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Despite being recognized as one of the most impactful public
health interventions in history,
there remain individuals and groups of individuals who are
vaccine-hesitant.
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Vaccine hesitancy is a delay in acceptance or refusal of
vaccines, despite availability.
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Vaccine hesitancy may be to all vaccines or just specific
ones.
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Often, when we consider vaccine hesitancy,
we're biased as to why we think an individual or group of
individuals may be hesitant to receive a vaccine.
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We often look at vaccine hesitancy through our own
experiences, through our own lens.
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However, it's important to be aware of our own biases and
examine vaccine hesitancy in a more objective way.
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Vaccine hesitancy has different origins for different groups
of people or populations.
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And in order for us to understand how to best develop public
health interventions
that increase vaccine adoption, we must first understand
what influences vaccine hesitancy.
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So I'm gonna share a couple of models with you that will
allow you to do just that.
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This is a diagram of the conceptual model of vaccine
hesitancy.
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You'll see here in the middle we have an individual's
decisions about that vaccine.
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There's a spectrum here, from refusal to acceptance.
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And this is influenced by a variety of different factors. So
let's take a look at those factors.
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On the bottom half of the model, we focus on the
community-level factors that influence vaccine hesitancy.
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Starting first on the left, we have public health services
and policies.
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This includes vaccine programs, availability of clinics or
implementation of policies
such as school entry vaccine mandates.
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On the bottom, we have communication and media.
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The media plays a major role on the perception of vaccines.
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The media can play a role in instigating or dispelling
misconceptions about vaccines.
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And on the right, we have healthcare professional
recommendations.
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This is not just general recommendations,
but the way in which we, as healthcare providers communicate
those recommendations and the education that we received
about vaccines.
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And then, along the top, we have personal-level factors that
influence vaccine hesitancy.
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Historical and socio-cultural contacts influence vaccine
behaviors.
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This includes knowledge and information, so what do people
know about the vaccine?
Past experiences and this can be either individual past
experiences,
the experiences of friends or family, or even other
community members.
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Next, we have perceived importance.
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So, how important does an individual think it is to get the
vaccine to be protected against the disease?
Next, risk perception. Does the individual think they're at
risk for the disease in the first place?
Subjective norms. What are people around them doing?
Is it the norm to get a vaccine or is it the norm to refuse
the vaccine?
And then finally, religious or moral convictions.
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Some people have beliefs that are in contrast to vaccines.
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And you'll see that this is all encircled by trust, the
amount of trust or the lack of trust,
that an individual or community has influences vaccine
acceptance.
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And I didn't include trust as an afterthought, rather I
saved it because it's the most important.
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We know that in order for health professionals to have a
positive impact on vaccine adoption,
there must be established trust. Without trust our efforts
are all in vain.
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Within this context, it's also essential that we consider
the influence of discrimination on vaccine hesitance.
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Specifically, racism, both individual and structural,
has impact on each of the constructs in this model.
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We need to consider the role of racism and discrimination,
the role that it's played in the availability of healthcare
services.
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What about the role of racism in trusting the healthcare
system?
Well, we often reference historical examples of
discrimination and racism in healthcare.
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The reality is, is that when I've talked to community
members
they don't just talk about injustices that happened years
ago,
they also have examples of discrimination that they have
felt recently, last week, yesterday.
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Together, these experiences influenced trust in the
healthcare system, and in this instance, vaccine hesitancy.
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Another way to examine vaccine hesitancy is through the
vaccine hesitancy matrix.
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We start first by looking at factors within their contexts.
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This includes examination of the world around us.
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The media environment, influential leaders, historical
influences.
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Also, individual factors such as religion or gender,
politics, policies.
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We look at the geographic region and barriers due to the
geographic location.
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Also, here we include the perceptions of the pharmaceutical
industry.
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Next, we consider individual and group influences.
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Some of these include personal experiences, beliefs,
knowledge, trust,
perceived risk, perceived benefits, and social norms.
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The last factors to consider are vaccine-specific issues.
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This include the risks and the benefits of the vaccine, the
introduction of a new vaccine,
the mode of administration, the vaccine program,
the reliability of sources of information about the vaccine,
the vaccine schedule,
costs or availability, and finally, the strength of vaccine
recommendations.
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Now, as with the previous model, it's essential that we
consider
the impact of discrimination and racism on each of these
constructs.
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This allows us to gain a more comprehensive understanding of
vaccine hesitancy.
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And you'll see many similarities between the conceptual
model for vaccine hesitancy and this matrix.
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Both are useful tools that we can use to explore vaccine
hesitancy.
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As we examine each construct, we can use the information
to design a more effective public health nursing
intervention that will increase vaccine adoption.
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So now that we've discussed models to help us better
understand vaccine hesitancy,
let's discuss strategies to address vaccine hesitancy.
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The first strategy is tell, don't ask.
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Essentially what this means is rather than ask someone if
they want a vaccine,
we simply state that it's time to receive the vaccine.
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I recently saw this approach during a well-child visit.
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According to the CDC schedule, it was time for my daughter
to get her DTaP vaccine.
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Rather than ask me if I wanted to have her get the vaccine,
the nurse simply explained that she was due for the vaccine
and would receive it at the end of the visit.
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This approach is typically well received when used for
routine vaccines that patients are familiar with.
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However, other approaches are helpful for more
vaccine-hesitant patients
or for vaccines the public is not quite as familiar with.
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Another strategy we can use is the use of motivational
interviewing.
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This is done by sharing very targeted information based on
the specific concerns of the patient.
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With this approach, we first ask thoughtful questions.
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These questions allow us to understand the patient's
specific concerns.
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Then, we're able to provide information that's specific to
those concerns.
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By using motivational interviewing, we support patient
autonomy.
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We reduce defensiveness, and through this, we also support
personal agency
to ensure the individuals understand that their efforts can
reduce risks,
all in the effort to increase vaccine adoption.
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The final approach is called CASE. This stands for
corroborate about science and explain.
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So first, we corroborate the patient's concerns and have a
respectful conversation about those concerns.
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Next, A stands for about. We tell the patient about
ourselves.
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Explain your level of expertise, what makes you a credible
source of information?
So for example, George may say, I'm a public health nurse.
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I've been working in this community for 20 years.
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It shows his expertise, why he should be listened to when it
comes to vaccines.
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Next, the S, stands for science. Use science as the base of
your recommendations.
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Recommendations should be evidence-based.
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And finally, E, explain. Explain and advise on vaccine
guidelines.
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Now, remember, before you use any of these strategies, it's
important that you do your homework.
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The conceptual framework or the matrix that we just talked
about can be used to understand why an individual or a
community might be vaccine-hesitant.
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Using that information, you can select the best strategy.
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The strategy that will be most impactful for increasing
vaccine adoption.