Motivational Interviewing: A Promising Tool to Address Vaccine Hesitancy

Generally, approaches to address vaccine hesitancy (VH) involve either mandatory immunisation policies or more traditional approaches of education and information. Policies compelling vaccination do not address the root causes of VH and may further polarise hesitant individuals; traditional educational methods have not been shown to be effective in addressing VH and may in fact exacerbate hesitancy. The authors of this commentary suggest that motivational interviewing (MI) is a more promising avenue to address the complex issue of VH.

MI is a patient-centred intervention style that seek to enhance patients' internal motivation to change behaviour by exploring and resolving their own ambivalence. It is based on 4 main principles: (i) avoid the "righting reflex" (the tendency of health professionals to advise patients about the right path for good health), (ii) listen with empathy, (iii) explore and understand the patient's own motivations, and (iv) encourage and support self-efficacy, i.e. the confidence in the person's ability to change. The underlying spirit of MI is based on partnership, acceptance, compassion, and evocation. The goal is to engage the patient in a collaborative working relationship, allowing him or her to feel involved in the decision to change in a respective and non-judgmental atmosphere. Counselling based on MI involves 5 core communication skills: (i) asking open questions, (ii) affirming, (iii) reflective listening, (iv) summarising, and (v) informing and advising only if the permission is given by the patient beforehand.

The authors developed a new approach to educate parents of newborns about vaccination using MI techniques, called the PromoVac strategy. PromoVac is delivered to parents during their postpartum stay at the maternity ward by research nurses who are trained in MI theory and techniques. This educational intervention lasts approximately 15 to 20 minutes and is carried out in simple and understandable language in order to allow discussion and questions from parents rather than to provide prescriptive and direct information. Each MI intervention is adapted to the parents' readiness to vaccinate their child. Using MI techniques, 5 points are discussed during this interview: (i) vaccine-preventable diseases (VPDs) targeted by the first vaccine series, (ii) vaccines and their effectiveness, (iii) importance of the immunisation schedule, (iv) concerns and fears about vaccination, and (v) organisation of vaccination services.

The PromoVac strategy has been validated with more than 3,300 Quebec, Canada, families in a pilot study and in a randomised controlled trial (RCT). The promising results suggest that using an MI approach is a short, effective and trust-building approach to diminish parental concerns and increase their intention to vaccinate as well as their child's vaccine uptake. According to the authors, the success of the MI approach is due to its being:

• Tailored - The traditional approach of oversaturating parents with facts about vaccination seems to be obsolete, particularly for the new generation of parents who can access a lot of information on the internet. With the MI strategy, healthcare practitioners can identify and target parental concerns or misconceptions about vaccination and then give tailored information. Using the MI approach, healthcare providers need to ask the parents' permission before giving information, which can diminish resistance.
• Timely - Considering that the discussion is meant to take place shortly after birth, parents have the chance to discuss vaccination with a healthcare practitioner without having to make a decision right away (the first infant vaccine series are given at 2 months of age in Quebec).
• Supportive of a robust decisional process - By eliciting and exploring the parents' reasons for vaccination, the MI approach enhances personal motivation to vaccinate.

"Only with a better understanding of the underlying causes of VH among hesitant parents can effective tailored information be delivered. This is what MI offers."