Sammi: Good evening everybody and welcome to this evening’s Addressing Vaccine Hesitancy and Refusal webinar. My name is Samantha and I am your host for this evening. Before we start I would like to make an Acknowledgement of Country. We recognise the traditional custodians of the land and sea on which we live and work and we pay our respects to Elders past and present.
Alrighty, so I would like to introduce our presenter and our facilitator for this evening. We are joined by Professor Julie Leask and our facilitator, Dr Linda Mann. Julie is a Professor and Social Scientist at the University of Sydney, the Susan Wakil School of Nursing and Midwifery. She studies what people think, feel and do about vaccinations. She is an advisor to the World Health Organisation and Visiting Fellow at the National Centre for Immunisation Research and Surveillance. She was overall winner of the Australian Financial Review’s 100 Women of Influence Award in 2019. So, thank you for joining us this evening, Julie.
And our facilitator, Dr Linda Mann. Linda is a Fellow of the RACGP and member of the RACGP Antenatal and Postnatal Care Network. Linda has both local and international medical experience, especially in genetics and women’s health. Linda is a GP representative on various national and local government committees and is an experienced medical educator. So thank you for joining us, Linda.
Alrighty, let us move on to our learning outcomes for this evening. So I will hand over to you, Linda and then we will hand over to Julie to start on tonight’s presentation.
Linda: By the end of this online QI and CPD activity, you should be able to recognise opportunities to increase and maintain vaccination rates within your own practice, assess patient’s vaccination communication needs and tailor your goals for the consultation, structure vaccination consultations to meet the parents’ and patient’s information and communication needs and achieve tailored consultation goals, and identify appropriate referral pathways for adverse events following immunisation.
Julie: Thanks very much Linda and good evening to everyone on the webinar this evening. My name is Julie Leask and I am looking forward to talking with you about the work we have been doing around vaccine hesitancy and refusal and I would also like to give thanks to Sammi as well for organising these webinars. Before we go on, I do want to acknowledge a number of people’s whose research and hard work has contributed to what you will be seeing this evening and also the funders of the project that I will be talking about. The National Centre for Immunisation Research and Surveillance and the Australian Government Department of Health, along with some seed funds from a previous Medicare local.
I want to jump right into a clinic conversation between a doctor and Kim, mother of six month old Kaylee. So this is an actual recorded conversation recorded with permission from the mum, the real mum. It is not her name here, it is not Kim, and the doctor. So the doctor says, “She has had some vaccines I see, is that right?”
Doctor: “Did you get the hepatitis B at birth?”
Kim: “Yes. In hindsight I really wish that I had not.”
Doctor: “Right, okay. That one in particular, or the other ones subsequent?”
Kim: “Just because they are brand new and I think it is completely unnecessary.”
Doctor: “Okay, yes.”
Kim: “I was sort of sticking my head in the sand because I did not want to go down this path, but then I read something and I got onto this track, and yes…”
So I want to give you a chance to jump in right now and share what you would do when you are faced with what Kim has just said to you. If anyone wants to briefly comment or share their possible responses? While we are waiting for you thoughts, I will go onto what the doctor actually said to Kim. So the doctor took a history and then said, “So what has got you worried about the six month ones?”
And Kim said, “It is not… it is actually all of them. It is just that this is the timing that – I have looked into it and I just think there is way too many they are getting that seem to me unnecessary. I am worried about the aluminium content in the vaccines.”
So that is what Kim was worried about, not just hep B. She was worried about ingredients. She was worried about the number of vaccines, and this is a really classic concern about vaccination, and I can see here some of your responses that you would explore more, ask what her concerns are, want to know what Kim was worried about, what she had seen online, what were her main concerns. And as you can see, that is precisely what this doctor did as well.
