Vaccine Communication With Parents: Best Practices

Nancy Messonnier, MD (CAPT, USPHS)


July 24, 2017

Editorial Collaboration

Medscape &

Hello. I am Dr Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases at the CDC. I am pleased to speak with you as part of the CDC Expert Commentary Series on Medscape. I want to personally thank you for the work you do every day to protect our nation's children from vaccine-preventable diseases. It cannot be overstated how important your role is in helping empower parents to vaccinate their children.

Although research shows that the majority of parents in the United States support vaccines,[1] you will encounter parents with questions. If a parent has questions or initially resists vaccinating according to the recommended schedule, this doesn't mean they won't accept vaccines. When a parent has questions about vaccines, I suggest delaying any assumptions you may have about the parent's position on vaccines. Your willingness to give parents your full attention and answer their questions will play a major role in building trust so that they will listen to and trust your recommendations.

I'd like to share five research-based strategies that will assist when you have vaccine conversations with parents:

Build trust. Building trust begins with open conversations, during which you provide balanced answers to questions. For example, parents may ask you about vaccine side effects. Make sure you understand what side effects parents are worried about and respond to those questions. If parents have misconceptions about vaccine safety, acknowledge their concerns, but make sure you also give them the correct information to clear up any confusion. Remind parents that you feel confident in the safety of the vaccines you are recommending to protect their children. Don't forget to mention the overwhelming benefit of preventing potentially serious diseases with vaccines. Let them know that not vaccinating is a risk that will worry you.

Use science and anecdotes. You may also want to try a mix of science and anecdotes when talking to parents. Many parents don't know the science behind why following CDC's recommended immunization schedule is critical to protect their children. Although some parents will feel reassured by the science, others may respond to more personal stories. Don't be afraid to share stories from your experience about an unprotected child who became ill, or even that your own children received all of their vaccines. If you don't have personal experiences to draw from, share your practice's experience. For example, you can mention that despite having administered thousands of vaccine doses, the practice has not seen serious side effects.

Remember your important role in the vaccine decision . Our research[2] shows that parents continue to list their child's healthcare professional as the number-one most trusted source of vaccine information. This holds true even for parents who are vaccine-hesitant or have considered delaying one or more vaccines. Try not to see parents' questions as a lack of confidence in you, but rather as a sign that they are trusting you to give the best answers to their pressing questions. Some parents are simply looking for reassurance from you, as the trusted provider for their child's healthcare. Evidence suggests that improving provider–parent communication about vaccines may increase parental vaccine acceptance.[3]

Participatory versus presumptive approach. Consider when it is best to use participatory or presumptive approaches. Research shows that when providers use participatory language to initiate vaccine discussions, parents are more likely to voice resistance than when providers use presumptive language.[4] An example of participatory language is asking a question like, "What do you want to do about shots?" On the other hand, a presumptive approach would be to say, "Your child needs three shots today." If parents voice resistance when you use the participatory approach, consider restating your original vaccine recommendations. You can say something like, "These shots are very important to protect him from serious diseases." Data show that when restated like this, half of parents accept vaccines.[4]

You may be concerned about using the presumptive approach to initiate vaccine discussions, fearing that this could negatively affect parents' experiences in your practice or whether they will accept vaccines for their child. Parents tend to perceive both approaches positively. However, the presumptive approach results in significantly more parents accepting vaccines for their child, especially at first-time visits.[4] This is also true for vaccines given later to children, such as the HPV vaccine.[5] In fact, when the HPV vaccine is recommended on the same day and in the same way as the other vaccines recommended for preteens, most parents will choose to protect their children from HPV cancers.[6]

Realize that success comes in many forms. Ultimately, seek to understand parents and prioritize the approach and strategies that will best lead to protecting their child with vaccinations. Depending on the parent and their information needs, success may mean that all vaccines are accepted when you recommend them, or that some vaccines are scheduled for another day. Work with parents to agree on at least one action, such as scheduling another appointment or encouraging the parent to read additional information that you may provide to them. If a parent declines vaccines once, it does not guarantee that they always will. Don't miss future opportunities to remind parents about the importance of keeping their child up-to-date on vaccines and work with them to get their child caught up if they fall behind.

I hope that these strategies and additional communications materials, which you, your staff, and parents can find on our website, will ensure your continued success in immunizing infants, children, and adolescents. Thank you again for the work you do to keep our nation's children healthy and safe.