Try this new technique when talking to vaccine skeptics [PODCAST]

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“When we hear skepticism, our first instinct may be to end the conversation. After all, why spend our time trying to convince someone who has made up their mind? Our second instinct may be to counter the person’s position without pausing to hear more about their perspective. Unfortunately, trying to force someone into getting the vaccine often results in defensiveness and anger.”

Alicia DiGiammarino is a health educator.

She shares her story and discusses her KevinMD article, “Try this new technique when talking to vaccine skeptics.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Alicia DiGiammarino. She is a health educator, and she wrote the KevinMD article “Try this new technique when talking to vaccine skeptics.” Alicia, welcome to the show.

Alicia DiGiammarino: Thank you. Thanks for having me.

Kevin Pho: We’ll get into the article in a little bit, but first off, can you share your story and journey to where you are today?

Alicia DiGiammarino: I have a master’s in behavioral health and have really focused my career on education for health professionals, particularly around engaging with patients for collaborative decision-making. I’ve also worked extensively as a health coach at the Center for Excellence in Primary Care with patients who are seeking to better self-manage their conditions.

And really, throughout the pandemic, the Center for Excellence in Primary Care has been a part of California’s Virtual Training Academy, and we have trained more than 12,000 contact tracers, case investigators, and vaccine outreach workers. The academy is a joint effort between the UCSF Pandemic Initiative for Equity and Action and also other partners at UCSF, UCLA, and the California Department of Public Health. Really, the role of the Center for Excellence in Primary Care is to embed the principles of health coaching into the training in order to empower people to have more positive conversations around topics that are really quite difficult, like quarantine and getting vaccinated.

Kevin Pho: So in your work with health care professionals and clinicians, what would you say are some of the biggest areas of improvement?

Alicia DiGiammarino: Actually, many of the people that we train have very limited public health background and may actually be coming from jobs in wildlife, fisheries, libraries, even DMVs. It’s been really satisfying to watch them start to feel comfortable about the COVID-19 protocols and vaccinations and having effective conversations with people. It’s pretty incredible.

Kevin Pho: And when you talk to, say, primary care physicians in general through the program, what would you say are the most common pieces of advice that you typically would give them?

Alicia DiGiammarino: We know that health care professionals, including clinicians, are one of the most trusted sources of information about COVID-19. I think my main advice would be to use every opportunity to engage people, patients, in conversation about vaccination, with that bigger goal of keeping our communities healthy.

Kevin Pho: All right. And we talked more about that in the KevinMD article that you wrote. It’s very relevant today: “Try this new technique when talking to vaccine skeptics.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Alicia DiGiammarino: So widespread vaccination is critical to restoring our economy and our social lives, and clinicians and other health care workers are encountering significant reluctance to vaccination. So we developed the HEAR technique as a practical tool to reframe conversations with people who are skeptical of the vaccine. The HEAR technique is an acronym that stands for hear, express gratitude, ask about pros and cons, and then finally respond.

So it might go kind of like this. Hear, the H. You could ask something like, “Could you tell me more about your concerns about the vaccine?”

And then E, express gratitude. It’s really a gift when someone tells you why they are not following your recommendation, so you could say, “Thank you for sharing that concern. You’ve been thinking carefully about this.”

And then A, for ask about pros and cons. You might want to start with, “What would be the bad things about getting a vaccine?” That really gets their concerns out on the table and into the conversation. And then asking, “What would be the good things about getting a vaccine?” People often have opinions on either side of something, so you kind of want to draw out what’s in that person’s mind for getting the vaccine.

And then R is respond. This is what we all want to do. This is your chance to share accurate information that that person can use to make a decision.

Kevin Pho: Can you share a success story or a success case study where someone hypothetically implemented the HEAR technique and perhaps was converted from vaccine skeptic to someone who would take the vaccine?

Alicia DiGiammarino: There’s actually a doctor that we work with who did a focus group at the beginning, when the vaccine was coming out, and everyone in that focus group said that they would not be getting the vaccine. They were 100 percent sure about that. But they reconvened a few months later, and all of them had been vaccinated, which was amazing and somewhat surprising. They reported that it was really about conversations with family, and hearing, “If I get vaccinated, I’ll be able to spend time with my grandson,” things like that.

And we hear from a lot of our learners. I think, actually, it’s really easy to write off a person who is skeptical of the vaccine as someone who will never get vaccinated, and it’s amazing to watch how many people change their minds. A lot of our learners come back and share stories of open conversations that led their family and friends, and the contacts that they’re reaching out to, to get vaccinated.

Kevin Pho: Now, when you train these clinicians in communication techniques, are there things that they should not be doing? Are there any red flags, things that they should not be doing, whenever they have a vaccine skeptic in the exam room with them?