Let us look at the big picture. Vaccine hesitancy which is really the topic of tonight’s webinar was named one of the top 10 threats to global health in 2019 by the World Health Organisation at the beginning of this year. You yourselves know that when you are sitting facing a patient, a parent, you have got a communication environment around you that impinges on that discussion, starting with messages, scary sounding messages about the ingredients in vaccines and there you see second on the list is Kim’s concern, aluminium and the claims that vaccines lead to all manner of modern ill where there is idiopathic origin. And these ills you see here have been named in writings by anti-vaccination activists as being linked to vaccination despite a lack of evidence for that link. You get media stories. Some of you might remember from back in 1996, the ABC produced a two part documentary called Vaccination Protection at what Price? And they purported to show balance, but actually showed a lot of false balance in presenting the so-called risks of vaccination at the time, and they were resoundingly condemned for producing this program. And of course, now we have got an American President who is vaccine hesitant. This is from 2014. A tweet. “I am being proven right about massive vaccinations – the doctors lied. Save our children and their future.” So vaccine misinformation and vaccine claims, erroneous claims are surrounding these consultations in different ways.
Often you might encounter a concern about vaccine safety. But that is often the surface concern and there are deeper values and anxieties that are behind vaccine safety concerns. Some of them are that the issue of can I trust medicine? Can I trust expert knowledge? Can I trust governments? And the pharmaceutical industry who produce vaccines? Some parents have grief that their child became unwell or developed an illness of some sort after a vaccine was given and they believe that the vaccine was the cause, and they managed their grief by becoming heart-felt advocates against vaccination. For some there is the issue of wanting to have choice in how they decide to raise their children. For others there are issues around the purity of the child’s body and not wanting to see it as they see it, degraded by vaccines. There are issues of belonging for those who live in social networks where vaccine refusal is common. And there are issues at the heart of this, regardless of whether people are for or against vaccination, of protection. Protecting vulnerable infants and children and communities from vaccine-preventable diseases, or from vaccines as some people see it.
It is often thought that people are either pro or anti vaccination and that is the way it is presented in public discussion, but this pyramid shows a variety of positions that people can have on vaccination, ranging from the unquestioning acceptors to the cautious, to the hesitant, who all in the green vaccinate fully, through to the hesitant who may delay all the vaccination or select out certain vaccines like the MMR, like hep B for example. And the parents who are what we call decliners of all vaccines. They never did or they no longer vaccinate. These are not static positions. They do change over time and sometimes people who end up in our research fully refusing vaccination began as unquestioning acceptors and something changed their path.
On the left, that pyramid is showing the population proportions in the national population, showing that most people are unquestioning or cautious acceptors, but of course in your own practice, that might look very different depending on your patient profile.
Then there are anti-vaccination activists. These are the people that are small, they are vocal, they are loud, they are online, they can be aggressive and they are very dedicated to dissuading people from vaccinating often. They may either be quite radical groups or what people have called reformists who want to see vaccine injury compensation or they want to prevent mandatory vaccination.
In our research, we have simplified those positions into the ready, the hesitant and the declining. And again, they are nationally representative proportions that we have found in survey work we have done. However again that would look different in your practice. So the ready to vaccinate, what we have learnt from our research with these parents is that they confident in vaccination and they just want their chance to ask questions usually. Some parents do not want to talk about it all, but most would like to at least have an opportunity to ask questions. The hesitant may have many concerns about safety, reactions, about having so many vaccines like Kim did in that earlier interaction. And of course the old chestnut, autism still comes up even though it has been thoroughly debunked. There is a strong sense of responsibility for these parents to make what they see as the right decision for their child. They can be quite intensive in their parenting and they want their child treated individually. It is similar with parents who decline vaccination. These parents are a little bit different in that they may not want to discuss or disclose their decision at all, they have often had negative interactions with the health care system where people have tried to convince them otherwise and they really are quite fixed, often. They may have had a bad experience with vaccination. They see vaccines as unsafe. They may or may not see vaccine-preventable diseases as risky, and that is important because when you are talking with them, if someone is not worried about a VPD, then they have really got no potential motivation to vaccinate. That is not going to be your goal then. Your goal might be to manage the risk or just keep the relationship there. They are confident in their ability to keep their child healthy, as we have found in our research with these parents. Some are alternative, but some are not and that does tend to be a little bit of a stereotype.
So you are influential with these parents and maybe some of you might not realise just how influential you can be. Health professionals in our research may have limited knowledge about vaccinations. Of course the schedule is complex, it is crowded. There is a lot to know about vaccination which is why of course there are many useful webinars the College offers. Particularly in undergraduate training for both doctors and nurses, there is not a lot about vaccination, but of course as people get more experience in primary care, they do build good knowledge. Health professionals might have their own hesitancy about vaccination, or certain vaccines such as the Fluvax, the paediatric flu vaccine. They might find vaccine refusal of parents really difficult.
