Changing Minds About Vaccination
Changing Minds About Vaccination
It has been our observation that few HCWs have received any formal instruction on patient decision-making styles and tend to default to a common education style—a highly analytic style informed by numbers, statistics, and nuanced probabilities. Many HCWs and government health agencies operate out of the analytical style that is focused on science-based facts and statistics. This style is evident in the Vaccine Information Statements that are required to be provided before vaccinations are given in the United States.
If HCWs can effectively understand a patient's preferred cognitive style and communicate with that person based on the patient's needs for decision-making, there is a far better chance of helping the patient make healthy decisions and engage in healthy behaviors. As examples, some of these cognitive styles are identified in the table.
Table. Cognitive Styles
Republished with permission from: Poland CM, Poland GA.
The table above outlines six primary cognitive styles, gives examples of how these cognitive styles appear in communication, and includes a few practical communication strategies to employ. Although statistics and facts are critical to making decisions, for individuals who don't operate with an analytical cognitive style, particularly innumerate individuals, statistics and probabilities serve only to confuse and are unlikely to move them to a desired behavior (in this case vaccine acceptance). We have illustrated this in the case of fear-based decision-making over Guillain-Barré syndrome and concerns over receipt of the pH1N1 vaccine.
How to Present Vaccine Information
It has been our observation that few HCWs have received any formal instruction on patient decision-making styles and tend to default to a common education style—a highly analytic style informed by numbers, statistics, and nuanced probabilities. Many HCWs and government health agencies operate out of the analytical style that is focused on science-based facts and statistics. This style is evident in the Vaccine Information Statements that are required to be provided before vaccinations are given in the United States.
If HCWs can effectively understand a patient's preferred cognitive style and communicate with that person based on the patient's needs for decision-making, there is a far better chance of helping the patient make healthy decisions and engage in healthy behaviors. As examples, some of these cognitive styles are identified in the table.
Table. Cognitive Styles
| Cognitive Style | Main Effect | Verbal Expression | Approach |
|---|---|---|---|
| Denialist | Disbelieves accepted scientific facts, despite overwhelming evidence. Prone to believe conspiracy theories. | 'I don't care what the data show; I don't believe the vaccine is safe." | Provide consistent messaging repeatedly over time from trustworthy sources; provide educational materials; solicit questions; avoid "hard sell" approach; use motivational interviewing approaches |
| Innumerate | Cannot understand or has difficulty manipulating numbers, probabilities, or risks | "A 1-in-a-million risk sounds high; for sure I'll be the 1 in a million who has a side effect; I'll avoid the vaccine." | Provide nonmathematical information, analogies, or comparators using a more holistic "right brain" or emotive approach |
| Fear-based | Decision-making based on fears | "I heard that vaccines are harmful so I'm not going to get them." | Understand source of fear; provide consistent positive approach; show risks in comparison with other daily risks; demonstrate risks of not receiving vaccines; use social norming approaches |
| Heuristic | Often appeals to availability heuristic (what I can recall equates with how commonly it occurs) | "I remember Guillain-Barré syndrome happened in 1977 after flu vaccines; that must be common, and therefore I'm not getting a flu vaccine." | Point out inconsistencies and fallacy of heuristic thinking; provide educational materials; appeal to other heuristics |
| Bandwagoning | Primarily influenced by what others are doing or saying | "If others are refusing the vaccine, there must be something to it; I'm going to skip getting the vaccine." | Understand primary influencers; point out logical inconsistencies; use social norming and self-efficacy approaches |
| Analytical | Left brain thinking; facts are paramount | "I want to see the data so I can make a decision." | Provide data requested; review analytically with patient |
Republished with permission from: Poland CM, Poland GA.
The table above outlines six primary cognitive styles, gives examples of how these cognitive styles appear in communication, and includes a few practical communication strategies to employ. Although statistics and facts are critical to making decisions, for individuals who don't operate with an analytical cognitive style, particularly innumerate individuals, statistics and probabilities serve only to confuse and are unlikely to move them to a desired behavior (in this case vaccine acceptance). We have illustrated this in the case of fear-based decision-making over Guillain-Barré syndrome and concerns over receipt of the pH1N1 vaccine.