Vaccine-hesitant Patients Research Articles

From vaccine hesitancy to vaccine motivation: A motivational interviewing based approach to vaccine counselling.

The COVID-19 pandemic highlighted Vaccine Hesitancy (VH) as an accelerating global phenomenon that must be addressed. According to the WHO, thirty to fifty percent of the world's population are VH. Motivational Interviewing (MI) is an evidence-based communication style demonstrated to significantly reduce VH. MI guides people toward change through the expression of empathy and by respecting an individual's autonomy. Healthcare providers (HCPs) are the primary implementors of vaccine policies and the most trusted advisors and influencers of vaccination intention at the individual patient level. Training HCPs in MI is one of the most effective strategies to overcome VH. Many countries are currently implementing HCP training programs and population-based MI interventions to improve vaccine uptake. MI conversations are 'the heart' of vaccine decision-making processes. Understanding individual patient-level drivers of hesitancy allows clinicians to efficiently provide tailored, accurate information that reinforces a person's own motivation and confidence in their own decision. This paper describes a 4-step practical framework designed to support HCPs in their dialogue with vaccine-hesitant patients. (1) Engaging to establish a trustful relationship and safety to freely express opinions, beliefs, and knowledge gaps; (2) Understanding what matters most to the individual; (3) Offering Information to co-build accurate knowledge in order to guide the individual toward vaccine intention (4) Clarifying and Accepting to validate an individual's decision-making autonomy. We believe that our pragmatic approach can contribute to greater acceptability of COVID-19 and other vaccines, and enable rapid deployment of practical MI skills across care systems.

The Impact of Motivational Interviewing and MOTIVE Tool Use by Pharmacists on Vaccine Acceptance.

Vaccines have played a significant role in reducing infectious disease burden. However, vaccine hesitancy remains a persistent challenge in public health, including for pharmacists who often interact with patients regarding vaccines. Thus, this study assesses the impact of motivational interviewing (MI) training and the MI-based vaccine hesitancy discussion tools (MOTIVE) on pharmacists' management of vaccine hesitancy. Pharmacists in eight Midwestern pharmacy practices who completed MI and MOTIVE training and engaged with vaccine-hesitant patients participated in this study. The pharmacist participants completed post-encounter surveys identifying the vaccine discussed, the tool utilized, and the outcome of the conversation. Descriptive results from 362 encounters indicated that the primary reasons for hesitancy were safety (39%), care coordination (31.5%), and efficacy (30.4%). Post encounter, 35.4% of patients received vaccines, 26% planned to, 25.1% considered it, and 13.5% were uninterested. The findings highlight the importance of patient-centered communication, such as MI, between patients and pharmacists to identify and address reasons for vaccine hesitancy. Pharmacists, equipped with conversation tools such as the MOTIVE tools, may effectively influence vaccine acceptance. Future research should evaluate the utility of MI and the MOTIVE tools in other settings and regions.

Healthcare professionals’ perceptions of challenges in vaccine communication and training needs: a qualitative study

BackgroundHealthcare professionals (HCPs) can play an important role in encouraging patients and their caregivers to be vaccinated. The objective of this qualitative study was to investigate HCPs’ perspectives on challenges in vaccine communication and unmet training needs in this domain.MethodsSemi-structured interviews were conducted with 41 HCPs (mainly nurses and physicians) with vaccination roles (23 in England; 18 in France), gathering information on: (1) HCPs’ approach to vaccine conversations with patients; (2) Challenges of communicating about vaccines; (3) Vaccine-related training and learning resources available to HCPs, and; (4) HCPs’ training needs around vaccine communication.ResultsHCPs described a range of communication experiences that indicated insufficient time, information, and skills to confidently navigate difficult conversations with vaccine-hesitant patients. Communication skills were especially important to avoid conflict that could potentially damage the patient-provider relationship. Some HCPs interviewed had received communication training, but for most, this training was not specific to vaccination. Although general communication skills were transferable to vaccine conversations, most HCPs welcomed specific training and informational resources to support countering patients’ misconceptions or misinformation about vaccines.ConclusionsHCPs would benefit from training tailored to address vaccine communication with patients, and this should be part of a systemic approach that also provides time and space to have effective vaccine conversations.