Here is an example, again this is a real conversation, names changed, where there are difficulties. So this is a mum, a dad, Amerita and Hosea are the parents, and the doctor.
Hosea: “The second thing that concerns me – that sometimes the four months vaccination – it is the first sign of something – of cognitive or whatever.”
Amerita: “But she said that. She said that she does not think that will happen.”
Hosea: “Yes, I know. But my question is, how can we make sure? How can we be sure it is the first sign or the cause?”
Doctor: “So the conditions that I am referring to that are uncovered if you like, or triggered by a vaccine that…”
Hosea: “Yes, I know, but you know”
Doctor: “but that trigger delay”
Hosea: “if is triggered or the cause.”
Doctor: “So the conditions that I am referring to … No just a minute, so at that point they are progressive, so the child gets worse not better.”
Hosea: “Yes, but you did not answer my question.”
You can see the confusion in this complex, unwieldy, difficult conversation. Everyone is getting frustrated and then after 15 minutes, and this is in our specialist immunisation clinic which is why there is so much time in discussion, there is a breakthrough. The mum says “No I think that we just had a very difficult labour. She was born with an Apgar of three or four and after a minute she was nine, her score was nine. So all doctors we have seen said she is okay, but still…”
Doctor: “Oh, so you have a nagging worry?”
The father says, “Exactly.”
Amerita: “That is the reason he asked you about the neurological things.”
Hosea: “That is the reason.”
Doctor: “You worry? For sure.”
And it was at that point that there was a real turn around in the conversation that we observed in the recording.
So as I said, these conversations can be frustrating and challenging for primary care providers. This is from an interview study we did with GPs and practice nurses. A couple of comments here exemplify that. One GP said, “I find it particularly annoying because I have seen measles and meningitis and varicella causing problems. I try and tell people these are real diseases and it is like talking to a brick wall.” Or another GP, “The first time I had to have the conversation I was really stressed. I was concerned about what was expected of me in that situation.” And we did see the slight difference between very junior, say registrars and more senior GPs. But sometimes we also observed that if there was a very negative interaction early on where someone had tried to convince a non-vaccinator to vaccinate and they had not gotten anywhere, they may have developed a pattern of giving up because it was very difficult. And what I am going to show you in our approach is a way to work with them where they are at, but not to give up.
So, our approach is called Sharing Knowledge About Immunisation, and it is essentially a system of support for conversations about vaccination in primary care, and it was developed years ago because we knew from our research with parents that GPs and practice nurses are really influential in these conversations and they can move a parent either way, particularly if they are sitting on the fence about vaccination or they have got some concerns. And they can even move some refusing parents towards vaccinating. We aim explicitly to move parents towards vaccination in a way that is respectful of parents, to build trust among non-vaccinators to support the hesitant and for all parents to facilitate consent.
This is what it looks like conceptually. So there are three, we will call them communication pathways, the ready, the hesitant and the declining. And SKAI offers flexible goals and resources that are tailored to that pathway and communication tips which I will show you some of in a moment. The resources there, the little thumbnails there are offered on the Talkingaboutimmunisation.org.au website which I will give you a link to on the next slide. As you can see, the goal with the ready and the hesitant is to fully vaccinate. With the declining, there may be a referral or deferring, but always returning to that discussion.
This is the SKAI website which is publically available. It is talkingaboutimmnuisation.org.au and it includes information for parents, so this is the parent-facing website and at the top left you see the little thumbs up, that is for the ready to vaccinate. So I am going to show you some of the resources in this website under I Am Vaccinating, for parents who are ready. Again, the goal here is to support consent and to fully vaccinate. So the resources we have here are information sheets about what vaccines are recommended for babies at birth, six weeks, four months. And you see all the dosage points for children up to four years in those little tear drops at the bottom of the screen. We have translated these resources into simplified Chinese characters, Arabic and Vietnamese. The Vietnamese resources are not quite ready yet, but the other ones are available under the I am Vaccinating tab. And at the end of this resource, there is an opportunity for parents to put in questions they might have before they go into have the vaccinations. So this could be offered as a laminated sheet in the waiting room for example, or sent as a link in an SMS reminder before the vaccination visit and the parents could print it out and write down any questions they might have to facilitate that consent process, so that we take the burden off that provider at that point of vaccination from spending a lot of time going through everything.
