Hal Willaby

DOCTORS play a central role in addressing parental concerns regarding the safety and necessity of childhood vaccines.

Vaccination rates in Australia are stable at around 92%, but more can be done to reassure parents who are hesitant, or outright scared of vaccines.

We conducted a survey, commissioned before the SBS Jabbed documentary, asking 452 parents about their orientation to vaccination. The results showed:

•  48% of parents had their children fully vaccinated and had no concerns about vaccine safety
•  38% were fully vaccinated and had “a few minor concerns” about vaccine safety
•  6% were fully vaccinated and had “a lot of concerns” about vaccine safety.

That’s 92% of parents who had their children fully vaccinated. The remaining 8% vaccinated only partially or not at all:

•  6% accepted some vaccines but either delayed or refused certain vaccines
•  2% refused all vaccines.

The above categories of parents fall along a continuum of vaccine orientation. The categories of attitudes or “positions” parents have on childhood vaccination have been developed from studies of vaccine acceptance and used to provide a structured approach to communicating about vaccination, available from a report published last year. The common goals for all parental groups are to build rapport and trust by eliciting, listening to, accepting and addressing concerns.

The studies show that to establish a parent’s position, gentle questioning in a consultation will indicate which category they fall into. Across these orientations, the conversations clinicians have with parents will differ, with different goals tailored to each orientation.

Parents with an unquestioning acceptance of vaccination will usually present with a child who is fully vaccinated for his or her age, or will state their intentions of getting this done. A clinician’s goal here is straightforward — to vaccinate the child in line with the expectations or request of the parent and the clinical indication.

Parents with a cautious acceptance of vaccination will also usually present with a child who is fully vaccinated for his or her age, or will state their intentions of getting this done. Such parents require a more open conversation where questions and concerns are elicited and readily received.

It is ideal to offer descriptions of the vaccine and disease risks, and then an explanation of common side effects, as well as rare but serious ones. Written resources may be helpful, especially if provided ahead of the vaccination day or in the waiting room.

This discussion will probably be brief but flexibly addresses the parent’s needs. With these parents, a good outcome to focus on is getting the child vaccinated with the parent accepting the decision.

Parents with a cautious acceptance of vaccination may have concerns ranging from only a few minor concerns to a lot of concerns.

Parents with a late/selective approach to vaccination often present with a child who is only partially vaccinated (eg, missing measles–mumps–rubella), or late with some vaccinations (eg, hepatitis B birth dose). As such, the concerns these parents have are usually focused on a particular vaccine.

The goal with these parents is to move them along the continuum to cautious acceptance. Decision aids — where available — and other quality sources of relevant information may be helpful. Risk–benefit information will be more convincing for these parents, as will dispelling misconceptions about the risks of vaccinating.

Parents with a refusal approach to vaccination will probably present for reasons unrelated to vaccination, or they may present with a “conscientious objection” form for signing.

Bringing up the topic of vaccination in a non-threatening manner is important to achieve a modest goal — discussion about vaccine safety and necessity. These parents want to be heard and seek a trusting relationship with their doctor or nurse. Evidence suggests that an adversarial approach with these parents results in them feeling alienated.

A safe place to start may be asking whether the parent is concerned about a particular vaccine-preventable disease. With permission, provide information about the threat of the disease and benefits of vaccination. Though it is an understandable urge, debating the credibility of information sources the parent relies upon will erode rapport and accomplish little with these parents.

Regardless of the group a parent falls into, people can change. You can guide parents from vaccine hesitancy to considering or agreeing to vaccination with an empathic acceptance of them and the (very natural) concerns they have for their children’s wellbeing.

Dr Hal Willaby and Associate Professor Julie Leask are from the School of Public Health, University of Sydney.