509 - Perceived Self-Efficacy in Vaccine Conversations is Associated with Use of Motivational Interviewing

Poster Number: 509
Publication Number: 509.325

Sean T. O'Leary, University of Colorado School of Medicine, Denver, CO, United States; Christine Spina, University of Colorado School of Medicine, Aurora, CO, United States; Kelly J. Zavaleta, University of Colorado School of Medicine, Aurora, CO, United States; Heather Spielvogle, Seattle Children's, Seattle, WA, United States; Cathryn Perreira, University of Colorado, Anschutz - ACCORDS, Aurora, CO, United States; Anna Furniss, University of Colorado School of Medicine, Aurora, CO, United States; Amanda Dempsey, Merck, dENVER, CO, United States; Jeffrey Robinson, Portland State University, Portland, OR, United States; Doug Opel, University of Washington School of Medicine, Seattle, WA, United States

Background: Use of a presumptive format to initiate vaccine conversations and motivational interviewing (MI) when parents resist recommendations are effective techniques for increasing vaccination uptake. Little is known about adoption of these techniques by pediatric clinicians and their association with perceived self-efficacy in changing parents’ minds regarding vaccines.

Objective: To assess among pediatric clinicians: 1) use of presumptive format for initiating vaccine discussions; 2) use of MI when parents resist recommended vaccines; and 3) characteristics associated with perceived self-efficacy in changing resistant parents’ minds.

Design/Methods: Pediatric clinicians in 24 clinics in Colorado and Washington were surveyed 5/2019-1/2020. First, they were asked how they most often initiate vaccine discussions (presumptive [“Johnny’s due for 3 shots”], participatory [“What do you think about shots today?”], or other). They were then asked how they respond when parents decline recommended vaccines (by “pushing back,” suggesting fewer shots, accepting parental refusal, other). Among those who stated they push back, respondents were asked how they most often do so (providing information about risks of refusal, providing personal anecdotes, MI, or other). Perceived self-efficacy was measured by disagreement with the statement, “When parents delay or refuse vaccines for their child, there is not much I can say to change their mind.” Clinician demographics collected included gender, race/ethnicity, and clinician type (dichotomized to MD/DO and other [nurse practitioner, physician assistant, other]). Generalized estimating equations and regression analysis were used to examine characteristics and communication strategies associated with perceived self-efficacy.

Results: Response rate was 99% (212/215). Most (93%) reported using presumptive format. When encountering resistance, 61% said they pushed back; among those, 40% stated they most often provided parents with information about childhood vaccines, 40% most often reported using MI techniques, 18% reported most often relating personal anecdotes, and 2% reported other. About half (56%) disagreed with the statement there is not much they can say to change a parent’s mind. Perceived self-efficacy was associated with MD/DO versus other clinician (aOR: 2.02, p=.02), use of MI vs. no push-back (aOR: 2.93, p=.01), and use of MI vs other strategy (aOR: 2.42, p=0.003).Conclusion(s): Most pediatric providers use a presumptive format to initiate vaccine conversations. Many use MI when meeting resistance. Perceived provider self-efficacy is associated with use of MI.