Training physicians in communication skills may not make it any easier
for them to convince vaccine-resistant parents to inoculate their
babies, a study suggests.
Researchers invited physicians at 30 clinics in Washington state to
attend 45-minute classes led by a pediatric immunization expert and
health educator. But doctors who attended the sessions were no better at
lowering vaccine resistance than their colleagues at 26 other clinics
where training wasn’t offered.
“It’s possible that a longer, higher-intensity version of the training
might be more effective,” lead study author Nora Henrikson, a specialist
in patient behavior at Group Health Research Institute in Seattle, said
by email.
On average, about 95 percent of children in most states are up to date
on the recommended childhood vaccinations against diseases including
measles, mumps, rubella, tetanus and pertussis, according to the U.S.
Centers for Disease Control and Prevention.
But clusters of much lower vaccination rates in certain communities,
driven in large part by parents’ resistance to inoculation, leave some
members of those communities vulnerable to serious and potentially fatal
illnesses, according to the CDC.
To understand how parents felt about vaccination in Washington state,
Henrikson and colleagues reached out to mothers of newborns at four
hospitals in two counties, inviting them to participate in the study if
their babies had no medical complications and they planned to receive
routine well-child care from a clinic participating in the study.
Researchers spoke to 347 mothers about their perception of vaccines
once when the babies were 4 to 6 weeks old and again six months later.
In the months between interviews with the mothers, researchers offered
communications training to some of the physicians treating their babies.
The training classes emphasized the importance of establishing trust
with families to improve vaccination rates, and participants also
received access to additional web-based training, monthly email
reminders on communication strategies and handouts for parents
explaining the value of vaccines.
At the start of the study, about 11 percent of the mothers were
hesitant about vaccinating their babies, and 2 percent of them were
extremely resistant.
Among women who took their babies to pediatricians who received
training, vaccine resistance dropped from 9.8 percent at the start of
the study to 7.5 percent six months later.
When doctors didn’t receive training, the mothers’ resistance dropped
from 12.6 percent initially to 8 percent at the end of the study.
One limitation of the study is that not all clinics that agreed to
participate saw mothers who also enrolled in the trial. Also, many
doctors and parents who initially agreed to help with the experiment
failed to complete all the surveys.
It’s also possible that the training didn’t appear very effective
because the number of mothers who were resistant to vaccines at the
start of the study was lower than expected, Henrikson said.
Doctors who need to improve their communication skills may also need
more than a single class to accomplish this goal, said Julie Leask, a
public health researcher at the University of Sydney, New South Wales in
Australia, who wrote an editorial accompanying the study in the journal
Pediatrics.
Moreover, the physicians who choose to attend extra training sessions
may very well be the ones who already have decent communications skills,
leaving less room for improvement, she said.
“Only two thirds of the doctors actually attended the training, and the
session was pragmatically brief to fit in with the realities of busy
clinicians,” Leask said by email.
“We need to be very careful in not abandoning an intervention that may
have not been delivered to enough people in enough of a dose.”
SOURCE: bit.ly/1dHFNKM Pediatrics, online June 1, 2015.
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