Primary care providers’ views of discussing COVID-19 vaccination with vaccine hesitant patients: A qualitative study

ObjectiveTo describe primary care providers’ (PCPs) perspectives on discussing COVID-19 vaccination with their patients. MethodsAll PCPs from 11 primary care clinics at 3 health systems were invited to participate. Focus groups were conducted between December 2021-January 2022, and were recorded and transcribed. Participants were asked about their experience communicating about the COVID-19 vaccine. Themes and subthemes were inductively identified using thematic analysis. Results40 PCPs participated. All PCPs viewed discussing COVID-19 vaccination as high priority. Strategies for promoting COVID-19 vaccination included influencing what people think and feel, building trust and leveraging their relationship with patients, and practical strategies such as on-site vaccination. Most strategies aimed at influencing what people think and feel and leveraging relationships were viewed as generally ineffective. On-site vaccine availability was identified as the most influential factor. PCPs expressed frustration by their interactions with vaccine hesitant patients, leading them to truncate their communication with these patients. ConclusionsDespite using a broad range of strategies, most PCPs were unable to change the strongly held beliefs among the most vaccine hesitant patients that were often informed by misinformation and mistrust. Practice implicationsPromising strategies for promoting vaccination include social/relational (expressing empathy) and practical (on-site COVID-19 vaccine availability).

Communication strategies for healthcare providers to enhance vaccine discussions with vaccine-hesitant patients

This study examines vaccine hesitancy as an emerging public health concern that undermines the efficacy of vaccination initiatives. Healthcare providers play a crucial role in addressing vaccine hesitancy; however, many lack effective communication strategies. This study developed evidence-based communication guidelines to assist healthcare providers in discussing vaccines with hesitant patients. Drawing on Bourdieu's theoretical framework, semi-structured interviews were conducted with ten vaccine-hesitant parents and ten paediatricians in Nigeria. Through reflexive thematic analysis of the interview transcripts, this study uncovers power dynamics, legitimacy struggles, and cultural capital's significance in vaccine conversations. The findings reveal that hesitant parents question the legitimacy of vaccine recommendations, feeling marginalised yet constrained by societal norms of responsible parenthood. Similarly, healthcare providers' reliance on biomedical expertise often proves insufficient without rapport building, cultural competency, and addressing patients' unique knowledge assets. The findings of this study contribute to communication theory, medical education, and clinical practice by advocating for power-conscious, dialogue-based strategies to promote vaccination amidst uncertainty and scepticism.

Medical and dental student knowledge about COVID-19 and influenza vaccines impact opinions about vaccine advocacy and future practice.

The World Health Organization has identified vaccine hesitancy as a global public health challenge. Healthcare providers are among the most influential and trusted figures for vaccine counseling. This article focuses on COVID-19 and influenza personal immunization behaviors, vaccine knowledge and opinions, and vaccine counseling confidence among future healthcare providers - dental and medical students. A cross-sectional anonymous online survey was conducted at four dental schools and one allopathic medical school in the United States. Items included personal vaccination status for the COVID-19 and influenza vaccines and vaccine-specific items developed based on past research to assess knowledge, opinions, and behaviors. Two hundred and thirty-two medical and 221 dental students completed the survey. 68 and 55% scored average/above-average knowledge on COVID-19 and influenza vaccine items, respectively. There were significant differences between those with average/above-average and below-average knowledge scores regarding learning about, recommending, and advocating for vaccines and counseling vaccine-hesitant patients for both vaccines (p < 0.0001). Although higher-knowledge students had higher vaccination rates (p < 0.0001), many had insufficient knowledge about vaccines. Healthcare providers play a crucial role in vaccine advocacy. The identified knowledge gaps are significant as they impact quality of patient care. And opinions about future vaccination practice such as recommending, providing, and counseling about vaccines. Equipping students with knowledge and communication skills will enable them to be strong vaccine advocates to improve overall public health.

Using the power of narratives in e-learning for COVID-19 vaccine hesitancy conversations

Background During the COVID-19 pandemic, we developed an e-learning resource to support medical students in having effective conversations with COVID vaccine hesitant patients (an urgent challenge). Development of information and communication skills elements was underpinned by narrative learning theory; learners interact with three fictional characters whose stories run through the resource in activities and role-plays. We co-developed the resource and characters with students, colleagues and local community. Methods We evaluated the resource using a survey of pre- and post- module self-confidence scores, and by thematic analysis of a focus group with seven final year medical students to explore their perceptions of how the story elements influenced their learning. Results All students surveyed reported an improvement in their confidence in having effective conversations with vaccine-hesitant patients. The focus group analysis suggests that character-based narratives can promote learning online, particularly through improved memory, relatability, and emotional connection. Conclusions This study suggests that the potential value of character-driven stories described in other healthcare education settings also applies in the online learning environment. Further research is needed to establish the nature of their impact on different aspects of learning including patient-related outcomes.

