title: Clinician-parent discussions about influenza vaccination of children and their association with vaccine acceptance.
abstract: To examine how clinicians communicate with parents about influenza vaccination and the effect of these communication behaviors on parental vaccine decision-making.
  
  
  
  We performed a secondary analysis of data obtained from a cross-sectional observational study in which health supervision visits between pediatric clinicians and English-speaking parents of young children were videotaped. Eligible visits occurred during the 2011-2012 and 2013-2014 influenza seasons, included children ≥6months, and contained an influenza vaccine discussion. A coding scheme of 10 communication behaviors was developed and applied to each visit. Associations between clinician communication behaviors and parental verbal vaccine acceptance and parental visit experience were examined using bivariate analysis and generalized linear mixed models.
  
  
  
  Fifty visits involving 17 clinicians from 8 practices were included in analysis. The proportion of parents who accepted influenza vaccine was higher when clinicians initiated influenza vaccine recommendations using presumptive rather than participatory formats (94% vs. 28%, p<0.001; adjusted odds ratio 48.2, 95% CI 3.5-670.5). Parental acceptance was also higher if clinicians pursued (vs. did not pursue) original recommendations when parents voiced initial resistance (80% vs. 13%, p<0.05) or made recommendations for influenza vaccine concurrent with (vs. separate from) recommendations for other vaccines due at the visit (83% vs. 33%, p<0.01). Parental visit experience did not differ significantly by clinician communication behaviors.
  
  
  
  Presumptive initiation of influenza vaccine recommendations, pursuit in the face of resistance, and concurrent vaccine recommendations appear to increase parental acceptance of influenza vaccine without negatively affecting visit experience.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA, United States; Seattle Children's Research Institute, Seattle, WA, United States. Electronic address: annika.hofstetter@seattlechildrens.org.
authors.forename: Annika M
authors.initials: AM
authors.lastname: Hofstetter
authors.affiliation: Department of Communication, Portland State University, Portland, OR, United States. Electronic address: jeffreyr@pdx.edu.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Robinson
authors.affiliation: Seattle Children's Research Institute, Seattle, WA, United States. Electronic address: katherine.lepere@seattlechildrens.org.
authors.forename: Katherine
authors.initials: K
authors.lastname: Lepere
authors.affiliation: Seattle Children's Research Institute, Seattle, WA, United States. Electronic address: cunnimor@ohsu.edu.
authors.forename: Morgan
authors.initials: M
authors.lastname: Cunningham
authors.affiliation: Seattle Children's Research Institute, Seattle, WA, United States. Electronic address: nicole.etsekson@seattlechildrens.org.
authors.forename: Nicole
authors.initials: N
authors.lastname: Etsekson
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA, United States; Seattle Children's Research Institute, Seattle, WA, United States. Electronic address: douglas.opel@seattlechildrens.org.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Opel
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D058015:Health Communication; D006801:Humans; D007223:Infant; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D010290:Parents; D010342:Patient Acceptance of Health Care; D011369:Professional-Patient Relations; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines
keywords: Communication; Infants; Influenza vaccines; Nurse practitioners; Parents; Pediatricians; Vaccination; Vaccination refusal