So the hesitant. The tips here are to take a bit more time with these parents, to elicit all questions and concerns to saturation before jumping in. And resisting the righting reflex. Now in that interaction you saw earlier between Hosea, Amerita and the doctor, there was this tendency to jump in and right the wrong thinking to address the concerns before all the of concerns and issues and the history was elicited. So here we are suggesting that you take a full concerns history if you like. Then once you have heard all the concerns and there are no more, briefly set and agenda and agree on what the priorities for the discussion are, because of course time is short. That means that you know by then that you have got all the concerns including the late breaker ones and that you prioritised which ones are the most important for the parent. When the discussion occurs, amplify motivation. So that is where the parents might be asked are there any diseases that you are concerned about? What might you be concerned about not vaccinating her? And when they talk about vaccine-preventable disease risk, that is where you might agree and reinforce that change talk, that yes you are right to be concerned about tetanus and I will show you an example of this in a moment. Recommend vaccination and vaccinate, even if people are very ambivalent a recommendation is important. It has been shown in trials that recommending vaccination at some point will increase the hesitant parent’s chance of vaccinating. It is just that your timing and tone might differ a little bit when they are very tentative. If that is not possible, then referring or deferring and I will show you an example of that in a moment.
The resources for this particular position on vaccination or for any parent, look like this. We have got the five resources that debunk the major concerns about vaccination that we see through surveys. The autism concern, the ingredients concern, what is in vaccines? The why are so many vaccines given? Why is our schedule different to the UK one for example? How do vaccines affect the immune system? And how are they shown to be safe? And again that website is there at the bottom on the right. Parents can access that particular website as well.
On the provider website, we have this resource which has been inspired by decision aids and includes an opportunity to work with the parents to go through if they are very ambivalent, what their concerns might be if they do not vaccinate and if they do vaccinate. And they can cross out things that are not important to them and come up with a printable pdf list to discuss with the clinician on weighing up the pros and cons, and we have evidence that this process with the ambivalent can move them towards vaccinating from other studies.
For the declining, the parents who are fully declining vaccinations, so they never did or they no longer vaccinate. We observe that these consultations can often take a long time because the clinician has wrongly thought they may be able to convince them to fully vaccinate that day. And what ends up is this descent into games of scientific ping pong, this back and forth with research evidence. And sometimes this back fire effect where the parents become more entrenched in their position by rehearsing their world views. So we recommend here that in relation to vaccination, less time is taken to attend to the actual issue that was presented. It is usually not vaccination, it may be a request for medical exemption. To explore their reasons for not vaccinating. To elicit their motivation as you heard earlier. To share your recommendation to vaccinate even though they are planning to not, and offer anticipatory guidance which I will show you in a moment.
Linda: You mentioned people presenting for a certificate for exemption. Can you remind us why people are entitled to exemption?
Julie: So, the only exemptions that are possible now are the medical exemptions. So we used to have conscientious exemptions, they are no longer available Federally and in New South Wales and most other states I think. So the medical exemptions relate to whether the child has a concurrent illness that puts them as immunocompromised, and there are other, a series of other instances where the child may not be able to be vaccinated at that point in time or may need to be assessed. However, these exemptions are extremely narrow and they are clearly set out on the medical exemption form. And that form is available if you were just to google medical exemption vaccination Australia, you will form that form. It will be available via the Department of Health website.
So this I mentioned. Offering anticipatory guidance. This is the resource that might be offered to parents who are clearly not going to have some or all vaccines. And it also helps closure. So it is the What should I look out for? resource. And this sort of came from research I was doing back in the year 2000 or 2001. I was looking at the anti-vaccination movement in Australia and noticing that in these lists were parents of sick children who had decided not to vaccinate would write to the other members and say my child has a fever or a rash or a terrible cough and I am not sure what to do, and they would say you can offer homeopathy or you know, do not go to Emergency. And it really concerned me, so that sort of inspired this resource which was to basically say, here is what you need to look out for. Your child is not fully vaccinated and this is when to call for help, and we welcome you coming back if your child is unwell. Because the last thing you want is someone who is not willing to come back with a sick child because they are mistrusting and afraid of the medical system and afraid of being shouted down.
