An Ounce of Prevention: Communicating the Benefits and Risks of
Vaccines to Parents
Communication in the Physician’s Office
Sharon G. Humiston, MD, MPH
Physicians play a large role in influencing the decisions parents make
about health care for their children. However, many barriers exist that can
impede the communication between physicians and parents. The most substantial
barrier to communication is lack of time. According to a study published in the
Archives of Pediatric and Adolescent Medicine in which physicians
were timed with a stopwatch, physicians spent a median of 1.9 minutes
discussing vaccines with parents. This is a small amount of time, considering
how many vaccines are administered in the current schedule.1
Communication barriers
According to a survey that was sent to family practitioners and
pediatricians, lack of time was the largest barrier to communication. Other
communications barriers identified by the survey were that many providers
believed parents did not want to know about vaccine safety issues or that they
felt the risks of vaccine were considered too rare to be important. It was
rarely reported that the providers were unsure of how to communicate with
parents (Figure 1).
Parents rely on their primary-care physician for most of the medical
information they receive. According to parent focus groups conducted in six
cities across the United States, parents want a relationship with their
primary-care physician that includes personal communication about not only the
benefits, but also the risks of each vaccine. Because parents also have limited
time, they requested clear, easy-to-understand information, both verbal and
written, about vaccines.2
The results of the focus group study indicated which questions
parents asked most frequently. These questions included: What vaccines will my
child receive? Why does my child need so many vaccines? What diseases do
vaccines prevent? What are the common, mild side effects of vaccines and how do
I manage them? Parents also wanted physicians to briefly describe the possible
severe risks of vaccines and give them information on the comprehensive
immunization schedule. These questions touch on all of the basic facts about
immunization.
Current office practices
Recently, a self-administered survey was mailed to family
practitioners and pediatricians regarding how communication with parents about
vaccine is conducted. Seventy-four percent of the physicians surveyed reported
that they spoke with parents about the immunization schedule and 72% of
physicians reported that they communicated common side effects of vaccines to
parents. Approximately 60% of physicians surveyed reported that they
communicated both health benefits of vaccines and severe side effects. Less
than half of those surveyed stated that they spoke with parents about
contraindications of vaccines and only 11% of those surveyed informed parents
verbally about the National Vaccine Injury Compensation
Program.3
Regarding written materials provided to parents, 69% of pediatrician
surveyed reported that they distributed the Vaccine Information Statement
provided by the Centers for Disease Control and Prevention (CDC). Only a small
minority of physicians stated that they distributed no written material to
parents about vaccines. Most physicians indicated that they distributed
materials about vaccines during each vaccine visit. Approximately one-third of
pediatricians indicated that they provided some materials prior to the
visit.
Distributing materials prior to the office visit is an effective
means to aid communication between physicians and parents. The inoculation
theory of communication states that if people receive small bits of information
before they need it, they are more likely to remember the information and to be
“immune” to anti-vaccine media stories.
According to the survey, the nurse is most likely to distribute
materials to parents during the office visits and to discuss common side
effects, but it is the physician who discusses the severe risk information with
parents. Physicians reported that the most useful additional materials that
could be provided to parents would include a pre-immunization booklet and
materials printed in other languages.
Improving communication
A pilot study was conducted in two pediatric practices in Shreveport,
La. in 2000 to examine how to improve communication between pediatricians and
parents. The intervention included an office in-service by a pediatric
infectious disease specialist and supporting materials.
During the intervention, an exam room poster inviting parent
questions was distributed in each of the pediatric offices. The poster was
brightly colored and showed the immunization schedule in picture format. The
poster included the most common questions parents ask about vaccines. The goal
of the poster was to start an interactive process — to empower parents to
ask questions and to remind physicians to speak to parents about vaccines.
Figure 1. Communication Barriers
Results of a
survey on communication barriers that was sent to pediatricians and family
physicians (P & FP), as well as to public health nurses (PHN).
(Reprinted with permission from Pediatr Ann.
2001;30(7):400-406.)
Researchers followed 208 well baby visits, 130 of which were
conducted prior to the intervention and 78 of which were conducted after the
intervention. The researchers concluded that the intervention improved
communication between the pediatricians and the parents. The Vaccine
Information Statement was given to more parents, and pediatricians were
more likely to screen for contraindications to the vaccine after the
intervention. In addition, communication about vaccines improved in areas such
as contraindications, the immunization schedule, side effects, benefits and
risks. The improvements in communication were noted for the nurses as well as
the physicians.