Alicia DiGiammarino: That’s a good question. I think that our instinct is often to either end the conversation, so whether you’re on the phone or in an exam room, end it right there, or to argue and to kind of throw out all those reasons why someone should get vaccinated. Unfortunately, that often leads to defensiveness and anger. Rather than arguing or walking out the door, I would recommend an open-ended question to draw that person out, to hear about their concerns, and to make them feel as if they’re being heard, because they are being heard and respected.

Kevin Pho: So from all your work with vaccine skepticism, what would you say are some of the main reasons why people are concerned about the vaccines in the first place?

Alicia DiGiammarino: Yeah, we hear a whole variety of reasons. Sometimes it’s concern about how quick the process was. Sometimes it’s misinformation from the internet. A lot of times, people are actually very, very open to hearing more information, and they want that accurate information but just haven’t had access to it. So I think getting to that point where you can share what you know to be true about the vaccine.

Kevin Pho: So I think that I echo what you said. When I see patients in the exam room, it’s really a lot of misinformation and disinformation that they’re getting from social media. So let’s say I have a patient that is clearly misinformed about the vaccines in front of me. How could I use the HEAR technique to alleviate those concerns?

Alicia DiGiammarino: Sometimes people are already sharing their concerns, so it sounds like in this hypothetical scenario, maybe you’re kind of hearing some of those concerns already. I would probably start by acknowledging those concerns, not agreeing with them but acknowledging, “OK, so it sounds like you’ve heard blank.” And then asking for more information, so, “Could you tell me more about that concern, or what you’ve heard about the vaccine?” Because it really helps as a clinician to know what that person is thinking.

And if they’re willing to share more, then I would thank them. I would say, “Thank you for sharing that, what you’ve seen on social media. That will help us in our conversation.” And you know that it might take more than one conversation. Sometimes not everything is drawn out right from the start.

But if you can get to that point where you can ask somebody, “What might be the good things about getting vaccinated?” those are the things that you want to build on. This step is really rooted in motivational interviewing, so some of your clinicians that are listening may actually be familiar with this technique. And then you really, really want to validate those things, so, “Yeah, that’s a great reason that you might want to get vaccinated. Tell me more about that.”

And I think, just throughout the process, knowing that it’s not your decision to make as a clinician. This is the decision that the patient is going to make, and your job is to provide accurate information that they can use in their decision.

Kevin Pho: We’re talking to Alicia DiGiammarino. She is a health educator, and she wrote the KevinMD article “Try this new technique when talking to vaccine skeptics.” So, Alicia, when you train these clinicians about motivational interviewing and communication techniques, what would you say are some of your biggest obstacles? When you train these physicians, do you encounter any resistance, or do you encounter any difficulties from these clinicians who try to adopt your techniques?

Alicia DiGiammarino: Yeah. I mean, most of the people that I’ve been working with this past year are contact tracers and case investigators who have been moved from other jobs within the state. Actually, we are now bringing this technique to a wider clinician audience, which is why I’m so grateful to have the opportunity to share with your listeners.

But I really do think some of the biggest obstacles are frustration with what people hear. We as clinicians and health professionals are human too, and have opinions, and want to have what’s right for the community. So I think just that first instinct to fight and to express your own opinion very strongly can be really, really strong. So this is really a shift in perspective. It’s a way to reframe a conversation in a way that’s different, and it takes practice. It’s not something that people are able to do immediately, usually.

Kevin Pho: No, I think you bring up a good point, because we live in such a polarized society where there is a strong impulse to really argue and be judgmental, and taking a non-judgmental approach, I think, certainly is critical if we want to convince people who don’t agree with science, or convince people who are skeptical of the science. So you mentioned practice, you mentioned other resources. What are some places clinicians can turn to, to practice these techniques and to read more about it? Because this is certainly something that I’m facing more and more in the exam room.

Alicia DiGiammarino: I would highly recommend heading to the Center for Excellence in Primary Care website. It’s ucsf.cepc.edu, and we have a lot of resources about vaccine outreach and talking to people about quarantine. The resources are very comprehensive in that you can watch videos of these interactions. There are dialogues that kind of demonstrate what a conversation might look like, and even prompts and scenarios that you can kind of consider on your own. So I would start there.

And the other thing I might say is, try these techniques out on your family and friends. See if someone’s willing to be a patient for you, and you can kind of practice it there and then bring it into your exam room.

Kevin Pho: My final question: What’s your take-home message that you want to leave for the KevinMD audience?

Alicia DiGiammarino: I think my take-home message is that, like I said, I think health care professionals and clinicians are just one of the most trusted sources of information. And I think if we recognize that, my hope is that the listeners will use every opportunity to engage people in open-ended conversations about vaccination.

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Alicia DiGiammarino: Thank you.

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