Vaccine Hesitancy (Nursing)

by Heide Cygan, DNP, RN

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    00:01 Despite being recognized as one of the most impactful public health interventions in history, there remain individuals and groups of individuals who are vaccine-hesitant.

    00:11 Vaccine hesitancy is a delay in acceptance or refusal of vaccines, despite availability.

    00:18 Vaccine hesitancy may be to all vaccines or just specific ones.

    00:23 Often, when we consider vaccine hesitancy, we're biased as to why we think an individual or group of individuals may be hesitant to receive a vaccine.

    00:33 We often look at vaccine hesitancy through our own experiences, through our own lens.

    00:38 However, it's important to be aware of our own biases and examine vaccine hesitancy in a more objective way.

    00:46 Vaccine hesitancy has different origins for different groups of people or populations.

    00:51 And in order for us to understand how to best develop public health interventions that increase vaccine adoption, we must first understand what influences vaccine hesitancy.

    01:01 So I'm gonna share a couple of models with you that will allow you to do just that.

    01:07 This is a diagram of the conceptual model of vaccine hesitancy.

    01:12 You'll see here in the middle we have an individual's decisions about that vaccine.

    01:16 There's a spectrum here, from refusal to acceptance.

    01:19 And this is influenced by a variety of different factors. So let's take a look at those factors.

    01:26 On the bottom half of the model, we focus on the community-level factors that influence vaccine hesitancy.

    01:32 Starting first on the left, we have public health services and policies.

    01:37 This includes vaccine programs, availability of clinics or implementation of policies such as school entry vaccine mandates.

    01:46 On the bottom, we have communication and media.

    01:49 The media plays a major role on the perception of vaccines.

    01:53 The media can play a role in instigating or dispelling misconceptions about vaccines.

    02:00 And on the right, we have healthcare professional recommendations.

    02:03 This is not just general recommendations, but the way in which we, as healthcare providers communicate those recommendations and the education that we received about vaccines.

    02:15 And then, along the top, we have personal-level factors that influence vaccine hesitancy.

    02:21 Historical and socio-cultural contacts influence vaccine behaviors.

    02:26 This includes knowledge and information, so what do people know about the vaccine? Past experiences and this can be either individual past experiences, the experiences of friends or family, or even other community members.

    02:40 Next, we have perceived importance.

    02:43 So, how important does an individual think it is to get the vaccine to be protected against the disease? Next, risk perception. Does the individual think they're at risk for the disease in the first place? Subjective norms. What are people around them doing? Is it the norm to get a vaccine or is it the norm to refuse the vaccine? And then finally, religious or moral convictions.

    03:09 Some people have beliefs that are in contrast to vaccines.

    03:13 And you'll see that this is all encircled by trust, the amount of trust or the lack of trust, that an individual or community has influences vaccine acceptance.

    03:23 And I didn't include trust as an afterthought, rather I saved it because it's the most important.

    03:29 We know that in order for health professionals to have a positive impact on vaccine adoption, there must be established trust. Without trust our efforts are all in vain.

    03:41 Within this context, it's also essential that we consider the influence of discrimination on vaccine hesitance.

    03:47 Specifically, racism, both individual and structural, has impact on each of the constructs in this model.

    03:55 We need to consider the role of racism and discrimination, the role that it's played in the availability of healthcare services.

    04:02 What about the role of racism in trusting the healthcare system? Well, we often reference historical examples of discrimination and racism in healthcare.

    04:11 The reality is, is that when I've talked to community members they don't just talk about injustices that happened years ago, they also have examples of discrimination that they have felt recently, last week, yesterday.

    04:24 Together, these experiences influenced trust in the healthcare system, and in this instance, vaccine hesitancy.

    04:32 Another way to examine vaccine hesitancy is through the vaccine hesitancy matrix.

    04:37 We start first by looking at factors within their contexts.

    04:41 This includes examination of the world around us.

    04:44 The media environment, influential leaders, historical influences.

    04:49 Also, individual factors such as religion or gender, politics, policies.

    04:54 We look at the geographic region and barriers due to the geographic location.

    04:59 Also, here we include the perceptions of the pharmaceutical industry.

    05:04 Next, we consider individual and group influences.

    05:07 Some of these include personal experiences, beliefs, knowledge, trust, perceived risk, perceived benefits, and social norms.

