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Building Trust in the Moment

Est. 4 minute read

A personalized, nonjudgmental, “listen and learn” approach is essential to building parents’ and caregivers’ confidence in childhood vaccines.

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One of the few proven ways to move parents from vaccine hesitancy to vaccine confidence is motivational interviewing. In this technique, health care providers figure out what might motivate that person to make a change, and then they strengthen that motivation by tapping into the arguments the person has already given. When it comes to COVID-19 immunization, a motivational interviewing approach helps us discern what mindsets are driving a parent’s decision-making, so that we can provide them with information that responds to their concerns. 

Treating an interaction with a family like an interview shouldn’t make it feel formal or one-sided. Rather, this technique is about intentionally guiding a conversation through different stages and deploying different processes to build the relationship. 

A motivational interview doesn’t always follow a linear outline. That said, the examples below are presented in one sequence that might unfold naturally.


Questions to Elicit Vaccine Motivations

When we draw out the thoughts of a parent or caregiver, we uncover their own commitments and values. These are much more powerful motivators than any opinion or fact we can offer. These carefully worded questions can get families talking about their priorities for their children’s health—which is a very different starting point than the vaccine itself:

“What do you think about the advantages of vaccination in general?”


“When it comes to the COVID-19 pandemic and your child, what has been important to you?”


Ways to Affirm Families’ Commitments to Their Children’s Health

When you highlight the values that families hold and the positive side of any actions they have already taken, you show that you notice their strengths. This can help to dispel fears of being judged or criticized.

For affirmations to work, they must be genuine and must connect somehow to what the family has shared. Depending on the context, these examples might help you affirm families:

“I can see that the health and safety of your children are important to you.” 


“You already have a lot of knowledge.” 


“I don’t think you’re off-base to be concerned; that makes total sense to me.”


Ways to Reiterate and Crystallize What Families Have Shared

Reflective listening summarizes what you are taking from what families have shared.  If you are new to this practice, it may feel awkward or artificial at first. Yet, it works, because it allows the family to add nuance or correct your understanding. 

Reflective statements can be simple, restating what they have just said, or complex, stating what you think they mean:  

Simple reflection: “It sounds like you have read articles about the relationships between vaccines and long-term side effects.”


Complex reflection: “What matters most to you is that your child is as healthy as possible.”


Opening Lines for Sharing Vaccine Information

When we gain our conversation partner’s permission before sharing advice or information, we gain a willing learner. Try these questions to elicit a family’s agreement to hear you out:

“If you’d like, I could add to what you know by sharing what I’ve learned. Would that be okay?”


“Are you interested in hearing more about what I’ve learned as I’ve studied this issue?”

If the answer is “no,” remember that the goal is to build a positive, trusting relationship. Don’t ask why they didn’t agree. Instead, re-engage the family by asking about what they have been reading or hearing about vaccination.

If the answer is “yes,” offer information that strengthens their vaccine motivations or responds to their concerns. (See our resource,Moving Mindsets: Techniques for Building Vaccine Confidence,” for suggested directions.)


Questions for Eliciting Reactions to New Vaccine Information

Once you have shared new vaccine information, verify what the family has understood and check to see what they will do with the information. 

Gently delivered questions can invite families to think aloud as they process what you have shared:

“I hope that made sense. Do you have questions or other reactions you’d like to share?”


“How does this new information land with you?”


Closing—or Returning to—the “Interview Loop”

If your interaction has led to the family feeling more confident than before, they may verbalize their intention to accept the vaccine. (Well done!) Help them act on their intention, making uptake as easy and convenient as possible.

If they express another concern or state that they aren’t ready to act, it can help to ask for permission to share more information or make other messaging moves that build confidence.


Previous: Must-Have Messenger Mindset (Est. 3 minute read)

Next: Family Mindsets (Est. 5 minute read)



This resource is based on the research of Arnaud Gagneur, a researcher in the Department of Pediatrics at the University of Sherbrooke in Quebec, Canada.