Teaching undergraduate medical students how to communicate with vaccine-hesitant patients: A scoping review

Introduction: Vaccine hesitancy poses a challenge to healthcare professionals. Prior to graduation, medical students may not be fully equipped with the knowledge or skills to manage interactions with vaccine-hesitant patients. The aim of this scoping review was to identify and evaluate the characteristics of educational interventions that improve medical students’ skills in communicating with vaccine-hesitant patients. Methods: EMBASE, OVID Medline, CINAHL, and ERIC databases were searched with keywords related to “vaccine hesitancy” and “undergraduate medical education”. One hundred and fourteen primary studies were identified, and seven articles were included for review. Data extraction included the characteristics of educational interventions, such as the modality, duration, frequency and assessment methods. Results: There is limited literature describing educational interventions that help medical students develop skills to effectively with vaccine-hesitant patients. This makes it difficult to draw conclusions on the effectiveness of different pedagogical approaches. Although the included studies generally reported an increase in student self-reported confidence to communicate with vaccine-hesitant patients, none assessed whether the interventions led to changes in student clinical practice or improvements in patient outcomes. Conclusion: Additional research into the identification of educational interventions that establish persistent changes in students’ knowledge, attitudes and skills to communicate with vaccine-hesitant patients is required. An evidence-based medicine component of an education program, which can adapt to evolving contributors to vaccine hesitancy and the variety of concerns across different vaccines, may present a potential solution. Educators would be better directed with further research that aligns health outcomes with teaching, assessment and evaluation of a proposed vaccine-hesitancy curriculum.

Understanding COVID-19 vaccine hesitancy in vasculitis patients.

To identify the factors that impact COVID-19 vaccine decision-making in vaccine-hesitant vasculitis patients, and compare their perceptions with other rheumatology patients, given existence of data suggesting rheumatology patients may have disease-specific factors that influence their COVID-19 vaccine decision-making. This cross-sectional study surveyed adult rheumatology patients from the Kaye Edmonton Clinic Rheumatology Clinic, in Canada, between June and August 2021, using an anonymous online questionnaire. Survey responses were analyzed for statistical differences using chi-square analysis. The COVID-19 Vaccine Perceptions Survey had a response rate of 70.9%. Of the total 231 respondents, 103 patients were diagnosed with vasculitis. At the time of the survey, 10.6% of vasculitis patients refused to receive a COVID-19 vaccine compared to 6.3% for other rheumatology patients. Compared to other rheumatology patients, vaccine-hesitant vasculitis patients were significantly more concerned about almost every aspect of available COVID-19 vaccines [e.g., safety (p < 0.001), components (p < 0.001)], and feared that they could contract SARS-CoV-2 from a vaccine (p < 0.001). These vaccine-hesitant patients were also significantly less pleased with the government's pandemic response, less confident in healthcare team-provided information (p < 0.001), and more likely to report that healthcare providers had no role in their COVID-19 vaccine decision-making (p < 0.001). Vaccine-hesitant vasculitis patients may have multiple considerations influencing COVID-19 vaccine hesitancy, including vaccine and disease-specific concerns, along with unfavorable perceptions of the healthcare system (government and healthcare providers). Healthcare providers can address some of these concerns by initiating patient-centered discussions around immunizations to help support educated decision-making.

The Impact of COVID-19 Pandemic on Clinical Findings in Medical Imaging Exams: An Observational Study in a Nationwide Israeli Health Organization.