    05:18 The last factors to consider are vaccine-specific issues.

    05:23 This include the risks and the benefits of the vaccine, the introduction of a new vaccine, the mode of administration, the vaccine program, the reliability of sources of information about the vaccine, the vaccine schedule, costs or availability, and finally, the strength of vaccine recommendations.

    05:44 Now, as with the previous model, it's essential that we consider the impact of discrimination and racism on each of these constructs.

    05:51 This allows us to gain a more comprehensive understanding of vaccine hesitancy.

    05:56 And you'll see many similarities between the conceptual model for vaccine hesitancy and this matrix.

    06:03 Both are useful tools that we can use to explore vaccine hesitancy.

    06:08 As we examine each construct, we can use the information to design a more effective public health nursing intervention that will increase vaccine adoption.

    06:18 So now that we've discussed models to help us better understand vaccine hesitancy, let's discuss strategies to address vaccine hesitancy.

    06:26 The first strategy is tell, don't ask.

    06:30 Essentially what this means is rather than ask someone if they want a vaccine, we simply state that it's time to receive the vaccine.

    06:37 I recently saw this approach during a well-child visit.

    06:40 According to the CDC schedule, it was time for my daughter to get her DTaP vaccine.

    06:46 Rather than ask me if I wanted to have her get the vaccine, the nurse simply explained that she was due for the vaccine and would receive it at the end of the visit.

    06:54 This approach is typically well received when used for routine vaccines that patients are familiar with.

    07:00 However, other approaches are helpful for more vaccine-hesitant patients or for vaccines the public is not quite as familiar with.

    07:09 Another strategy we can use is the use of motivational interviewing.

    07:13 This is done by sharing very targeted information based on the specific concerns of the patient.

    07:19 With this approach, we first ask thoughtful questions.

    07:22 These questions allow us to understand the patient's specific concerns.

    07:27 Then, we're able to provide information that's specific to those concerns.

    07:32 By using motivational interviewing, we support patient autonomy.

    07:35 We reduce defensiveness, and through this, we also support personal agency to ensure the individuals understand that their efforts can reduce risks, all in the effort to increase vaccine adoption.

    07:49 The final approach is called CASE. This stands for corroborate about science and explain.

    07:56 So first, we corroborate the patient's concerns and have a respectful conversation about those concerns.

    08:03 Next, A stands for about. We tell the patient about ourselves.

    08:08 Explain your level of expertise, what makes you a credible source of information? So for example, George may say, I'm a public health nurse.

    08:18 I've been working in this community for 20 years.

    08:21 It shows his expertise, why he should be listened to when it comes to vaccines.

    08:26 Next, the S, stands for science. Use science as the base of your recommendations.

    08:32 Recommendations should be evidence-based.

    08:34 And finally, E, explain. Explain and advise on vaccine guidelines.

    08:41 Now, remember, before you use any of these strategies, it's important that you do your homework.

    08:47 The conceptual framework or the matrix that we just talked about can be used to understand why an individual or a community might be vaccine-hesitant.

    08:56 Using that information, you can select the best strategy.

    08:59 The strategy that will be most impactful for increasing vaccine adoption.

    About the Lecture

    The lecture Vaccine Hesitancy (Nursing) by Heide Cygan, DNP, RN is from the course Epidemiology (Nursing).

    Included Quiz Questions

    1. A town only has one vaccine clinic during flu season.
    2. The school board’s vaccine mandates.
    3. A news station is airing a segment on how vaccines are dangerous.
    4. A family member has a severe reaction to a vaccine.
    5. A person feels as if the vaccine is unnecessary.
    1. Contextual influence
    2. Individual influence
    3. Group influence
    4. Vaccine specific issues
    1. Using motivational interviewing to determine the cause of vaccine hesitancy.
    2. Using the “tell, don’t ask” method for routine vaccines.
    3. Using the STOPP method for providing scientific evidence.
    4. Withholding medications and services until the client consents to vaccination.
    5. Giving the client a copy of the Vaccine Hesitance Matrix.
    1. Racism
    2. Risk perception
    3. Past experiences
    4. Perceived importance of vaccination

    Author of lecture Vaccine Hesitancy (Nursing)

     Heide Cygan, DNP, RN

    Heide Cygan, DNP, RN

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