Crucial Conversations QA

How to Discuss Childhood Immunization with Reluctant Parents

Dear David,

With the recent rise of children getting measles and the increasing number of people who refuse to have their children vaccinated, I have become very curious about the decisions that parents are making about their children. I work in healthcare and support vaccinating children, and I know that people who refuse to vaccinate their children can put together an informed case to support their point of view. I think their case is flawed and I can identify specific flaws in their case, which makes it difficult for me to hold a conversation with them.

Do you have some suggestions about how to hold conversations with parents opposed to vaccinating their children when I really do believe that they are taking a huge and unnecessary risk with their child and, as a result, other children?

Signed,
Concerned Healthcare Professional

Dear Concerned,

Thanks for a great question. It’s not just vaccines that cause communication breakdowns. We see breakdowns across our culture, which makes your question especially relevant. I’ll outline some tips below that should help.

You Can’t Win an Argument. It’s a paradox that it becomes harder, instead of easier, to convince someone when you are supremely confident in your own point of view. It has to do with Dale Carnegie’s insight, “You can’t win an argument.” Here is how a conversation can turn into an argument:

  • I ask the parent why they don’t want to vaccinate their child.
  • The parent shares all the reasons they have against vaccination.
  • I attack their reasons and try to add reasons for vaccination.
  • They attack mine and defend theirs.
  • I attack theirs and defend mine.
  • Rinse and repeat.
  • They win, because it’s their child.
  • In trying to win an argument I’ve fallen into what’s called the Persuasion Trap. I have become the champion for my cause and pushed the parent into being champion for the opposite cause. The result is an argumentative cycle I can’t win.

    Motivational Interviewing. Motivational Interviewing is an approach that is designed to avoid the Persuasion Trap. Instead of taking sides, it helps the parent explore and resolve the ambivalence they probably feel about vaccinating their child. And it recognizes the reality that it’s the parent who will make the final judgment. The goal is to engage the parent’s own intrinsic motivation. Below are a few principles you can use:

    Ask for Permission. When the parent says they are unwilling to have their child vaccinated, don’t launch into an argument. Instead, ask permission to discuss it further. This puts the parent into the decision-making role.

    Explore their Ambivalence. Most unwilling parents have doubts. Make it safe for them to voice their concerns. This establishes your role as helper, rather than opponent. Below are how these first two elements might sound in a conversation:

    YOU: Your child is due for her measles immunization today, but I heard you declined it from the nurse. Would it be okay if we discussed it?

    PARENT: Um, okay.

    YOU: Many of my patients are concerned about the safety of vaccines and whether their child is more likely to get sick from the shot than the actual disease. Others have questions about how bad it would be if their child got the measles. Would it be like a common cold, or could it affect their heart? Could their child die? Still other parents want to spare their child the pain of one more shot. These are all valid concerns. What do you see as the pros and cons of having your child vaccinated?

    I like to draw a line down the middle of a piece of paper and write the pros on the left and cons on the right side of the line. This helps the parent turn their vague feelings and fears into a finite number of specific concerns—concerns that can be addressed.

    Paraphrase to Ensure Understanding. Summarize each concern. This makes sure you understand it and also demonstrates that you are listening. “So, correct me if I’m wrong, but you are worried the vaccine will make your child’s arm sore and that she might feel sick for a week. You’ve also heard that measles used to be considered a relatively minor childhood disease. So, you have questions about how serious a problem it is. Is that right?”

    Address Each Concern with Facts. But first, ask for permission (again), “Would you mind if I provided you with more information about the measles, so you’ll have all the facts before you decide about the vaccine?” Then provide clarifying information in a nonjudgmental way.

    Consider the Messenger. Ask yourself whether you are the right person to provide the facts. If you are a nurse, a physician, or another healthcare provider, consider yourself credible. Your profession puts you among the most trusted people in our society. If that’s you, then you might make your presentation more personal, “I’ve had all of my children vaccinated. My son, Elijah, hates shots, but none of my children had any kind of bad reaction. I feel very good about my decision.”

    If you don’t think the person sees you as a credible messenger, then use information that comes from a more credible source. Provide a handout from the American Academy of Pediatrics or a pamphlet from your local public health agency.

    Consider Multiple Influences. You asked how to have a conversation with an unwilling parent. These conversations are important, but they’re only one aspect of a comprehensive influence strategy. If it was your job to improve vaccination rates in your region, country, or hemisphere, you would want to employ a combination of strategies at the Personal, Social, and Structural levels. These would include conversations, but also involve community leaders within schools, churches, and sports teams. They would also include changes to laws, incentives, and perhaps the way the vaccines are delivered. I hope this is helpful. Try a few of these approaches and let us know how they work.

    Best,
    David