“While a small percentage (~1%) of parents reject all vaccines, most parents vaccinate their children according to the recommended schedule; even the majority of hesitant parents hold some ambivalence that can be influenced by trusted clinicians. Some parents express concerns about the number of vaccines given at once, while others fear potential long-term adverse effects. Additionally, medical mistreatment over generations and inconsistent access to health care contribute to distrust among some communities. What all these parents have in common, though, is that—like the clinician caring for them—they are trying to do what is best for their children. This is the single most important thing to recognize when communicating with families about vaccines. [..]
When encountering resistance, the World Health Organization, US Centers for Disease Control and Prevention, and the American Academy of Pediatrics recommend using motivational interviewing. Evidence for the use of motivational interviewing for health behavior change is strong, although data supporting its use in vaccine conversations are limited. A multicomponent cluster randomized clinical trial of 43 132 patients in 16 clinics (8 interventions, 8 controls) testing a motivational interviewing–based communication training designed to improve clinician-parent communication to increase human papillomavirus (HPV) vaccination demonstrated that adolescents in intervention clinics had significantly larger increases in HPV vaccine series initiation (31.6% at baseline, 42.9% postintervention) compared with adolescents in control clinics (37.1% at baseline, 38.9% postintervention; absolute difference, 9.4%). Techniques of motivational interviewing include open-ended questions, affirmations, reflections, asking permission to share (also known as “elicit-provide-elicit”), and autonomy support. Using asking permission to share as an example, a parent may say they do not want the seasonal influenza vaccine because it causes the flu. The tendency is to refute that by telling the parent that influenza vaccine has some adverse effects that occasionally cause fever or fatigue, but that it cannot cause the flu. This type of response leads to an ineffective expert vs nonexpert dynamic. Inserting a simple statement, such as “I’ve heard that concern before and I’ve looked into it. Would you mind if I share with you what I found out?” may make parents more receptive to the subsequent shared factual information. [..]
Clinicians can also leverage values-based messaging—based on Jonathan Haidt’s Moral Foundations Theory—to align vaccine acceptance with parental priorities. Many vaccine-hesitant parents value natural health approaches and personal autonomy. Instead of positioning vaccines in opposition to these values, clinicians can frame immunization as a way to support a child’s natural defenses and protect personal freedom by preventing serious illness. Additionally, emphasizing the broader community benefits of vaccination—such as protecting newborns, immunocompromised individuals, and older family members—can appeal to parents’ sense of community.
Vaccine conversations should not be seen as one-time discussions, but as ongoing dialogues built on a trusting relationship. Parents who initially refuse vaccines may change their minds over time, especially if they continue to hear consistent messages from a trusted clinician. Gentle persistence—combined with respect for parental decision-making—can ultimately lead to higher vaccine uptake.”
Full article, ST O’Leary, JAMA, 2025.4.9