When you approach a parent who is hesitant about vaccinating her infant at the appropriate well-baby visits, perhaps you say something like this: “Well, we have to do some shots.” Or you might say, “How do you feel about vaccines today?” The former strategy (a “presumptive” approach) is more likely to be effective than the latter (a “participatory” approach), according to a study in parents whom a standardized survey classified as being hesitant about vaccines.
Investigators assessed the immunization status of the newborns of 73 parents when the infants reached age 8 months. Using electronic immunization records, they obtained data from 82%, 73%, and 53% of participants after the 2-, 4-, and 6-month visits, respectively.
At each time point, clinicians used a presumptive approach more often than a participatory approach (65% vs 42%, respectively, at 1 or more visits). A minority of parents brought up the subject of vaccines themselves. The presumptive format at 1 or 2 or more visits was associated with increased immunization, and that association increased along with the number of visits at which this approach was used. The participatory format at more than 2 visits was associated with significantly more underimmunization, also in a dose-response relationship (Opel DJ, et al. Acad Pediatr. 2018;18:430-436).
Thoughts from Dr. Burke
The authors are not proposing that we should give vaccines without consent, but rather that you can lead a hesitant parent to consent more comfortably by projecting the expectation that she will want her child to be vaccinated. It turns out that the spin is important.