Alfery 1

Courtney Alfery

Dr. Jerz

SLA 101 05 STW

9 May 2016

The Parent and the Provider: The Communication Issues Regarding Vaccinations and the

Effects Thereof

Vaccines affect all of us, each and every day. Even though approximately 95% of the US

population is vaccinated, the small margin of the unvaccinated can cause great damage, for it

does not take too many unvaccinated people to cause a spread of a harmful disease. According to

Moser, Reiss, and Schwartz, an outbreak of a vaccine-preventable disease has a high monetary

effect because “when those costs come out of the public purse, resources are diverted from other

needs, and important public values can suffer” (643). Aside from the funds related to not

vaccinating, those harmful diseases could eventually affect your child, at which point you would Commented [CA1]: Here, I lessened the amount of
redundancy on the cost subject.
definitely have a strong opinion on the topic. What if you knew there was a solution to the

unvaccinated population? Would you not hope it would at least be tried out for effectiveness?

That is why, in order to improve vaccination rates, it is crucial for the medical community to

implement a system that centers on nurse’s taking charge of the education and counseling

regarding vaccination. Through doing so, it would lower the amount of people turning to poor

Internet sources for information, and could eventually eliminate government involvement

through laws and regulations regarding vaccines.

Providers are doing the bare minimum when it comes to educating parents about

vaccines. The approach that is being taken assumes each parents learns and obtains information

the exact same way. There are many more factors to be considered when evaluating how to
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speak to a patient about vaccines and their questions regarding the topic. According to Lyons, Commented [CA2]: Here, I took out how providers
“should” do something, and I added what they are doing
and why it is not working.
“the ways in which public health messages and implementation of vaccination programs are

understood depend on the cultural contexts they are situated within” (38). Since the patient’s

relationship with vaccine knowledge relies greatly on the various ways they learn, medical

professionals would benefit from allowing the nurses take over the process of vaccine education

due to the fact they underwent training in counseling. Through a study conducted by Kennedy et Commented [CA3]: I included why the nurses should
take over in this aspect.
al., the findings “highlighted the need to approach parents’ vaccine concerns and attitudes along

a spectrum rather than as a dichotomy between having or not having concerns, and to deliver

vaccine information in a way that is more tailored to individual needs” (1155). Providers often

hear skepticism from their patients about vaccines and shoot it down, without even

acknowledging the fact that the individual simply needs more education on the topic. I know this

because I have experienced it first hand, and it is a problem. As patients relying on our

children’s’ doctors to inform us completely, we expect them to feed us with knowledge despite

any concerns we have that they do not agree with. Due to the fact that many providers do not

engage in conversation that fancies the uncertainty of vaccinations (simply because the views do

not align with their own), many parents resort to the Internet to find information on the questions

they may have.

Many providers lack the skills to effectively communicate and educate the vast majority

of patients that they provide for. According to Birgette Norgaard et al., despite the focus

regarding good communication and providers, “serious communication problems persist between

health care providers and patients” (90). Although incorporating physician-targeted Commented [CA4]: Instead of just stating that many
providers lack communication skills, I found a source
that expresses there is a communication issue going on,
communication intervention “did not reduce maternal vaccine hesitancy or improve physician despite the efforts to fix it.

self-efficacy” (Henrikson et al.), I believe the error in the system is that nurses are not taking on
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the vaccine education role. Many people do not take into consideration all of the knowledge

about the vaccines that could come from the nurses. According to Hoekstra and Margolis, nurses Commented [CA5]: Here, I trimmed a quote that did
not exactly help my paragraph.
are trained to see that the patients’ health care needs are being met, and the nurses are trained to

have openness when dealing with new information and questions. This means there is usually

“no judgment expressed on the part of the nurse about parents’ hesitancy regarding vaccination”

(401). This is where the answer to the communication issue is clear. Nurses are trained in

counseling and communication skills, and they are “consistently ranked as the most trusted

profession” (Hoekstra and Margolis 401). Therefore, they should be the ones taking on the role

of vaccine education in order to increase parent’s comfort levels with the questions they have

about vaccinations. For the reasons that “parents come to the vaccine debate from many Commented [CA6]: Fixed my quotation a bit so that I
was not always introducing the quote by saying
“according to so and so…”
different angles and their specific concerns are varied” (Hoekstra and Margolis 402), a

counseling-type conversation would be beneficial, and nurses are ultimately best for that job.