The outbreak of the COVID-19 pandemic had a major effect on consumption of healthcare services. Changes in the use of routine diagnostic exams, increased incidences of post-acute COVID-19 syndrome (PCS), and other pandemic-related factors, may have influenced detected clinical conditions. The study aimed to analyze the impact of COVID-19 on the use of outpatient medical imaging services and clinical findings therein, specifically focusing on the time period after the launch of the Israeli COVID-19 vaccination campaign. In addition, the study tested whether the observed gains in abnormal findings may be linked to PCS or COVID-19 vaccination. Our dataset included 572,480 ambulatory medical imaging patients in a national health organization, from January 1, 2019 to August 31, 2021. We compared different measures of medical imaging utilization and clinical findings therein, before and after the surge of the pandemic, to identify significant changes. We also inspected the changes in the rate of abnormal findings during the pandemic after adjusting for changes in medical imaging utilization. Finally, for imaging classes that showed increased rates of abnormal findings, we measured the causal associations between COVID-19 infection, hospitalization (indicative of COVID-19 complications), and vaccination and future risk for abnormal finding. To allow adjustment for a multitude of confounding factors, we used causal inference methodologies. After the initial drop in the utilization of routine medical imaging due to the first COVID-19 wave, the number of these exams has increased, but with lower proportions of older patients, patients with comorbidities, women, and vaccine-hesitant patients. Furthermore, we observed significant gains in the rate of abnormal findings, specifically in musculoskeletal magnetic resonance (MR-MSK) and brain computed tomography (CT-brain) exams. These results also persisted after adjusting for the changes in medical imaging utilization. Demonstrated causal associations included: COVID-19 infection increasing the risk for an abnormal finding in a CT-brain exams (odds ratio [OR] of 1.4, with 95% confidence interval [CI] 1.1 to 1.7); and COVID-19-related hospitalization increasing the risk for abnormal findings in an MR-MSK exam (OR 3.1, 95% CI 1.9 to 5.3). COVID-19 impacted the use of ambulatory imaging exams, with greater avoidance among patients at higher risk for COVID-19 complications: older patients, patients with comorbidities, and non-vaccinated patients. Causal analysis results imply that PCS may have contributed to the observed gains in abnormal findings in MR-MSK and CT-brain exams, respectively.

Coronavirus disease 2019 vaccine skin testing and graded challenges in vaccine-hesitant patients

Coronavirus disease 2019 vaccine skin testing and graded challenges in vaccine-hesitant patients

Relationship between COVID-19 vaccine hesitancy and willingness to pay for the booster dose of COVID-19 vaccine of oncology patients in Taizhou, China

Objective This population-based study aimed to determine the hesitancy and willingness to pay (WTP) for the booster dose of a coronavirus disease (COVID-19) vaccine among patients with cancer in Taizhou, China. Patients and methods A self-administered online questionnaire was administered to patients with cancer in Taizhou, China. The chi-square test, binary logistic regression model were used to evaluate the WTP for the booster dose of a COVID-19 vaccine. The minimum sample size was 218, determined by G*Power software (latest ver. 3.1.9.7). A total of 354 patients received the survey, and 256 (72.3%) patients responded. Results Overall, 69.9% (179/256) of respondents were willing to pay for the booster dose, and 78.8% (141/179) of these patients were willing to pay 1–99 CNY. Furthermore, 50.4% (129/256) of respondents were hesitant to receive a COVID-19 vaccine. Being unhesitant was significantly associated with WTP for the booster dose (aOR: 3.040; 95% CI: 1.669–5.540). Conclusion Hesitant patients with cancer had a lower WTP for the booster dose against COVID-19 than non-hesitant participants. These results imply that further health education programmes are essential to decrease the hesitancy of patients with cancer and enhance booster dose vaccination rates for public health improvements. KEY MESSAGES Our research showed that 70% of patients with cancer are willing to pay for the booster dose of the COVID-19 vaccine, and most are willing to pay less than 100 CNY, and this result reflects the economic value and affordability of the third dose of vaccination. COVID-19 vaccine-hesitant patients with cancer had a lower willingness to pay for a booster dose against COVID-19 than non-hesitant participants and few patients are still unwilling to pay among patients do not hesitate to receive the third dose. Therefore, promoting willingness to pay among oncology patients and addressing vaccine hesitancy remains key.

Healthcare Provider's Perceived Self-Efficacy in HPV Vaccination Hesitancy Counseling and HPV Vaccination Acceptance.

