a cross-sectional observational study in which we videotaped provider-parent vaccine discussions during health supervision visits. Parents of children aged 1 to 19 months old were screened by using the Parent Attitudes about Childhood Vaccines survey. We oversampled vaccine-hesitant parents (VHPs), defined as a score ≥50. We developed a coding scheme of 15 communication practices and applied it to all visits. We used multivariate logistic regression to explore the association between provider communication practices and parent resistance to vaccines, controlling for parental hesitancy status and demographic and visit characteristics. RESULTS: We analyzed 111 vaccine discussions involving 16 providers from 9 practices; 50% included VHPs. Most providers (74%) initiated vaccine recommendations with presumptive (eg, “Well, we have to do some shots”) rather than participatory (eg, “What do you want to do about shots?”) formats. Among parents who voiced resistance to provider initiation (41%), significantly more were VHPs than non-VHPs. Parents had significantly higher odds of resisting vaccine recommendations if the provider used a participatory rather than a presumptive initiation format (adjusted odds ratio: 17.5; 95% confidence interval: 1.2–253.5). When parents resisted, 50% of providers pursued their original recommendations (eg, “He really needs these shots”), and 47% of initially resistant parents subsequently accepted recommendations when they did. CONCLUSIONS: How providers initiate and pursue vaccine recommendations is associated with parental vaccine acceptance.
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Virtual simulation games can provide psychological safety and lessen fear, anxiety, and embarrassment in new learners who worry about making mistakes in front of fellow students and instructors.
“VSGs can also provide psychological safety and lessen fear, anxiety, and embarrassment in new learners who may worry about making mistakes in front of fellow students and instructors [16–18].”
From Development and evaluation of virtual simulation games to increase the confidence and self-efficacy of healthcare learners in vaccine communication, advocacy, and promotion (2024) · cites this paper as [18]
The Qualitative and Study Participants sections describe coding training and observation of pediatric vaccine discussions, not virtual simulation games. Searches for psychological safety and for learners’ fear of making mistakes found no passage addressing whether games reduce fear, anxiety, or embarrassment; page numbers were not available in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredHealthcare providers are most likely to improve their confidence in communication skills through repeated practice with patients, and simulations are an effective way to emulate real patient scenarios.
“Ultimately, HCPs are most likely to improve their confidence in communication skills through repeated practice with patients, and simulations are an effective way to emulate real patient scenarios.”
From Development and evaluation of virtual simulation games to increase the confidence and self-efficacy of healthcare learners in vaccine communication, advocacy, and promotion (2024) · cites this paper as [18]
The Discussion describes communication practices associated with parental vaccine resistance, not how providers gain confidence in their communication skills. Searches for repeated practice with patients and for simulations found no passage addressing either claim; the Qualitative section's training session concerns researchers coding encounters, not provider training. (LLM, conf=0.76)
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The impact of access to immunization information on vaccine acceptance in three countries
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Measles, Mandates, and Making Vaccination the Default Option
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Impact of Childhood Vaccine Discussion Format Over Time on Immunization Status
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Life-course immunization as a gateway to health
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Interventions to Improve Adolescent Vaccination
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- Authors
- Opel, D. J., Heritage, J., Taylor, J. A., Mangione-Smith, R., Salas, H. S., DeVere, V., Zhou, C., & Robinson, J. D.
- Affiliations
- University of Washington (US)
- University of California, Los Angeles (US)
- Seattle Children's Research Institute (US)
- Portland State University (US)
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2013-12-01
- Volume
- 132
- Issue
- 6
- Pages
- 1037-1046
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- PMC
- PMC3838535
- OpenAlex
- W2116049831
- Cited by
- 507
- References
- 58
- Citations by year
- 2026: 38 · 2025: 25 · 2024: 43 · 2023: 44 · 2022: 44 · 2021: 48 · 2020: 41 · 2019: 44 · 2018: 51 · 2017: 33 · 2016: 34 · 2015: 44 · 2014: 16 · 2013: 2
- FWCI
- 36.42
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- PEDIATRICS (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (1K23HD06947, K23HD069467)
- Topics
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
- Keywords
- vaccine hesitancy, vaccine communication, childhood immunization, vaccine recommendations, participatory communication, vaccine acceptance, pediatric primary care
- MeSH terms
- Adult, Cross-Sectional Studies, Female, Humans, Infant, Male, Parents, Patient Acceptance of Health Care, Professional-Family Relations, Vaccination, Video Recording, Washington, Multivariate Analysis, Logistic Models, Practice Guidelines as Topic, Qualitative Research, Directive Counseling
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