Understanding how health care providers can prompt vaccine uptake

Key takeaways:

• Vaccine hesitancy can be addressed with physician recommendations that are tailored to a patient’s individual level of hesitancy.
• Unvaccinated individuals desire unbiased information on vaccines from providers.

WASHINGTON — There are different ways to promote vaccination, and provider-patient communication is a major component to addressing vaccine hesitancy, according to a presentation at the American Thoracic Society International Conference.

“[There are] several levers for increasing vaccination, which can really map to different levels in the health care ecosystem, with vaccine requirements at the health policy level, on-site vaccine availability in doctor's offices at the health care system level, and then down to the importance of provider-patient communication,” Kimberly A. Fisher, MD, MSc, associate professor of medicine and pulmonary critical care at UMass Chan Medical School, said during the presentation.

In a vignette-based experimental survey, Fisher and colleagues evaluated 756 individuals in January 2021 who reported that they are either not sure or do not plan to receive the COVID-19 vaccine to determine if messages from a health care provider on vaccination positively impact a patient’s intent to be vaccinated.

Individuals who participated in this survey were asked to put themselves into a hypothetical scenario, Fisher said.

“In this group [of vaccine-hesitant individuals], we asked [them] to imagine that they were at a visit with their doctor for a regular checkup,” Fisher said. “At the end of the appointment, the doctor said we have the COVID-19 vaccine available, you’re eligible to get it. It’s very safe and very effective. At this point, the participants were randomly assigned to receive one of five different additional messages from their health care provider, and then we reassessed their vaccination intent.”

According to Fisher, each of the four persuasive messages were written to touch on concerns regarding the COVID-19 vaccine: “I’ve reviewed the studies carefully,” “This vaccine is as safe as the flu vaccine, and it’s MORE effective,” “Millions of people have already gotten it,” and “It’s the best way to protect the people you are close to.” Following each message was the statement, “I recommend that you get it,” as well as, “What do you think?”

When evaluating how many participants became less vaccine hesitant, Fisher and colleagues found that the influence of the different messages did not significantly differ within the “not sure” group; however, they did find that the message “It’s the best way to protect the people you are close to and keep them healthy” led to a significant increase (P = .03) in vaccine intent in the group that said they do not plan to get the COVID-19 vaccine.

“I think these findings really support ... the need for tailored communication according to the degree of hesitancy, and it also suggests that a prosocial message may be one of the more effective messages among the more hesitant individuals,” Fisher said.

Learning patient, provider concerns

In addition to this survey study, Fisher was involved in a focus group study, in which 35 COVID-19 vaccine-hesitant individuals voiced their thoughts on communication with their provider.

Before presenting these patient responses, Fisher said health care providers should keep several things in mind when talking to patients who are vaccine hesitant based on what was heard from patients in this study, including that they are skeptical of information related to the COVID-19 vaccine, they have trouble navigating information that conflicts with other information and they may feel stigmatized for their unvaccinated status.

Fisher said, “One person said, ‘There’s a lot of shaming. It’s all over social media. People are very hateful towards people that aren’t vaccinated.’”

In terms of what unvaccinated patients want from their providers when they are talking about vaccines with them, three main desires emerged. Fisher said these patients desire detailed and unbiased information, do not want to feel like they are being “force fed” information and desire that they are being listened to and understood.

To hear both the patient and provider sides, 40 primary care physicians participated in focus groups, to which Fisher said four common experiences were brought up when thinking about how they communicate with vaccine-hesitant patients. In the focus groups, PCPs expressed that this group of patients do not seem open to information, which in turn made them question their trustworthiness, shorten the time they spent talking with these patients about vaccines and feel frustrated.

Other ways to promote vaccination

Although health care provider recommendations play a role in getting individuals vaccinated, it is important to understand that there are other ways to promote this action, according to Fisher.

In a survey that asked individuals where they would want to receive the COVID-19 vaccine, Fisher and colleagues found that 683 individuals (42%) said a doctor’s office, of which more individuals with a “not sure” intent to get vaccinated answered with this location than patients with an accepting intent. Further, compared with Latino or white individuals, more Black individuals preferred to get the vaccine in a doctor’s office, and this was found in both those with an accepting intent and those with a hesitant intent.

“We think that COVID-19 vaccine availability at doctor’s offices may be an important lever to increase uptake among vaccine-hesitant individuals and also members of racial minority groups,” Fisher said.

To wrap up her presentation, Fisher shared preliminary findings from a study that sought to understand the reason for which 51 individuals vaccinated after April 2022 chose to get vaccinated. According to Fisher, many of these individuals were vaccinated because it was required in order to do something, such as get a job or travel.