We also have a provider facing website with SKAI. And this is what the landing page looks like. It has got a different URL. It is not available via the public parent website, but I will show you a link to it at the end of the webinar. It has talking tips for parents who are vaccinating, have questions and who are declining, and those resources. So for example the one I showed you just then, the anticipatory guidance on the right is the information about non-vaccination resource. You can also email or print that or download it. And it is also possible to download all the resources at once via a link at the bottom of this website.
What we learnt along the way was that there are some small things in what you say that can make a real difference in patient communication in general. And you as experienced communicators would already have a bevy of tools available to you. But these are some really interesting things. So one was that it is important to deal with emotions. If someone presents an emotional cue, like in the study mentioned here which was a study of consultations between older people and nurses. They observed that if the nurses responded to emotional cues by a nod or a simple verbal acknowledgement, the patients were more likely to go on to subsequently process the information that was given to them. In other words, acknowledgement is really important. Asking if there is anything else you want to address gets different responses to asking if there is something else you want to address. That simple word made a difference in one trial in general practice, where asking “something” resulted in more unmet concerns being raised and therefore addressed. So that is why we recommend that in relation to consent to vaccination, we recommend saying “I understand you are here for vaccination today,” or whatever you normally say, “Do you have some questions before we go ahead and vaccinate?” And in neighbourhood disputes were a service was trying to get waring neighbours to agree to come in for mediation, they were finding it very difficult to convince the neighbours on the telephone to come in. But this magic word, would you be willing, seemed to be associated with greater success. So, “Would you be willing to consider vaccinating him fully today? I know you are concerned but I would like to see him vaccinated.” Or, “Would you be willing to maybe start with the tetanus containing vaccine today? Or the measles vaccine today because we have outbreaks at the moment.” MMR vaccine.
I mentioned earlier that there are some talking tips on our website. Here are some of the examples. And these are pdf sheets that can be downloaded, and they show examples of the SKAI process, setting and maintaining the agenda with parents who have questions with some examples taken from actual conversations and examples of sharing your recommendation with a parent who will not vaccinate, on the right for example, “Would you consider vaccinating Stefan if there is an outbreak in our community or if you are planning travel?” As you cans see here a lot of these are questions, because that engagement is so important with these parents.
I mentioned earlier, amplifying motivation. Here is another real life example in the consultation between Kim and the doctor. This is at the very end of the consultation. The doctor has just gone through and described each vaccine-preventable disease on the NIP schedule, and they have gotten to tetanus. And this doctor strategically aims to end at tetanus because tetanus can be quite a good motivator for very ambivalent parents.
Doctor: “See the other thing about tetanus is, tetanus is not person to person spread.”
Doctor: “Tetanus is in the ground, in the community. So you cannot, even if you are a hermit – but you ride a bike, you can still get tetanus.” This is because some of these parents think that they can control VPD risk because they will keep their children away from exposure and so forth.
Kim: “Yes. Well I am into horses so… we are around dirt and…”
Doctor: “There is dirt and dust and rusty nails and stuff.”
So you might like to think yourselves about what you might be able to say at this point to amplify what is clearly some motivation to vaccinate. She is acknowledging a risk here.
In motivational interviewing, you may have heard about particularly in relation to techniques to get patients to quit smoking, reduce harmful addictive behaviours, and lose weight for example. They describe three types of communication, following, guiding and directing. With vaccination, generally following type communication is probably not that helpful. So that is where a clinician might say “I will give you the information and you can make your decision”. If vaccination is evidence based, the benefits outweigh the risks. So we recommend that a guiding style is better with the ambivalent. “I am going to recommend that you vaccinate her but let us work through your concerns first. How does that sound?” And for directing, “I really think you should vaccinate her.” That may be appropriate at times where there is an immediate and high risk, it just depends on the situation. But what I am saying here is that a guiding style is probably your best bet when someone is ambivalent.