There are many different comfort levels to communication, especially when it comes to

communicating with those we view as authority. It would be valuable to physicians, patients, and

the community if these comfort levels were taken into consideration when planning how to

conduct vaccine education to parents within a physician’s office. If these revisions in the nurse’s

role regarding patients and vaccination education were to be effective, it could potentially put an

end to parents leaving their doctor’s appointments unsatisfied and turning to the Internet for

further education on the topic.

One of the issues with the Internet as a source for information on vaccines is the fact that

it is a vast space with many non-credible sources. Since the medical professionals at the doctor’s

office are ultimately the sources the parent will listen to most, it is highly necessary that the

medical community come up with a solution to the communication issue. According to Mary
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Healy and Larry Pickering, because providers “are the most important influence on a parent’s

final decision on immunization, establishing ongoing, non confrontational dialogue from the

initial HCP-parent interaction is essential when dealing with vaccine-hesitant parents” (132). The

problem lies within the fact that there are a number of parents that experience negative outcomes

from their doctor’s appointments (whether it is lack of education from the appointment or

unanswered questions), meaning they are “more likely to obtain information about vaccination

through the Internet with the help of search engines” (Harmsen, et al.). Parents’ information hunt Commented [CA7]: Added evidence to support this
claim.
on vaccines via the Internet usually includes searches for “information they missed from the

Public Health Institute” within their information packets distributed by their providers (Harmsen,

et al.). The top hits on the topic lead parents to poor quality sources speaking of conspiracy

theories and strictly opinions on the topic shaped to look like facts. The majority of people

coming across these sources may not realize just how non-credible they truly are. Many parents

read through these websites thoroughly, and form a stance that could result in their child not

being immunized.

Highly professional medical institutions own many pro-vaccine sources. On the other

hand, anti-vaccination sources are “often operated by activists of the anti-vaccination movement,

that is private citizens expressing their personal views on the topic” (Sak, et al. 8). Many of these

types of sources contain opinions and information that is only appealing to parents’ emotions,

rather than appealing to logic. Many parents may not realize this is a tactic used to persuade them

to believe the anti-vaccination claims. While it is not always a bad thing to appeal to the

emotions of the reader, it can most certainly be negative when an author is not including both

sides to the story, with evidence to back the points up. According to Mary Healy and Larry

Pickering, “some Internet sites aim to capture a target audience by providing information in a
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form that attracts attention, is comprehended easily, and disregards scientific validity, ensuring

that the story is not ‘balanced’” (129). Often times, once people read the ins and outs of the

conspiracy theories, their bold stance of anti-vaccine is formed and they will not revisit the topic.

That is mostly due to the fact that the sources appeal to emotion. This causes the information to

stick with the reader differently than the content of a ‘boring’ pro-vaccination article. According

to a study done by Jolley and Douglas that closely examined how anti-vaccination conspiracy

theory sources affect vaccination intentions, “anti-vaccine conspiracy theories appear to

introduce undue suspicion about vaccine safety, and increase feelings of powerlessness and

disillusionment, whilst decreasing trust in authorities, which in turn introduce reluctance to

vaccinate” (6). Since these sources are popular for the fact that they are merely interesting and

easy to understand, the pro-vaccine sources that are full of facts come off as boring to the reader.

This is because communicating the truth via the web is difficult “because definitive studies often

use scientific language and terms that are familiar to physicians and scientists but are confusing

for parents who are trying to process the information” (Healy and Pickering 129). In order to

keep the audience of pro-vaccination sources interested, the medical community would greatly

benefit from placing funding sources that make the topic interesting. I believe many of these

behind the scenes changes that improve the patient and provider relationship when involving

vaccines could be much more beneficial than any law or regulation.

Since the anti-vaccination theories have been so persuasive to vaccination decisions, I

can see why some believe that government intervention and laws that force vaccination are a

valuable solution to the issue. I believe vaccines are simply an issue that the government cannot

control, and the resolution needs to be more thought-through than a few laws. According Elisia

Cohen and Katharine Head, parents “believed it was their responsibility to make good Commented [CA8]: Here, I cut out a lot of extra
verbiage about the article itself.
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vaccination decisions for their child regardless of what was required by policy or law” (301).

