During the conversation

• Be compassionate, show empathy, and be genuinely curious about the reasons why the family feels the way they do.⁴⁰
• Be sensitive to culture, family dynamics, and circumstances that may influence how patients view vaccines.⁴⁰

Obtaining permission from the family to discuss vaccines gives the power back to them. When families feel empowered, they are more likely to trust the information given.³⁹

If the family says no: There are a have a few options.

• Option 1: Respect the no and move on to a different topic.³⁹
  • Remember: It is important for the home visitor to continue to incorporate vaccine education into all future conversations, as vaccinations are an essential part of maintaining a healthy lifestyle.
• Option 2: Based on the family's demonstrated emotions and overall assessment of its worldview and values, you could spend several minutes curiously exploring why the family doesn’t want to talk about it.³⁹
  • Remember: the goal is to understand, not to change their mind.

If the family says yes: Move to the next step!

Remember, these conversations may take time, and they may continue over multiple visits.

When approaching a vaccine conversation, it is important to be compassionate, show empathy, and have a genuine curiosity around the reasons why families feels the way that they do.⁴⁰

• Use motivational interviewing to engage respectfully and respond effectively; This allows tailored information for the family and creates a space for them to explore ambivalence in a non-judgmental manner.³⁸
• Share stories when appropriate: Messaging in the form of storytelling with the use of gist, emotive anecdotes, and imagery has been shown to be among the most persuasive messaging strategies.⁴⁰
• For examples of personal stories (families that have been affected by vaccine-preventable diseases) see the links below:
• Vaccinate Your Family
• Families Fighting Flu, Inc.
• Immunize.org
• ShotByShot.org
• Children’s Hospital of Philadelphia

• Be sensitive to culture, family dynamics, and circumstances that may influence how families view vaccines.⁴⁰

Remember, success comes in many forms. For vaccine hesitant families, success may simply mean agreeing to leave the door open for future conversations. It may also mean to agree on a mutual goal.

What is a mutual goal?

It's a goal that is a smaller step towards vaccine acceptance.

Some examples of mutual goals to set with your vaccine-hesitant families:

• Scheduling a future professional visit dedicated to vaccine conversations
• Encouraging the family to read additional evidence-based resources provided
  • Refer to Evidence Based Sources within this toolkit
• Agreeing on an alternative vaccine schedule
  • Refer to Vaccine Schedules (subsection: Alternative Schedules) within this toolkit

While you are discussing vaccine hesitancy, try pinpointing the main concern. Getting to the root cause of the hesitancy may help to frame and gather resources around that apprehension.

It is much more efficient and effective to ask the family what their concern is and approach the conversation around that, rather than to offer a cookie-cutter educational approach to all families.⁴¹

For Example: While explaining vaccine ingredients can be helpful, it will likely not resonate with someone whose main concern is focused on the timing of vaccines.

Families consistently rank their child's health care provider as their most trusted source for vaccine information.⁴² With the unique position of home visiting programs, specifically MIHP, being an expert in the field of vaccinations, and giving strong recommendation is critical for vaccine acceptance.

For example: To give a strong recommendation, the home visitor will need to clearly state the recommendation.

                                Start by saying, "I strongly recommend..."

                                After stating the recommendation, it is then important to share how vaccines help to protect from potentially life-threatening disease.

Use the implements within this toolkit, specifically the General Vaccine Information webpage, to frame the conversation.

Although most families support vaccines, many still have questions. If a family has concerns, resists following the recommended vaccine schedule, or questions the strong recommendation, try to remember that this doesn't necessarily mean that they won't accept vaccines.⁴³

Sometimes parents simply want additional resources and are eager to continue the conversation throughout the course of care within MIHP.

Additionally, it is important to normalize questions around health decisions.

Applauding families for having questions encourages them to engage, not only with vaccine conversations, but with other topics such as safe sleep, family planning, and more.⁴⁰

*** If you encounter questions that you do not know the answer to, or information from sources that you are unfamiliar with, it is best to acknowledge the family's concerns and connect with local resources, referrals, or the MDHHS MIHP team to provide additional support.

• Offer to review the information they have found and, if necessary, schedule to discuss it further during a future professional visit.
• Finding the answers and reconnecting with families when you do have the answers is commendable and a great rapport-building effort.

Remember, you are the trusted source of information. If you share details that are not backed by facts you may cause more harm than intended.