Part of SKAI includes referring and deferring. So the referral information looks like this. Again, this is the provider website and under resources there is a drop down menu with all the resources available in SKAI including at the bottom, specialist immunisation services. So, on the right you see some information about the New South Wales Specialist Immunisation Service, and that is a service that is available, requires a GP referral and it is available for children and adults who have had an adverse event following immunisation or require a complex catch-up schedule, have needle phobia and parents who are very hesitant who may have concerns about vaccinations. So this clinic is happy to see your patients if you feel that their concerns are complex and difficult to address, and they are willing to go and see this service. On the left, just a mention of the process for reporting adverse events following immunisation. In that box, there is the definition. AEFI is any untoward medical occurrence that follows immunisation. It does not necessarily have a causal relationship with the vaccine.
On the New South Wales Health website, the link you see there, includes recommendations about how to report adverse events. We strongly encourage that you do report any suspected adverse events. They have the TGA form for reporting and they also recommend that you contact your local public health unit.
At the bottom right also, is the link to the information about the New South Wales immunisation specialist service, about adverse events and other referral service. And that is, the clinicians that run that service are highly experienced, paediatricians and clinical nurse consultants who specialise in vaccination.
So, what happened to Kim? Well, Kaylee her daughter was vaccinated at a subsequent visit at a specialist immunisation service. So, my take home message today is that most parents are ready to vaccinate, and the goal here is to support consent with a simple open question, “Do you have some questions?” and appropriate resources that are available to you on the SKAI website. Some parents and adults of course, they are not hesitant and they are not ready to vaccinate at all. When I say adults, I mean people who are thinking about vaccination for themselves. So there we recommend a process of asking, listening and understanding before jumping in and addressing the issues or correcting wrong thinking. Validate the person, acknowledge them and their intent to do the right thing by their child. Share your knowledge and use the resource tools that are available to you. Recommend vaccination and vaccinate if the person is ready. And if they are not ready at all, keep it brief and close with a plan. Ask if they are willing to come back and have another chat about the decision or let them you know that you are very happy to revisit the discussion and that some parents do that when there is a measles outbreak for example, or another VPD outbreak. Or when the child gets older or when the parents are planning overseas travel and they re-appraise the risk.
Linda: I was wondering whether or not you could talk about the family who have decided on their particular mode of vaccination which is homeopathy or something equivalent. Would you have any ways of managing that without blowing a gasket?
Julie: Yes. It is really hard when I hear that someone is planning homeopathy. What I want to do is say that it is not evidence-based, and that is my reflex. So, what the intention to have homeopathy actually signals, is the motivation to protect their children and if they are motivated to protect their children, then they might be worried about vaccine preventable disease. And if that is the case, then the task is to explore their reasons, to explore them to saturation until you hear no more. And then set that brief agenda and then provide information signalling that I would like to talk a bit with you about homeopathy and I mean there are some little tips like for example, there is a College of Homeopaths in the UK who recommend vaccination. There are actually many homeopaths, one who works for me as a researcher who recommends vaccination.
Linda: So maybe even having a conversation about the fact that homeopathy is not against vaccination and maybe the parent could do both?
Julie: Well, exactly. As you suggest, homeopathy are similar in concept in that you are treating like with like, but homeopathy is useless for preventing vaccine-preventable diseases. Because it is carrying on with the memory of the molecules, allegedly.
Linda: One of the things you also mentioned was you know, not to get into a sort of a slanging match about science. It is always difficult though when there is any doctors or other professional person that has been quoted. It takes a bit of skill I think not to have that righting reflex and you know, pushing the fact that you know science is science. We should not talk about that in climate change environments, you know what I mean. How do we manage our own frustration in that situation?
Julie: Now that is a really good question. Because I think recognition is the first thing, recognising that when our emotions are being tweaked in our conversations, because not vaccinating, when a parent says I am not going to vaccinate, it can have a number of meanings for the clinician. It can feel like they are saying I do not trust your expertise. It can feel like they are saying I do not trust science which is very frustrating for people that value science. It can feel like they are saying I am not going to let you protect my child. And that can create as we showed in that study, all sorts of emotional reactions, anger, hurt, being upset, being incredibly frustrated, throwing hands up in the air, and sometimes giving up and abandoning it. So, I think we all have ways of managing our emotions in general practice that have worked. Mindfulness, just being aware of how one is feeling about this and acknowledging that one is feeling annoyed or frustrated can actually be very helpful in being able to put that aside and move on, but may be you have got some tips yourself?
