Building trust may be key to vaccine conversations with hesitant families

When parents express uncertainty about childhood vaccines, pediatricians may be more effective by focusing first on building trust rather than trying to resolve every concern during a single office visit, according to Lori Handy, MD, MSCE, associate director of the Vaccine Education Center at Children's Hospital of Philadelphia and a pediatric infectious disease physician.

For families who say they are "not sure" or "not yet" about vaccination, Handy said the clinician's immediate objective does not necessarily need to be changing the parent's decision. Instead, the encounter can establish a relationship in which parents feel comfortable continuing to ask questions and returning to the discussion.

How should pediatricians approach families who are hesitant about vaccines?

Vaccine decisions frequently involve questions about whom families trust, Handy said. Parents may enter the exam room with information from relatives, friends, or other sources they have trusted for years while meeting a pediatrician for the first time.

"The family is trying to figure out who they trust to get their information, and they may just be meeting a provider for the first time," Handy said. "They may have heard a lot from their aunt or their cousin or someone that they really trust on most things, and they're now just meeting you."

For that reason, she cautioned against defining a successful first encounter solely by whether a vaccine is administered.

"When you have families that are hesitant or say, 'I'm not sure' or 'Not yet,' the goal of that interaction is not to say, 'I'm going to convince you today to get vaccinated.' The goal is really to let that family know we're building a relationship, we're establishing trust," Handy said.

What does establishing trust look like in clinical practice?

Handy described credibility, compassion, and character as components of establishing a relationship with families.

"You have to show those things. You don't just get to have them; you have to earn them," she said.

In some cases, that may mean giving parents additional time. Handy suggested that a clinician could acknowledge a parent's hesitation and arrange to revisit vaccination in a month.

The approach can also apply when parents decline vaccination during an acute illness, even when vaccination would be medically appropriate.

"As a pediatrician, you might say it's perfectly safe to do that. But here's a family that needs to see something else first," Handy said. "You're able to say, let's care for your child, let's make sure they get better, and then we're going to book you out for a week from now to make sure he's better. And if so, we can do vaccines then."

Why does continuity matter in vaccine discussions?

When pediatricians offer to revisit vaccination, Handy said following through on that commitment is critical.

"That follow-up is so so so critical because they are building a relationship with you specifically, not your practice, not the name of your hospital, but you as a human, and that we kind of can't take for granted," she said.

If the pediatrician tells a family they will meet again in a week, Handy said that family should ideally see the same clinician rather than another member of the practice.

She acknowledged that maintaining these longitudinal relationships can be challenging within current health care systems.

"It's very hard to keep those longitudinal relationships, but I think they're really critical in this area," Handy said.

Should vaccine conversations focus on the child or the community?

Handy distinguished between vaccine communication delivered at the public health or practice level and conversations between an individual pediatrician and parent.

Community-level messaging can appropriately emphasize broader benefits, she said. In the exam room, however, clinicians may be more effective by centering the discussion on the child sitting in front of them.

"When we're in that one-on-one provider-patient interaction, that focus right there is on that child because if a parent is hesitant to vaccinate, you know their daughter Sophie in front of them, you're not going to convince them or talk them into vaccinating Sophie on Johnny's behalf, right?" Handy said.

Instead, pediatricians can explain what vaccination means for that child's health.

"They're vaccinating Sophie for Sophie," Handy said.

For pediatricians navigating vaccine uncertainty, Handy's approach emphasizes an ongoing relationship rather than a single conversation: establish trust, follow through on commitments, and keep the individual child's health at the center of the discussion.