Through implementing quality education and counseling within physician’s offices on the topic

of vaccinations, it is possible that parents would feel more confident in making a decision that

they felt was best, rather than a decision they were forced into by law. Ultimately, it is the

parents’ choice of whether or not to vaccinate. The actual decision that a parent makes cannot be

controlled. The amount of education, knowledge, and answers a parent has obtained about the

topic can be controlled through simply correcting misinformation “to move some parents to

accept vaccination, as poor knowledge was often coupled with poor attitudes toward

vaccinations (particularly voluntary ones)” (Cohen and Head 301). Coupling the lack of Commented [CA9]: Prior to my revision, I had this
quote standing alone in a sentence. I integrated the quote
into the previous sentence to help the flow of this
knowledge with strict laws regarding vaccines will only make most parents want to refuse, since paragraph.

they will not feel as if they have control over choices for their children. According to a recent

article by the Washington Post, there was a new law put in place in California that states that

“under the new rules, only children with serious health problems (such as a compromised

immune system) would be exempt from mandatory vaccination schedules, and those who opt out

will have to be homeschooled” (Kaplan). This law excludes religious reasons from being valid

enough to not vaccinate. Such laws cause anger and frustration from parents who are against

vaccination, which pushes them even further away from a possible change of heart. What is even

more worrisome is the fact that many parents who are unsure about vaccinations may have

automatic negative feelings about them since they feel that they are mandated and they do not

have a say. Without pressure from the government, parents are able to form their own decisions,

rather than forced decisions, when it comes to vaccines.

Although fair amounts of people form their anti-vaccination stance from the web, not

everyone falls under this category. There are most certainly some people who simply do not
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believe in science, therefore they will neglect any scientific evidence or reasons that the medical

field swears vaccinations are crucial and effective. However, studies have shown that most

parents do view their providers as the best form of information regarding vaccines. For that

reason, providers (and nurses) delivering vaccine information would “be more effective if they

work to convince parents of the dangers of failing to vaccinate their children” rather than

“convincing parents of the safety of vaccines” (Horne et al.). This is because most parents would

be more willing to vaccinate if they knew they were protecting their children from harm. They

would be less willing to vaccinate if the harmfulness were not exposed and they were only left

with information about vaccination benefits and essentially their doubts thereof. If providers or

nurses do all that they can when it comes to vaccine communication and they still fall short, they

may ultimately have to decide whether or not to refuse to see the patient that is rejecting the

vaccines. The reason in doing so would be because “pediatricians want to provide only the best

of established standards for all of the children under their care” (Block 652). The threat to herd

immunity that comes along with non-vaccinated patients is enough for most pediatricians to

refuse an uncooperative parent/patient. As for that patient, we can only hope the refusal of their

doctor’s office to see them at their practice anymore would open their eyes to the fact that their

decision is most definitely a harmful one that is not being taken lightly. Commented [CA10]: Here, I added information and
evidence about how some pediatricians deal with parents
who simply refuse to vaccinate.

At this point, I would like you to put yourself in the shoes of a parent whose child goes to

school where a recent outbreak of a vaccine preventable disease occurred. Would you not be Commented [CA11]: Added some pathos for the reader
at the beginning of my conclusion in order to draw the
audience’s attention and tie my ideas together with some
frustrated with the parents that chose selfishly to not vaccinate their children? Does their choice new information.

not infringe upon your confidence of herd immunity? There is no doubting the fact that parents

who refuse to vaccinate their children are putting their communities at risk. If only those parents

understood that “public health is a collaborative effort, with each of us making decisions that
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impact not only our own well-being but that of those around us as well” (Vietri 455), the anti-

vaccination movement may not be such a prominent issue that it is today. The extent of the issue

may not have been clear until recently when the “measles outbreak that began at Disneyland in

California in December 2014 and had spread to at least 17 states, Canada, and Mexico by late

February” (Yang and Silverman 1481). This outbreak truly opened people’s eyes to just how fast

(and far) these vaccine preventable diseases can spread. Although outbreaks such as these cause

the government to feel the need to interfere through social distancing, “such infringement of

individual rights should be minimized and undertaken only when necessary to protect the

public’s health”(Yang and Silverman 1483). Perhaps serious outbreaks could be diminished if

the communication regarding vaccines were to take on “altruistic motivation” since it “manifests

in vaccination decisions”(Vietri et al. 454). Since other changes to the vaccine education system

would be beneficial, it is important that the medical community takes proactive steps in

revamping their current vaccination communication strategies. This could happen through

implementing a system that centers on nurse’s taking charge of the education and counseling

regarding vaccinations. Through doing so, it would be possible to lower the amount of people

turning to poor Internet sources for information, and could eventually eliminate any laws and

regulations regarding vaccines.

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Works Cited

Block, Stan L. "The Pediatrician's Dilemma: Refusing The Refusers Of Infant Vaccines."

Journal Of Law, Medicine & Ethics 43.3 (2015): 648-653. Academic Search Elite. Web.

