The tactic that convinces reluctant parents to vaccinate their babies

Keep the tone of vaccine conversations “very conversational and empathetic.”
Keep the tone of vaccine conversations “very conversational and empathetic.”
Image: Reuters/Paulo Whitaker
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Vaccines have been saving lives around the world for over 200 years. But in 2017, there’s still ample debate about the safety and efficacy of the medical intervention. While vaccination rates in children remain high overall in the United States, they fall short of goals set for 2020. Pockets of low vaccination rates have led to the resurgence of several diseases that are easily prevented by vaccines, including measles.

Researchers have been looking into ways to increase parents’ confidence in vaccines. But many intervention attempts have been unsuccessful. In one study, providing facts about vaccination may even lead to a “backfire effect,” causing worried parents to become more entrenched in an anti-vaccine mindset than they had been prior to the intervention, though this effect was not replicated in a subsequent study.

Now a new study by researchers at Kaiser Permanente Colorado, the University of Colorado, and Emory University, published in Pediatrics, offers a promising insight into how the medical community may seek to break through to anti-vaccine parents. Using social media as a means of answering questions about vaccination beginning during pregnancy, the team found that parents who received this type of intervention were more likely to have infants who were vaccinated on schedule following birth.

“We know that concerned parents use the internet to gather their vaccine information, and on the internet, there’s some good but there’s also a lot of poor information,” says Jason Glanz, the lead author of the study and a senior investigator at the Institute for Health Research at Kaiser Permanente, as well as an assistant professor at the University of Colorado Department of Epidemiology. Recent research showed that exposing research participants to anti-vaccine information for just five to 10 minutes increased doubt about vaccines among the study group—suggesting an uphill climb on the part of the research team.

To counter this misinformation, the study enrolled 1,093 pregnant women, divided into three groups. One group received no additional information on vaccines during pregnancy or following birth. A second received access to a website with vaccine information. The third group received the same website access, but was also able to interact via social media with the research team and with other participants, asking questions regarding vaccines. Each woman was given a quiz to gauge their level of hesitancy around vaccines at the beginning of the study, and they were then randomly distributed among the three groups as either “vaccine hesitant” or “non-hesitant.”

The study followed all participants from pregnancy until their babies were 200 days old to check for infant vaccination status. The results: Infants whose mothers were in the group receiving the social media intervention were significantly more likely to be up-to-date at the end of 200 days than those receiving no additional information. No difference was seen between the groups receiving no additional information and the website only.

Why does the social media effect seem so valuable? Beginning the intervention during pregnancy, rather than after birth, may have been one key to success.

“We hypothesized based on some of the work we’ve done that parents already had begun thinking about vaccines, and in some cases already made up their minds, by the time they get to those two-month visits,” which is the first appointment with the pediatrician following birth for most parents, noted Glanz. At this first visit, the infant would typically be vaccinated against the Hepatitis B virus, rotavirus, diphtheria, tetanus, and pertussis bacteria (“DTaP”), Haemophilus influenzae bacteria (“Hib”), pneumococcus bacteria, and inactivated polio virus per the Centers for Disease Control and Prevention schedule. Babies are also typically vaccinated against Hepatitis B at birth.

Parents with doubts about vaccines may be easily overwhelmed by attempting to ask a slew of questions during their baby’s first pediatrician visit. “There often isn’t enough time at those well-child visits to digest all of that information before having to make the vaccine decisions, so we’ve also heard from providers and doctors that parents with concerns have tons of questions and they don’t feel like they can answer all of them in those short well-child visits,” said Glanz. “That gave us the idea to create an online information web-based resource for parents, but one that also had interaction and allowed them to have some control over the information, and allowed them to interact with our group of experts.”

Social media as a source of information was a way to fight fire with fire. “We know that bottom-line, these anti-vaccine groups are really adept at using social media to spread their misinformation, so we thought one way to combat that would be with our own tool,” Glanz said.

The downside of the intervention is that it may be hard to scale up. The process was quite labor-intensive, and staffed with a team of experts including physicians with expertise in pediatrics and infectious disease; vaccine safety researchers; risk communication experts; behavior science researchers, and Glanz, an epidemiologist. Parents were able to submit questions to the research team, who would discuss the questions and respond within two business days. Glanz notes, “We wanted to give a substantive but succinct rebuttal to some of those rumors, so it took some time to actually go through that all information and craft an easy-to-digest answer.”

This means there may be difficulty in broadening this intervention to reach more parents who feel hesitant about vaccines. An ordinary pediatrician would likely lack the time to spend chasing down rumors and crafting lengthy responses to concerned parents. Further, the social media platform in this study wasn’t your ordinary Facebook group. It was a private group limited to the study participants, and the research team was therefore able to respond to questions without interference from online trolls or other types of outside influencers who could hijack the conversation and sow doubt.

Still, some parts of the intervention have applications for the effort to combat anti-vaccine sentiment—both on social media and off. When responding to questions, Glanz emphasized that the researchers did more than just myth-busting. We “tried to keep the tone very conversational and empathetic,” he says. “We did bring in our own experiences. We used humor when appropriate. We tried to provide the facts but we also tried to make the conversation personable and engaging. And that included talking about some of our own experiences with patients, treating some of these horrible diseases that are just about 100% preventable with vaccines.” In other words, facts are important—but trust and empathy are also keys to changing hearts and minds.