COVID-19 vaccines showcase the effectiveness and efficiency of modern science and are providing the surest way forward for getting out of the pandemic which has gripped the world for the past 18 months.
Yet, some Canadians remain hesitant about taking advantage of them and these represent a significant minority of your patients. Overcoming their hesitancy involves supporting their decision-making process so they can make the choice that is best for them, not telling people what to do. This can be achieved using motivational communication approaches.
Canadian data from the iCARE (International COVID-19 Awareness and Responses Evaluation) study that we have been coordinating since last March indicates that about 50%-60% of people are ready and willing to receive a COVID-19 vaccine as soon as it is made available to them. Another 10% of people are not necessarily “anti-vaccination” but have very low intentions of being vaccinated. Their perspective is often the result of pre-existing and often long-held negative beliefs that are not necessarily specific to COVID-19 vaccines.
What is Vaccine Hesitancy?
The remaining segment of the population – about one third – are what can be termed ‘vaccine-hesitant’. These people want to get vaccinated and experience all the protections and benefits that come with it, but have concerns about the need to get vaccinated, or have concerns about the safety of vaccinations (which may be driven in part by conflicting media reports about safety and side effects). These individuals tend to be slightly younger than those who are positive about the vaccines, more likely to be from underrepresented groups, have lower incomes and live in suburban areas. Interestingly people in this group are also more likely to be health care providers.
Talking to your patients about COVID-19 depends very much on where they fall on the continuum of vaccine acceptance. For those who are receptive the conversation is easy and straightforward. Once you ask them about their intent to get the vaccine and they answer positively, all you need to do is reinforce their intent. You can then administer the vaccine to them if you have that capacity or talk to them about making an appointment as soon as possible.
What to do if someone does not want to receive a vaccine?
For those who are adamant they are not going to be vaccinated, there is very little that you can say that will convince them there and then to get the vaccine. You should avoid getting into a debate or argument with them. Instead, the focus of the discussion should be on understanding their point of view about vaccines, not convincing them to get vaccinated. You may also want to ask permission to share information about COVID-19, and if they give you permission to share information, you could remind them of the following:
- If they are not vaccinated, they have a higher probability of getting COVID-19 and transmitting it to others;
- The need to be aware of the symptoms of COVID infection;
- The need to get tested and self-isolate;
- If they do get infected, they need to know the risks of severe disease and long-term effects.
What is important to emphasize when sharing this information is that you are giving it to them NOT to convince them to get vaccinated, but to prepare them for what is more likely to happen among those who are not vaccinated. Regardless of what they say, the goal is to remain open to hearing their views and keeping the door open for future discussion.
Shifting from Vaccine Hesitancy to Vaccine Acceptance
Good evidence-based communications strategies exist to help increase the willingness of the vaccine-hesitant segment of the population to be more accepting of COVID-19 vaccines. These communications skills are often wrongly regarded as “soft skills” by those who prefer to focus on other areas of expertise required to conduct clinical examinations. The reality is that what you say and how you say it can strongly influence patient behavior and communicating poorly is not only not effective, but can actually increase resistance to vaccination.
Motivational communications enhance internal motivation to change a behaviour such as by aligning being vaccinated with altruistic goals and values or by showing it will increase the chances of achieving desired outcomes such as returning to work or being able to travel. It focuses on exploring and resolving ambivalence with an emphasis on shared decision-making tailored to a person’s preferences and values.
In talking to vaccine-hesitant patients, you should avoid beginning your discussion by saying the vaccine will definitely protect you and others around you from COVID-19 and that you should definitely be vaccinated. Also, you should avoid pointing out any erroneous perspectives they may have – this tends elicit defensiveness and build resistance.
What you really need to do is engage in a conversation about the issue rather than force your agenda and views on them. This approach is not proscriptive and allows you to tailor the information you provide to a specific patient to help them view vaccines more positively.
It is likely that this conversation will address at least one of the three key issues creating barriers to people’s willingness to be vaccinated:
- Complacency and a skewed perception of individual risk of becoming infected
- Confidence in the efficacy and safety of the vaccine
- Convenience and the ease in obtaining the vaccine. This latter point is often the quickest and easiest to address.
Discussing Vaccines with patients
At the core of all behaviour change are influencing three variables: knowledge, motivation and confidence, which must be addressed to change how a person makes decisions about their behaviour.
The process of engaging a patient should always begin with an open question to discover their specific concerns about the COVID-19 vaccines. Showing that you are listening and have heard their perspective is fundamental and should be reflected in your response to them. The next step is to ask their permission to provide them with information to counter any inaccurate views they may have about the safety or efficacy of the vaccines, for instance. The information you provide should be factual and provided in a very neutral way rather than your personal view or perspective.
If you provide a patient any information, you want to check what the patient’s interpretation or understanding of that information. The final step should be to get a commitment from the patient to do something – be it making a commitment to be vaccinated or think further on the information you have provided and get back at a planned follow-up visit.
During all steps in this process it is important to be clear that it is the patient who will ultimately decide whether to get vaccinated or not. It’s not your job to convince them get vaccinated and we must, at all times, respect their autonomy and right to choose. Your only responsibility as a healthcare provider is to ensure patients have the necessary information with which to make an informed decision.
What You Need to Remember
At the end of the day, you should always come back to the fact that the data points to the fact that COVID-19 vaccines are safe and effective for the vast majority of individuals. Communicating this information in the right way can sway a large proportion of the hesitant population to make an informed decision.
About the authors
Kim Lavoie is a Full Professor in the Department of Psychology at UQAM and an Adjunct Professor of Medicine at University of Montreal. She holds a Tier 1 Canada Research Chair in Behavioural Medicine and is a researcher in the Research Centre of the CIUSSS-NIM. She is the Co-Director of the Montreal Behavioural Medicine Centre and Co-Lead of the International Behavioural Trials Network (IBTN). Dr.Lavoie co-leads the iCARE study that seeks to assess public awareness, attitudes, concerns and behavioural responses to public health policies implemented to reduce COVID-19 transmission, as well as the impacts (e.g., psychosocial, health, economic) of the pandemic among Canadians and people around the world.
Dr. Kim Lavoie
PhD, FCPA, FABMR
Simon Bacon is a Full Professor in the Department of Health, Kinesiology, and Applied Physiology at Concordia University and an Adjunct Professor of Medicine at University of Montreal. He is a professor and CIHR SPOR Chair in Innovative, Patient-Oriented, Behavioural Clinical Trials, Health, Kinesiology and Applied Physiology. He is also the co-director of the Montreal Behavioral Medicine Centre (MBMC) – primary investigator of iCARE study, a researcher at the CIUSSS-NIM, and co-leads the International Behavioural Trials Network.