Characterizing providers’ immunization communication practices during health supervision visits with vaccine-hesitant parents: A pilot study

ObjectiveTo determine the feasibility of using direct observation of provider–parent immunization discussions and to characterize provider communication practices with vaccine-hesitant parents.MethodsOver a 6 month period in 2010, we videotaped immunization discussions between pediatric providers and vaccine-hesitant parents during health supervision visits involving children 2–15 months old (N = 24) in the Seattle area, Washington, USA. Videotapes were analyzed using the qualitative method of conversation analysis.ResultsWe approached 96 parents seen by 9 different providers. Of those who were eligible (N = 56), we enrolled 43% (N = 24). Four videotaped visits were excluded from analysis for failure to obtain parental HIPAA authorization. Of the remaining 20 visits, there were ≥2 visits each that involved children aged 2, 4, 6, 9, 12, and 15 months, and all videotaped visits contained at least a brief immunization discussion. We identified 6 communication practices and several behavior types within each practice relevant to immunization: Practice 1, providers’ initiations of the topic of vaccination; Types: participatory or presumptive format; Practice 2, parents’ responses to providers’ topic initiations; Types: strong or weak acceptance or resistance; Practice 3, providers’ follow-ups to parent's responses; Types: no, immediate, or delayed pursuit; Practice 4, parents’ vaccine-related questions or statements; Types: fact- or concern-based; Practice 5, providers’ explicit solicitations of parent's questions/concerns; Types: designed to discourage or encourage discussion; and Practice 6, parents’ responses to providers’ solicitations of questions/concerns; Types: no question or fact- or concern-based inquiry.ConclusionDirect observation of immunization discussions in the primary care pediatric setting is feasible and yields insight into several provider–parent immunization communication practices that are worthy of further study to determine which are effective at improving parental acceptance of immunization.

► We directly observed outpatient provider–parent immunization discussions.
► Direct observation in this setting is feasible.
► Six provider immunization communication practices are characterized.