HPV vaccine hesitancy is a key contributor to the sub-optimal HPV vaccination uptake in the United States. We aimed to determine the association between healthcare providers' self-efficacy in HPV vaccination hesitancy counseling and HPV vaccination acceptance after initial and follow-up counseling sessions. Population-based cross-sectional study of healthcare providers (HCPs) practicing in Texas. Logistic regression analyses were used to determine the odds of HPV vaccination acceptance by vaccine-hesitant patients. Additionally, generalized estimating equations were used to compare HPV vaccination acceptance by hesitant patients after follow-up versus initial counseling sessions. 1283 HCPs completed the survey with a mean (SD) age of 47.1 (11.3) years. HCPs who believed that they were very/completely confident in counseling HPV-vaccine-hesitant parents had higher odds of observing HPV vaccination acceptance very often/always after an initial counseling session (adjusted odds ratio (AOR): 3.50; 95% CI: 2.25-5.44) and after follow-up counseling sessions (AOR: 2.58; 95% CI: 1.66-4.00) compared to HCPs that perceived they were not at all/somewhat/moderately confident. The odds of HPV vaccination being accepted very often/always by vaccine-hesitant parents was 61% (AOR: 1.61; 95% CI: 1.32-1.95) higher after follow-up counseling sessions compared to an initial counseling session. The results were similar for the counseling of HPV-vaccine-hesitant adult patients. The confidence level of HCPs in counseling hesitant parents and adult patients impacts HPV vaccination acceptance. Importantly, acceptance was higher after follow-up counseling sessions than initial counseling sessions. HCPs should receive training in HPV vaccination counseling to enhance their confidence in counseling hesitant patients and should utilize every visit to counsel hesitant patients.

Vaccine knowledge, attitudes, and recommendation practices among health care providers in New York State

ABSTRACT Community-wide vaccine uptake remains sub-optimal. Healthcare provider (HCP) vaccine recommendations influence patient vaccination; however, provider vaccine recommendation behavior is highly influenced by one’s own vaccine attitudes and/or knowledge. We aim to describe vaccine knowledge, attitudes, and recommendation practices (KAP) among New York State HCPs. A survey to assess HCP KAP was developed and electronically distributed to NYS members of national medical organizations via their local chapter administrators. Descriptive statistical methods were used to define provider KAP. A total of 864 surveys were included, 500 (60%) and 336 (40%) primary and specialty care providers, respectively. Eighty-one percent (402/499) of primary care providers (PCPs) report encountering vaccine hesitant patients daily or weekly. Of the 500 PCPs who responded, only 204 (41%) stated strong agreement with confidence in their communications with vaccine hesitant patients. HCPs who correctly answered all four knowledge questions were more likely to self-report routine recommendations of standard vaccines to all patients when compared to those who correctly answered fewer questions (489/588 (83%) vs 135/241 (56%), p < .05). HCPs were more likely to routinely recommend standard vaccines to all patients if they also report initiating vaccine discussion (476/485 (98%) vs 148/344 (43%), p < .05) and reviewing and recommending vaccinations at each encounter (315/320 (98%) vs 308/508 (61%), p < .05). Vaccine hesitancy exists across healthcare specialties and provider roles. Focused interventions should include reaching all HCPs to promote vaccinations for disease prevention, tailoring messages to reduce HCP vaccine misperceptions, and increasing awareness of evidence-based office strategies known to facilitate immunizations.

Addressing Vaccine Hesitancy Through a Comprehensive Resident Vaccine Curriculum.

Vaccine hesitancy can lead to incomplete vaccination, increased risk of vaccine-preventable diseases, and distrust or conflict between physicians and patients. Yet many physicians are uncomfortable navigating vaccine hesitancy and educating vaccine-hesitant patients and families. We developed a vaccine hesitancy curriculum to increase vaccine knowledge, comfort, and communication skills in pediatric residents. The curriculum consisted of four interactive 40-minute sessions delivered to pediatric residents over 10 months. The first two sessions discussed recommended childhood vaccines, the third session examined common vaccine misconceptions, and the final session reviewed vaccine hesitancy-specific communication skills, incorporating practice through role-playing. Residents completed pre- and posttests assessing knowledge and comfort as well as receiving a standardized patient (SP) assessment of vaccine-specific communication skills after the curriculum. Thirty-five residents were in the educational intervention group and 35 in a control group. Pretest scores did not differ significantly between the groups. The mean knowledge score for the intervention group increased from 47% on the pretest to 66% on the posttest. The mean self-reported comfort score (1 = low comfort, 5 = high comfort) for the intervention group increased from 2.9 on the pretest to 3.8 on the posttest. The control group showed no difference between pre- and posttest scores for knowledge or comfort. The mean postintervention SP assessment score was significantly higher for the intervention group (78%) than the control group (52%). Implementation of a comprehensive vaccine hesitancy curriculum resulted in improved vaccine knowledge, self-reported comfort, and communication skills among pediatric residents.

