title: Communicating with parents about vaccination: a framework for health professionals.
abstract: BACKGROUND
  A critical factor shaping parental attitudes to vaccination is the parent's interactions with health professionals. An effective interaction can address the concerns of vaccine supportive parents and motivate a hesitant parent towards vaccine acceptance. Poor communication can contribute to rejection of vaccinations or dissatisfaction with care. We sought to provide a framework for health professionals when communicating with parents about vaccination.
  
  
  METHODS
  Literature review to identify a spectrum of parent attitudes or 'positions' on childhood vaccination with estimates of the proportion of each group based on population studies. Development of a framework related to each parental position with determination of key indicators, goals and strategies based on communication science, motivational interviewing and valid consent principles.
  
  
  RESULTS
  Five distinct parental groups were identified: the 'unquestioning acceptor' (30-40%), the 'cautious acceptor' (25-35%); the 'hesitant' (20-30%); the 'late or selective vaccinator' (2-27%); and the 'refuser' of all vaccines (<2%). The goals of the encounter with each group will vary, depending on the parents' readiness to vaccinate. In all encounters, health professionals should build rapport, accept questions and concerns, and facilitate valid consent. For the hesitant, late or selective vaccinators, or refusers, strategies should include use of a guiding style and eliciting the parent's own motivations to vaccinate while, avoiding excessive persuasion and adversarial debates. It may be necessary to book another appointment or offer attendance at a specialised adverse events clinic. Good information resources should also be used.
  
  
  CONCLUSIONS
  Health professionals have a central role in maintaining public trust in vaccination, including addressing parents' concerns. These recommendations are tailored to specific parental positions on vaccination and provide a structured approach to assist professionals. They advocate respectful interactions that aim to guide parents towards quality decisions.
authors.affiliation: School of Public Health, and Discipline of Paediatrics and Child Health University of Sydney and National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, Australia. Julie.Leask@sydney.edu.au
authors.forename: Julie
authors.initials: J
authors.lastname: Leask
authors.forename: Paul
authors.initials: P
authors.lastname: Kinnersley
authors.forename: Cath
authors.initials: C
authors.lastname: Jackson
authors.forename: Francine
authors.initials: F
authors.lastname: Cheater
authors.forename: Helen
authors.initials: H
authors.lastname: Bedford
authors.forename: Greg
authors.initials: G
authors.lastname: Rowles
mesh_terms: D002648:Child; D003142:Communication; D017408:Guidelines as Topic; D006282:Health Personnel; D006801:Humans; D007398:Interpersonal Relations; D010290:Parents; D016312:Treatment Refusal; D014611:Vaccination