Best Shot: The Use of Motivational Interviewing to Decrease Vaccine Hesitancy in Parents of Children 0-12 months of Age

 

 

 

 

Best Shot: The Use of Motivational Interviewing to Decrease Vaccine Hesitancy in Parents of Children 0-12 months of Age

 

 

 

Kristin Jamison

 

Purdue University

 

NUR 689: DNP Project II

 

Dr. Azza Ahmed DNSc, RN, IBCLC, CPNP; Deborah A. Spoerner, DNP, MSN, APRN, CPNP; Daniel Kinney, MD, MS, FAAP

 

 

 

 

Problem Statement and Significance

The use of vaccines, which prevent up to 3 million deaths worldwide each year, have been identified as an economic solution for disease prevention (World Health Organization [WHO], 2019). Despite the well documented benefits of vaccines along with the historic eradication of preventable diseases such as the measles in the United States (US), the number of parents who choose not to vaccinate their children is increasing (Dubé et al., 2021). An analysis of national vaccine status data identified that over 40% of all children 19-35 months old in the US are not up to date on their vaccines and of those being vaccinated over 30% are utilizing an alternative or unknown schedule (Hargreaves et al., 2020). The term used to describe this decrease in vaccine confidence and acceptance is vaccine hesitancy (VH). The World Health Organization (WHO) Immunization Practices Advisory Committee (IPAC) defines VH as a fluid state that involves the refusal of or deviation from the recommended vaccine schedule despite vaccine access (Immunization Practices Advisory Committee [IPAC], 2019).

In 2019, WHO identified vaccine hesitancy as one of the top ten threats to global health (WHO, 2019). In the US each year, adherence of children to the standard seven vaccine series schedule precludes 14 million illnesses, prevents 33,000 deaths, and decreases direct costs of health care by nearly $10 billion (Office of Disease Prevention and Health Promotion [ODPHP], 2020). Understanding vaccine hesitancy and addressing parental apprehensions is imperative for clinicians to improve vaccination coverage. 

One tool that may assist practitioners in addressing vaccine hesitancy among parents is the incorporation of motivational interviewing. Motivational interviewing (MI) is a communication tool that uses a guiding approach for “eliciting from patients their own good motivations for making behavior changes in the interest of their health (Rollnick et al., 2008, p. 6) Motivational interviewing allows the provider to work in partnership with the parent by eliciting and affirming vaccine concerns while guiding the individual towards a desire for change and vaccine compliance (Rosengren, 2018).  Although some benefits of MI have been identified, additional research is essential to determine the impact of using MI in an outpatient clinic (Lemaitre et al., 2019; Limaye et al, 2021; Mical et al., 2021).

The purpose of this study was to determine if the use of motivational interviewing by pediatric providers during routine well child appointments, when compared to standard of care, increase vaccine rates in children 0-12 months of age? In addition, provider comfort talking to parents about vaccines, provider comfort using MI, provider confidence in the use of MI to decrease vaccine hesitancy, and caregiver vaccine hesitancy were also explored in this study.

Methodology

Design

Upon Institutional Review Board (IRB) approval from Purdue University and Beacon Health, a quasi-experimental study was conducted on a convenience sample of caregivers presenting with children for a 0-12 month well child check (WCC) from June 1, 2021, to August 31, 2021. A data-sharing agreement was completed between the researchers, the medical group, and the overseeing university. Retrospective data was obtained for both intervention and control providers in the corresponding months of 2019 and 2020 and repeated during the intervention period in 2021. Providers were recruited through an email with an attached provider flyer. Caregivers were recruited using informational cards in both English and Spanish that were displayed at all participating practices. Intervention providers received training on MI in May prior to the study onset. During the well child visit the Parent Attitudes about Childhood Vaccines (PACV) survey was completed, and the MI intervention was implemented. 

Settings & Participants

The setting included three urban clinics in a midwestern county. Both family practice and pediatric providers participated in the study. All clinics accepted both private insurances and Medicaid. A range of clinics was used to increase the generalizability of findings. Caregivers o

Order Now