Why It Matters
Conversations about COVID-19 vaccines that focus on listening and learning about thoughts, feelings, and beliefs about the vaccines — rather than persuasion — can build trust and have longer-lasting impact.
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How to Earn COVID-19 Vaccine Confidence? Build Trust

By IHI Team | Friday, March 12, 2021
How to Earn COVID-19 Vaccine Confidence Build Trust Photo by Brett Jordan | Unsplash

When you encounter or hear about colleagues, patients, or family members who are not sure they want to receive the COVID-19 vaccine, do you find yourself thinking about how you can convince them to get it? You may mentally prepare a range of questions:

How could you turn down a lifesaving vaccine?

Aren’t you concerned about your safety or that of your family and patients?

Why don’t you believe the science?

If you’ve had these thoughts — or asked these questions — you are not alone. For many health care professionals, our typical reaction to someone expressing disagreement or uncertainty may be to arm ourselves with data, studies, and facts to convince the person to take the action we prefer. This approach stems from what we see as a well-meaning view: “I’m an expert. I care about you. I’ll tell you what I think you should do.”

We have good reasons for concern. According to the February KFF COVID-19 Vaccine Monitor, 22 percent of US adults want to “wait and see” how the vaccine is working for others before getting it themselves, 7 percent will get the vaccine “only if required for work, school, or other activities” and 15 percent will “definitely not” get vaccinated. (Survey responses from health care workers are similar.) This leaves far too many adults prone to the virus and its spread. It also means that those disproportionately affected by COVID-19, especially Black and Indigenous People of Color, may be further at risk for infection.

However, well-intended persuasion tactics can often convey blame and judgment. For the recipients, they can feel disrespectful and dismissive. Conversations that instead lead with respect, and focus on listening and learning about thoughts, feelings, and beliefs about the vaccines, can build trust.

For example, many people have expressed worries over the speed of vaccine development, wondering if manufacturers may have cut corners or prioritized profit over safety. The sources of information that some people rely on may cast seeds of doubt about the vaccine developers or the reasons for large-scale vaccine rollout. Black, Indigenous, or People of Color who have experienced systemic racism while using or trying to get access to health care services may not trust health care services, research, or government-funded initiatives.  

To facilitate effective conversations, the Institute for Healthcare Improvement (IHI) has created a Conversation Guide to Improve COVID-19 Vaccine Uptake. IHI developed this resource to help health care staff and leaders engage in trust-building conversations about the vaccine at work and in their communities. Trust building is a key component of addressing and correcting inequities in health care. Exploring people’s thoughts and feelings through respectful, trust-building interactions over time, offers the potential to generate positive emotions that set the stage for trust and potentially increase the uptake of vaccinations.

The content of this guide is derived from what IHI has learned about the IHI Psychology of Change Framework to Advance and Sustain Improvement and from having “What matters to you?” conversations with colleagues and patients. Many of the skills addressed in the guide are based in narrative medicine and strive to understand the lived experience of others. Using the guide can help with trust-building conversations on an array of difficult topics.

The Conversation Guide is based on these principles:

  • If those in health care use trust-building behaviors consistently over time, it will be a meaningful step in addressing inequities throughout health care systems. Trust building is an ongoing series of conversations, not a one-time event.
  • Understanding why a person may be unsure about getting the vaccine is essential for a successful conversation.
  • Build a trusting relationship together rather than feeling you, as a health care team member, have to resolve the situation immediately.
  • Adapt this guide to your own local language and culture and improve it through emergent learning in conversations with others.

Busy health care staff need easy-to-use, practical tips that can be put into practice and adapted immediately. The guide includes Do, Don’t, and Steps to Try advice. Rather than make generalizations like “confirm you understand what was stated,” the guide provides specific language to try: “Here’s what I heard you say . . . [insert]. Did I get that right?”

Try the Conversation Guide, adapt it to your context, share it with others, and let us know how to improve it. Together we can build trusting relationships and improve vaccine confidence and uptake.

Barbara Balik, EdD, MS, RN, is leadership faculty for IHI. Kate Hilton, JD, MTS, is leadership faculty for IHI. Teaka Isaac is an Associate Project Manager at IHI.

You may also be interested in:

Conversation Guide to Improve COVID-19 Vaccine Uptake

Activating Agency with the Psychology of Change online course with coaching

IHI Psychology of Change Framework white paper

Vaccines Alone Won’t Solve the Problem of Health Care Worker Safety

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