During the intervention phase, physicians spent an average of 20
extra seconds each visit discussing vaccines with parents, but the increase in
communication led to a significant improvement in parent satisfaction with
vaccine safety conversations.4
At the conclusion of the pilot study, a recommendation was made for a
systems approach to vaccine communication using the most current vaccine
messages prepared in advance. The poster, listing frequent parent questions
about vaccines, helps to prepare the office staff with easily understood and
fast answers to those concerns. Teaching the entire office staff to use these
messages and provide competent risk-benefit communication takes some of the
burden away from the physicians.
It is important for immunization nurses and staff to develop succinct
messages for parents about vaccine safety so they are prepared when parents
have questions. Staff should provide vaccine information statements before
vaccines are administered and use the booklet and contraindication screening
sheets to streamline communication.
According to a poll of the audience in attendance at the interactive
symposium, “An Ounce of Prevention: Communicating the Benefits and Risks
of Vaccines to Parents,” the best way to prepare office staff to handle
vaccine safety questions is with continuing education programs, instructional
posters, and reading materials (Figure 2).
Characteristics of parent attitudes regarding vaccines
In one study regarding vaccine communication, researchers determined
that parents could be broadly divided into four groups, “Vaccine
Believers,” the “Relaxed” group, the “Cautious” group,
and the “Unconvinced” group. Vaccine believers were found to be more
affluent and educated than those in the Cautious or Unconvinced groups.
Ninety-seven percent of Vaccine Believers considered immunization extremely
important and the members of this group had the highest confidence rating in
vaccine safety. The most significant predictors of a Vaccine Believer included
a strong belief in vaccine safety, compliance with recommendations and
mandates, and creative, flexible thinking.5
Figure 2. Audience Response Poll
Office staff can
be better prepared to handle questions about vaccine safety through the use of
reading materials instructional posters, and continuing education programs.
(Figure 2 from the Infectious Diseases in Children meeting
“An Ounce of Prevention: Communicating the Benefits and Risks of Vaccines
to Parents;” Sept. 18, 2002; Chicago, Ill.)
According to the study, 34% of parents fell into the Relaxed group.
Members of this group were also more affluent and educated than those of the
Cautious and Unconvinced groups. The most significant predictor for members of
this group was being less likely to agree with statements of parental guilt or
worry. Members of this group spent the least amount of time talking to their
doctor or seeking health care information. They were less likely than the
Cautious parents to view the world as unsafe.
According to the study, parents in the Cautious group tended to rely
on more sources of information, including health clinics, day cares, schools,
pharmacists, media and pharmaceutical company pamphlets. The best predictors of
this group were high emotional involvement of parent with child and rigid
thought patterns. Like the Vaccine Believers, Cautious parents tended to
believe that disease protection was necessary. This is the group that
physicians will need to spend the most time with because Cautious parents will
have the most questions and concerns.
The study found that only 65% of Unconvinced parents thought that
vaccination was extremely important. Parents in this group were more likely to
have treated a child with alternative natural therapies and not to trust health
care providers except chiropractors. Members of this group were more likely to
be single and to have not finished college. They were also more likely to
home-school their children.5
Conclusion
Physicians face different challenges in communicating with each of
the parent styles identified by this study. Vaccine Believers are the easiest
to communicate with because they agree that vaccines are important. For the
Relaxed parents, it is important that physicians not overlook unasked
questions. The Cautious parents are the most time-consuming and require the
most attention. The Unconvinced parents are the most difficult to communicate
with because they may not trust public health authorities or doctors.
Communicating with parents about vaccine safety and the risks and
benefits of vaccines is crucial to empowering parents with information so that
they can make the most educated decisions for their children. Physicians should
realize that not all communications styles will be effective for all parents
and they may want to tailor their method of communication to parent personality
types.
References
LeBaron CW, Rodewald L, Humiston S. How much time is spent on
well-child care and vaccinations? Arch Pediatr Adolesc Med.
1999;153(11):1154-1159.
Fredrickson DD, David TC, Bocchini JA Jr. Explaining the risks and
benefits of vaccines to parents. Pediatr Ann.
2001;30(7):400-406.
David TC, Fredrickson DD, Arnold CL, et al. Childhood vaccine
risk/benefit communication in private practice office settings: A national
survey. Pediatrics. 2001;107(2):E17.
Davis TC, Fredrickson DD, Bocchini C, et al. Improving vaccine
risk/benefit communication with an immunization education package: A pilot
study. Ambul Pediatr. 2002;2(3):193-200.
Keane MT, Walter MV, Patel BI, et al. Confidence in vaccination: A
parent segmentation model. From the Merck Vaccine Division, Merck & Co.;
unpublished data, 2002.