Engaging Empathically: Effects of a Motivational Interviewing Learning Session and Standardized Patient Encounter on Medical Student Confidence in Counseling COVID-19 Vaccine-Hesitant Patients.

Purpose: Though vaccines against COVID-19 are now widely available, a significant portion of the U.S. population remains unvaccinated. 1 Motivational interviewing (MI) has been shown to be effective in mitigating vaccine hesitancy. 2 We aimed to develop a training module for medical students to learn and practice MI techniques for use in counseling COVID-19 vaccine-hesitant patients. Approach: We developed an integrated learning module consisting of a 20-minute prerecorded didactic session covering the basics of vaccine hesitancy, MI techniques, Sharing Information, and SMART Goal Setting followed by a 15-minute telehealth standardized patient (SP) encounter with a vaccine-hesitant individual. During AY 2020–2021, all third-year (CO 2022, n = 124) and fourth-year (CO 2021, n = 88) students at the Florida International University Herbert Wertheim College of Medicine completed the module. Before viewing the prerecorded sessions, students completed a 4-question presession confidence survey (5-point Likert, Strongly Disagree–Strongly Agree). After completing the SP encounter, students completed a 5-question postsession confidence and satisfaction survey. Pre- and postsession survey results were compared by unpaired t test. Outcomes: Mean presession agreement with the statement “I feel comfortable counseling patients who demonstrate vaccine hesitancy” was found to be 2.98 (SD 0.90) and 3.67 (SD 0.70) for third- and fourth-year students, respectively. Postsession agreement increased to 4.08 (SD 0.55, P < .05) and 4.35 (SD 0.62, P < .05), respectively. Mean presession agreement with the statement “I am comfortable using MI techniques to encourage patients to become vaccinated” was found to be 3.3 (SD 0.83) and 3.65 (SD 0.69) for third- and fourth-year students, respectively. Postsession agreement increased to 4.00 (SD 0.63, P < .05) and 4.28 (SD 0.69, P < .05), respectively. Mean presession agreement with the statement “I can identify patient populations who are most at risk for vaccine hesitancy” was found to be 3.17 (SD 0.84) and 4.01 (SD 0.6) for third- and fourth-year students, respectively. Postsession agreement increased to 4.08 (SD 0.59, P < .05) and 4.50 (SD 0.54, P < .05), respectively. Mean presession agreement with the statement “I am familiar with common vaccine myths” was found to be 3.52 (SD 0.83) and 3.9 (SD 0.49) third- and fourth-year students, respectively. Postsession agreement increased to 4.20 (SD 0.48, P < .05) and 4.52 (SD 0.52, P < .05), respectively. Postsession satisfaction was high at 3.83 (SD 0.73) and 4.35 (SD 0.64) third- and fourth-year students, respectively. Significance: COVID-19 vaccine hesitancy remains a significant public and individual health threat and discussions about vaccine acceptance are difficult and sometimes divisive. To affect change, health care professionals must learn to engage empathically with vaccine-hesitant individuals. Implementation of our COVID-19 vaccine hesitancy learning module resulted in significant improvements in student confidence and high levels of learner satisfaction across both medical student cohorts. We developed a vaccine-hesitancy learning module that provides medical students with basic skills for engaging with vaccine-hesitant patients (“knows”) and provides an opportunity for early learners to practice those skills (“shows”). We have since developed an interactive online learning platform to replace the prerecorded didactic session, incorporated additional knowledge assessments, and introduced a post-SP encounter video reflection exercise. Data from this new version is forthcoming.

Prediction of Influenza Complications: Development and Validation of a Machine Learning Prediction Model to Improve and Expand the Identification of Vaccine-Hesitant Patients at Risk of Severe Influenza Complications.