9 May 2016.

Cohen, Elisia L., and Katharine J. Head. "Identifying Knowledge-Attitude-Practice Gaps In

Parental Acceptance Of Adolescent Vaccinations In Appalachian Kentucky: Implications

For Communication Interventions." Journal Of Communication In Healthcare 7.4

(2014): 295-302. Communication & Mass Media Complete. Web. 27 Apr. 2016.

Harmsen, Irene A., Doorman G, Mollema L, Ruiter R, Kok G, de Melker H. "Parental

Information-Seeking Behaviour In Childhood Vaccinations." BMC Public Health 13.1

(2013): 1-19. Academic Search Elite. Web. 8 May 2016.

Healy, C Mary, and Larry K Pickering. "How To Communicate With Vaccine-Hesitant Parents."

Pediatrics 127 Suppl 1.(2011): S127-S133. MEDLINE. Web. 27 Apr. 2016.

Henrikson, B Nora, Douglas J. Opel, Lou Grothaus, Jennifer Nelson, Aaron Scrol, John Dunn,

Todd Faubion, Michele Roberts, Edgar K. Marcuse, David C. Grossman. "Physician

Communication Training And Parental Vaccine Hesitancy: A Randomized Trial."

Pediatrics 136.1 (2015): 70-79. Academic Search Elite. Web. 27 Apr. 2016.

Hoekstra, Shelley, and Lewis Margolis. "The Importance Of The Nursing Role In Parental

Vaccine Decision Making." Clinical Pediatrics 55.5 (2016): 401-403. Academic Search

Elite. Web. 27 Apr. 2016.

Horne, Zachary, Derek Powell, John E Hummel, and Keith J Holyoak. "Countering

Antivaccination Attitudes." Proceedings Of The National Academy Of Sciences Of The

United States Of America 112.33 (2015): 10321-10324. MEDLINE. Web. 9 May 2016.
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Jolley, Daniel, and Karen M. Douglas. "The Effects Of Anti-Vaccine Conspiracy Theories On

Vaccination Intentions." Plos ONE 9.2 (2014): 1-9. Academic Search Elite. Web. 12 Apr.

2016.

Kaplan, Sarah. "The California Assembly Just Approved One of Nation’s Strictest Mandatory

Vaccine Laws." Washington Post. The Washington Post, 26 June 2015. Web. 25 Apr.

2016.

Kennedy, Allison, Katherine LaVail, Glen Nowak, Michelle Basket, and Sarah Landry.

"Confidence About Vaccines In The United States: Understanding Parents' Perceptions."

Health Affairs 30.6 (2011): 1151-1159. Academic Search Elite. Web. 11 Apr. 2016.

Kennedy, Allison, Michelle Basket, and Kristine Sheedy. "Vaccine Attitudes, Concerns, And

Information Sources Reported By Parents Of Young Children: Results From The 2009

Healthstyles Survey." Pediatrics 127 Suppl 1.(2011): S92-S99. MEDLINE. Web. 25 Apr.

2016.

Lyons, Antonia. "Morality, Responsibility And Risk: The Importance Of Alternative

Perspectives In Vaccination Research." International Journal Of Behavioral Medicine

21.1 (2014): 37-41. Academic Search Elite. Web. 25 Apr. 2016.

Moser, Charlotte A., Dorit Reiss, and Robert L. Schwartz. "Funding The Costs Of Disease

Outbreaks Caused By Non-Vaccination." Journal Of Law, Medicine & Ethics43.3

(2015): 633-647. Academic Search Elite. Web. 6 Apr. 2016.

Norgaard, Birgitte, Jette Ammentorp, Kirsten Ohm Kyvik, and Poul-Erik Kofoed.

"Communication Skills Training Increases Self-Efficacy Of Health Care Professionals."

Journal Of Continuing Education In The Health Professions 32.2 (2012): 90-97. ERIC.

Web. 8 May 2016.

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Sak, Gabriele, Nicola Diviani, Ahmed Allam, and Peter J Schulz. "Comparing The Quality Of

Pro- And Anti-Vaccination Online Information: A Content Analysis Of Vaccination-

Related Webpages."BMC Public Health 16.(2016): 1-12. Academic Search Elite. Web.

21 Apr. 2016.

Vietri, Jeffrey T., Meng Li, Alison P. Galvani, and Gretchen B. Chapman. "Vaccinating To Help

Ourselves And Others." Medical Decision Making 32.3 (2012): 447-458. PsycINFO.

Web. 9 May 2016.

Yang, Y. Tony, and Ross D. Silverman. "Social Distancing And The Unvaccinated." New

England Journal Of Medicine 372.16 (2015): 1481-1483. Academic Search Elite. Web. 9

May 2016.