Linda: Well I have to say for me, the best thing for me to have in my mind is remembering this is a parent who is worried to bits about their child. And their particular way of expressing that worry gets on my nose, on my toes, whatever you want to call it. But really if I go past my own hurt, poor me, I really, really, really am there for that parent with that kid. And there is value in my hearing what is underneath their concern. And really at the end of the day they want the best for their child. Because you know what, if they did not, they would not be here in the first place.
Julie: And that acknowledgement, thinking it and saying it, is good. I can see you want, you have really looked into this, you have obviously done a lot of thinking about this. As part of that agenda setting, the acknowledgement is very powerful. So verbalising it is worth doing as well. Often if you get people emotionally on side and create a sense of you working together to resolve this one, it sometimes means that you do not have to come up with really, really clever ways of answering these particular concerns because once they are on side and you can use those resources, that can sometimes be enough.
So, I will go to the next slide which is that SKAI package and you will have this available to you. The parent website which you can share with your parents, talkingaboutimmunisation.org.au. Again you could send it with an SMS reminder ahead of the visit if you do that. Or you could have a laminated sheet, the laminated sheets for consent support in your waiting room that are handed out by the person at the front desk for example. And we have actually tested this whole system in a few practices to see how it works and tweaked it accordingly. The provider website, you see the link there. That is not publically available. We are giving it to you this evening because you are doing this webinar and that will give you the talking tips and the discussion list and the referral information as well. So it has a few extra features along with the typical resources that parents can get. And there is an e-learning module that takes about an hour to 90 minutes that you can do. If you go to this link it will take you to the National Prescribing Service website. And that is CPD point awardable. And that is interactive. It is an animation based module and that is also available. You could share that with your practice staff.
I want to zoom out really briefly now and talk about the big picture, because I have been talking about the children who may or may not get vaccinated because of a lack of acceptance of vaccination. But, we are also thinking about the families who lack opportunity or capability to get their children vaccinated on time. So the yellow and the orange there are the coverage gap in Australia at the moment. And actually the parents who lack opportunity or capability, these are the parents who face practical or logistical barriers or they may have had a vaccine delayed by a provider inappropriately because the child was slightly unwell at the time and that is in fact a false contraindication. So there are a whole bunch of reasons why children are not fully vaccinated and lack of acceptance is only part of that.
So given that is the case, how can you improve your practice to improve the coverage rates within your practice and more generally? Here are some activities that have been found to be effective that relate to general practice. They are taken from systematic reviews from the US and other countries and from Australia. One of the most important things to do is ask all patients if they are Aboriginal or Torres Strait Islander. Give them the opportunity to identify as such because then you will know that there are certain extra vaccines that are recommended for those patients. Checking the vaccination status of all your patients. We have very low coverage rates for adults for flu vaccine, for pneumococcal and opportunities to give vaccinations are extremely effective and important way to get people vaccinated and up to date. Catch up plans work, recalls and reminders. So reminders are what are sent ahead of the scheduled vaccine or recall is what happens when they have not presented on time. Routine audits of records, self-assessment and feedback of the practice vaccination rates and systems, clinical decision support systems, standing orders and continuing education. So this evening’s webinar will help you improve coverage, but only if you add it with maybe one of these other interventions or something else that you have found useful in the past to improve coverage in your practice.
Linda: So I think we can say that we have presented information about recognising opportunities to increase and maintain vaccination rates within our practices. I think we can say that we have covered that assessment of the parent’s and patient’s vaccination communication needs, and how we can tailor our goals for the consultation. We have looked at how to structure vaccination consultations to meet parents’ and patient’s information and communication needs and achieve tailored consultation goals. And I think we laid out very nicely the appropriate referral pathways for adverse events following immunisation.
Julie: Thank you.
Sammi: That is great. I would like to thank both Linda and Julie for joining us this evening and also to everybody on line. We really hope you enjoyed the session and that we have covered those learning outcomes off for you. So thank you again to everybody for joining us, and enjoy the rest of your evening.