Cited by 507Vaccine Coverage and HesitancyPatient-Provider Communication in HealthcareEthics and Legal Issues in Pediatric Healthcare

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The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits

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Opel, Douglas J., Heritage, John, Taylor, James A., Mangione-Smith, Rita, Salas, Halle Showalter, DeVere, Victoria, Zhou, Chuan, Robinson, Jeffrey D.·2013·Pediatrics

DOI 10.1542/peds.2013-2037PMC PMC3838535

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Abstract

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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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)
ORCID: Opel, Douglas J.
Heritage, John
Zhou, Chuan
Robinson, Jeffrey D.
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
DOI: 10.1542/peds.2013-2037
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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The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits

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