An Ounce of Prevention: Communicating the Benefits and Risks of
Vaccines to Parents
Matching Communication Styles with Parent Personalities
Stephen R. Barone, MD
To communicate effectively with parents, pediatricians may need to
develop methods of communication that are suited for each different parent
personality type.
According to a poll of the 65 pediatricians in attendance at the
Sept. 18, 2002 interactive symposium, “An Ounce of Prevention:
Communicating the Benefits and Risks of Vaccines to Parents,” most
attendees receive questions about vaccines from at least 25% to as many as 75%
of parents. The most frequent questions parents ask are related to safety. The
majority of the symposium attendees also responded that they spent
approximately one to two minutes speaking with parents about vaccines during a
typical office visit. It is evident that communication with parents is
important but that there is little time during office visits to conduct a
lengthy discussion (Figures 1-4). Therefore, it would benefit physicians to
find the most effective method to communicate with each parent who comes into
the office.
Figures 1-4. Audience Response Poll
(Figures 1-4 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.)
When asked how many times in the last month a parent objected to a
vaccine that was scheduled, more than half of the symposium attendees responded
one to five times. It is clear from this answer that parental concerns about
vaccine safety affect office practices.
Pediatricians understand the importance of immunizations, but they
must also appreciate parental concerns about vaccines and vaccine safety.
Because pediatricians do not have much time during a typical office visit to
discuss vaccines with parents, it is important that they communicate quickly
and effectively to convey the risks and benefits of vaccination to the parents
they are dealing with.
Communication with parents may be difficult for a variety of reasons.
Parents may lack disease awareness or they may have concerns over public health
vs. individual autonomy. The media also fuel misperception about vaccines. The
primary challenge that physicians face when discussing vaccines is adapting
their communication approach because each parent’s perception of risk
differs. Perception of risk may be influenced by culture, religious belief,
race, education, personal beliefs and socioeconomic status (Figure 5).
Communicating with different parent types
Based on the information from one study, parents’ personalities
with regard to how they feel about vaccination were broken into general types:
“Vaccine Believers,” the “Relaxed” group, the
“Cautious” group and the “Unconvinced” group.1
Pediatricians should modify their discussion of vaccines to relay the message
about vaccine safety most effectively to parents.
Vaccine Believers
The Vaccine Believer is most likely to accept the physician’s
recommendation regarding a vaccine and ask basic questions about the safety and
side effects of the vaccine. For this type of parent, the pediatrician should
provide information on both the benefits and risks of vaccination, but stress
that the benefits outweigh the risks. The pediatrician should also distribute
the vaccine information sheet to provide further written information to the
parent.
The Relaxed parent
It may be more difficult to communicate with the Relaxed parent. A
Relaxed parent is less likely to ask for detailed information about vaccine
safety from their physician or to research information on immunization.
Pediatricians are advised to initiate conversations with this type of
parent regarding immunization, emphasizing the benefits that vaccines offer to
children. For a new vaccine, it may be beneficial to speak with parents about
the illness so that the parent understands the necessity of the vaccine.
Framing the discussion is an important part of communication. Risk
vs. benefit analyses have shown that if a parent’s conception of vaccines
is that they are generally safe, the discussion about immunization should be
framed in terms of benefits of vaccines. However, for cautious and unconvinced
parents, the discussion may need to be framed differently.
The Cautious parent
A Cautious parent is likely to inquire if his or her child would
benefit more from contracting natural disease, as opposed to being administered
the vaccine. They would also be likely to challenge the addition of a vaccine
to the vaccine schedule. For this type of parent, it may be important for the
pediatrician to emphasize the risks of the disease. For example, many parents
believe that varicella is not a dangerous disease and that the varicella
vaccine (Varivax, Merck & Co.) is unnecessary. However, varicella is not a
harmless disease. The disease may result in scarring and significant school
absenteeism and is easily spread to other children or adults. Some children may
experience more serious complications of varicella, such as pneumonia or
necrotizing fascitis.
Physicians should present a balanced view of immunization. Parents
must understand that while vaccines are not 100% effective, they prevent severe
complications associated with disease. For example, shortly before the
varicella vaccine was licensed, more children died in the United States each
year from varicella than measles, mumps, rubella, diphtheria and tetanus
combined, which were all preventable with available
vaccines.
The Unconvinced parent
Figure 5. Risk Perception
Risk perception may be influenced by a variety of
factors. (Courtesy of Stephen R. Barone, MD.)
The Unconvinced parent may be the most difficult type of parent for
physicians to communicate with. This type of parent is likely to believe that
vaccines are not safe or that the diseases vaccines prevent are harmless. They
may argue that parents should be able to choose whether or not to vaccinate
their children without interference from the government. For example, this type
of parent may be likely to believe the myth promoted by anti-vaccine groups
that there is a connection between the measles-mumps-rubella (MMR, M-M-R II,
Merck & Co.) vaccine and autism and that the MMR vaccine may be dangerous.
A parent who is certain that a particular vaccine is unsafe may be
unwilling to have their child vaccinated. Pediatricians must then consider the
implications of having an unvaccinated child in their practice. There may be
legal implications, even if the decision not to vaccinate is actually the
parents’ choice.
It is important for a pediatrician to recognize that, even in this
situation, most parents want what is best for their children and form their
beliefs based on what they have read and heard. The pediatrician should try to
help an Unconvinced parent understand that vaccination is ultimately best for
the child, because it is the responsibility of pediatricians to be advocates
for both children and their families.
When parents question vaccine safety, the best way for physicians to
frame a conversation is to discuss the risk of illness. Pediatricians should
make use of existing knowledge about vaccines and how to dispel the myths about
vaccine safety.
Conclusion
Pediatricians bring their own biases to any conversation about
vaccines. It is important to be as informed as possible about vaccines to
present parents with the most current information and to be prepared to answer
any questions about safety. Engaging parents in conversation, rather than
lecturing, is the most efficient way to conduct a dialogue.
What parents really want to know about vaccines is if they are safe
and why their child must receive so many of them. Pediatricians should convey
their personal experience to parents, including what they would recommend for
their own children, if this is applicable.
Addressing each parent’s concerns about immunization and vaccine
safety, which are based on parent personality types and risk perception, will
ensure that each parent receives the personal information required to make the
most informed decision about immunizations.
Reference
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.