Influenza vaccinations are recommended for high-risk individuals, but few population-based strategies exist to identify individual risks. Patient-level data from unvaccinated individuals, stratified into retrospective cases (n = 111,022) and controls (n = 2,207,714), informed a machine learning model designed to create an influenza risk score; the model was called the Geisinger Flu-Complications Flag (GFlu-CxFlag). The flag was created and validated on a cohort of 604,389 unique individuals. Risk scores were generated for influenza cases; the complication rate for individuals without influenza was estimated to adjust for unrelated complications. Shapley values were used to examine the model’s correctness and demonstrate its dependence on different features. Bias was assessed for race and sex. Inverse propensity weighting was used in the derivation stage to correct for biases. The GFlu-CxFlag model was compared to the pre-existing Medial EarlySign Flu Algomarker and existing risk guidelines that describe high-risk patients who would benefit from influenza vaccination. The GFlu-CxFlag outperformed other traditional risk-based models; the area under curve (AUC) was 0.786 [0.783–0.789], compared with 0.694 [0.690–0.698] (p-value < 0.00001). The presence of acute and chronic respiratory diseases, age, and previous emergency department visits contributed most to the GFlu-CxFlag model’s prediction. When higher numerical scores were assigned to more severe complications, the GFlu-CxFlag AUC increased to 0.828 [0.823–0.833], with excellent discrimination in the final model used to perform the risk stratification of the population. The GFlu-CxFlag can better identify high-risk individuals than existing models based on vaccination guidelines, thus creating a population-based risk stratification for individual risk assessment and deployment in vaccine hesitancy reduction programs in our health system.

Incorporating a learning unit on vaccine hesitancy into a first-year doctor of pharmacy immunization course

IntroductionVaccine hesitancy is a growing threat to public health. The objective of this research was to investigate the effect of incorporating a learning unit on addressing vaccine hesitancy into a doctor of pharmacy immunization delivery course. MethodsThe learning unit, implemented fall 2019 at the University of Rhode Island, involved two interactive lectures and an at-home assignment. A family medicine physician spoke about her experiences with vaccine-hesitant families, and students viewed video scenarios depicting a pharmacist talking with vaccine-hesitant patients followed by an in-class discussion. Data was collected using pre- and post-surveys and a one-year follow-up survey. ResultsOut of 125 students enrolled in the course, 121 completed the pre-survey, 113 the post-survey, and 120 the follow-up survey. For pre-/post-survey comparison questions, statistically significant improvements were seen in 9 of 13 items. The follow-up survey showed 83.4% of students had applied knowledge and 85.7% had applied skills gained from the learning unit. ConclusionIncorporating a learning unit on addressing vaccine hesitancy into a pharmacy immunization class resulted in improvements in student self-reported knowledge and comfort in talking with patients who are vaccine hesitant. Long-term use of self-reported knowledge and skills gained was seen one-year post-implementation.

Improving Conversations With COVID-19 Vaccine Hesitant Patients: Action Research to Support Family Physicians.

Vaccination delivery and efforts to counter vaccine hesitancy have become focal issues for family medicine teams as the COVID-19 pandemic has evolved. Conducting action research, our team developed an interactive web-based guide to improve clinical conversations around a broad range of vaccine hesitancies presented by patients. The paper presents a step-by-step account of the guide being codesigned with family physicians-its targeted end users-in a process that included validation interviews; role-play interviews; and user-tested design. The validation interviews sought to understand the pragmatic realities of vaccine hesitancy in family medicine clinical practice relative to relevant psychological theories. The role-play interviews drew out conversational strategies and advice from family physicians. The principles of motivational interviewing-an evidence-based approach to vaccine hesitancy conversations that supplements information deficit approaches-were used to codesign the content and layout of the guide. User counts, stakeholder engagement, and web-based analytics indicate the guide is being used extensively. Formal evaluation of the guide is presently underway.Originally published as Annals "Online First" article.

Increasing COVID-19 Vaccination Rates Among Patients With Serious Mental Illness: A Pilot Intervention Study.

This pilot project aimed to maximize COVID-19 vaccine uptake among patients with serious mental illness. Psychiatric providers were engaged to directly address COVID-19 vaccine-related concerns with patients during outpatient visits. A quality improvement project encouraged COVID-19 vaccinations in a cohort of outpatients treated with clozapine (N=193, ages 19-81 years, mean age=46.4 years) at a community mental health center. In-service education was provided to clinicians to identify vaccine-hesitant patients and build vaccine confidence. A vaccination-monitoring tool was created and embedded in patients' electronic medical records. Starting in February 2021, the tool guided semistructured interviews at each visit and supported population-based management. The full COVID-19 vaccination rate by June 30, 2021, was 84% among the outpatients, compared with the estimated state rate on the same date of between 62.1% and 77.3%. The active involvement of psychiatric providers in preventive health care can help increase vaccination rates among patients with serious mental illness.