The Universal Language of Story | Developing Model Narratives for Provider Parent Interactions to Guide Child Vaccination Decisions

Background: Vaccine hesitancy is driven by various contextual, group, and individual determinants and vaccine-specific factors. Vaccine hesitancy acts as a barrier to childhood vaccination. While literature suggests narrative communication may be influential towards promoting health behavior, there is a gap in understanding how narrative communication approaches can be utilized to support parent-provider conversations around childhood vaccines. The objectives of this study were to: (1) Conduct secondary analysis of in-depth interview data from parents and providers to identify commonalities within the decision-making process for parents making vaccine choices for their children and determine aspects of priority for providers when engaging in vaccine communication. (2) Develop fictional narratives that represent the four distinct parental positions on childhood vaccination (unquestioning acceptors, cautious acceptors, go along to get along, late/selective vaccinators, and refusers) (3) Assess the feasibility and acceptability of the fictional narratives to guide parent-provider communications related to childhood vaccines. Methods: This study conducted a secondary data analysis from the study Development and Testing of ADEPT: A Parent Decision Support for Childhood Vaccinations (ADEPT) by Vasudevan et al. Additionally, we recruited parents and healthcare providers to conduct interviews via zoom. We developed four fictional narratives, by aggregating stories from healthcare providers currently administering childhood vaccines, and parents of young children, that followed a range of mothers making vaccine decisions and their varying concerns. In-depth interviews with vaccine-hesitant and nonvaccine-hesitant parents provided feedback on the acceptability and feasibility of these narratives. Results: 5 healthcare providers and 12 parents with children 3-6 years of age we interviewed. Parents with shared decisions to accept, refuse or delay vaccines describe similar factors influencing their decision such as family experiences and vaccine-specific concerns. Healthcare providers’ steps in vaccine conversation first address parent concerns, create a trusting environment and provide a strong recommendation. Parents chose none, one, or multiple narratives they resonated with, and there was no relationship between vaccine decision-making history and the parental position represented in the narrative. Conclusions: The results suggest that the providers approach vaccine conversation by understanding parents' perspectives and providing a solid recommendation. A multitude of factors influences parents' vaccine decisions. This study suggests the use of narrative in the distribution of healthcare information, and further research can further validate the narratives and refine them for broader use.