Motivational Interviewing for Vaccine Hesitancy (COVID-19) – Occupational Therapy EBP

Introduction

I have been thinking for a while about how we can help those who are anti-vax or the vaccine-hesitant to change their mind and be more willing, if not ultimately more receptive and take action to become vaccinated. I am not just talking about COVID-19, but for other diseases for which vaccines have a proven track record for helping humanity – ones like MMR, hepatitis, varicella, tap, and so on. In occupational therapy school, you may have learned bout motivational interviewing. I looked at the research myself to see how effective it can be for vaccine programs. Here’s what I found.

About Motivational Interviewing

Motivational interviewing is a communication approach that I think aligns well with occupational therapy. After all, one of our jobs is to help people engage in meaningful activities in their daily life. Motivational interviewing is a person-centered, goal-oriented communication style, discussion, or interview that helps to strengthen a person’s intrinsic motivation and help them commit to a change. Or at least the hope is a change, but I think a consideration or getting someone to start thinking about making a change is a win – because it is a step in the right direction and away from no change and complacency.

Some of the techniques used in motivational interviewing include listening more than talking, learning about the patient more than trying to persuade or convince them and guiding their thinking by hearing them out and understanding more, then asking more appropriate questions to follow-up up with developing insights. It’s empathetic and has many elements of therapeutic listening.

Motivational interviewing should be authentic and although we personally may have intentions or want a certain outcome, we can’t as therapists be manipulative or have an agenda, despite it being in the patient’s best interests. I won’t go into the specifics of motivational interviewing, but you should know that overall, it has been shown to be effective with many different things such as smoking cessation, substance abuse problems, promoting physical activity, diet change, and much more!

MI Research

A study published in 2018 titled, ‘a postpartum vaccination promotion intervention using motivational interviewing techniques improves short-term vaccine coverage: the Promovac study'^[1]Gagneur, A., Lemaître, T., Gosselin, V., Farrands, A., Carrier, N., Petit, G., … & De Wals, P. (2018). A postpartum vaccination promotion intervention using motivational interviewing … Reference List divided mothers of newborns who were 2, 4, and 6 months into an experimental group that received motivational interviewing versus a control group that did not receive it. The vaccines that were discussed included diphtheria, tetanus, poliomyelitis, whooping cough, HIB, and pneumococcus. Of the thousands of newborns who were studied, there was a 3%, 5%, and 7% increase in vaccine coverage for 3 different aged months. The authors concluded that motivational interviewing may be effective in increasing vaccine coverage. Study limitations included this not being a randomized control trial and specific characteristics of the mothers that were part of the study. For example, the control group (those who did not receive motivational interviewing) may have had a stronger intention to vaccinate than the experimental group. Despite these limitations, the experimental groups showed an increase in vaccine coverage with an 8% higher chance of having complete vaccination status than children of mothers who did not receive the intervention.

How about for COVID-19? While research is still limited due to how recent this pandemic is ongoing – one article I found mentioned how it was important to stay current with the myths surrounding COVID-19 vaccines just as much as our understanding of the risks and benefits of the vaccine themselves. This makes sense because the reasons, or ‘conspiracy theories’ are strong reasons why people may take a stance and be more vaccine-hesitant. Myths such as the vaccine being new, the vaccine altering DNA, reactions after getting the vaccine, taking supplements to prevent COVID-19, alternative treatments such as ivermectin, effects on menstrual periods and pregnancy, even for me myself at one point – questions and fears about it affecting breastfeeding. Based on this, it shows how motivational interviewing techniques stress the importance of understanding each person and their thought process, reasons, for the ‘root cause’ towards their decision for whether they have received the covid-19 vaccine.

What’s Working

And while yes, it would be great if study after study with the best scientific methods such as randomized control trials with large sample sizes, little limitations, and so on existed and proved that motivational interviewing worked definitively, but I think really there’s nothing to lose in using it. It certainly won’t do any harm compared to other methods we are currently using. What healthcare providers and healthcare workers are currently using is not really working. We try scaring people, penalizing people, persuading people, giving them all the scientific data, or even sharing real stories, but they don’t seem to work at all in changing people’s minds about vaccines such as that for COVID-19.

Discussion

I don’t think necessarily that they made up their mind so much that they will never change it. Some may not, but some may though, especially those who may be on the fence. I was one of these people at one point and ambivalent in the beginning during the emergency use authorization stage thinking maybe I should wait a bit until more people get vaccinated. As a healthcare worker, I was also one of the first groups who could have gotten it besides the study participants. Nothing is really black and white or clear cut and you have to weigh the pros and cons and look at all possible angles – do your own research and challenge your thinking and not take what others tell you as the truth. I think for the majority of us, we want what is best for ourselves, our children, and our families – whether you are pro-vaccine, in the middle, or strongly against it – you probably want what’s best for them. Whatever choice you make, it’s up to you. [This is the type of language and approach that MI happens to use.]

As a provider, nurse, therapist, pharmacist, or other healthcare professional, we should try to use more of the components of motivational interviewing because it shows a lot of promise and hope for addressing the controversial issue of vaccinations. Anti-vaccination is not a new phenomenon, but it has been heightened during the pandemic for many reasons from political to cultural to personal to financial to spiritual. I have been reading comments online such as on Reddit and many healthcare workers feel hopeless in helping patients to change their stance on vaccines. I feel like we should not throw our hands up and give up and just let ‘patients or people do what they want to do’ and/or have that Darwinism mentality of survival of the fittest.

As healthcare workers, such as occupational therapists, we want people and groups of people to participate in their meaningful activities and to lead healthy lives so that they can do these activities. I realize that it is especially hard for humanity to do this during a pandemic. Some people are having an easier time than others. But when science shows continued evidence of certain vaccines being beneficial in minimizing or eradicating diseases, some of which are disabling or deadly, I think we have a responsibility to not only present the latest and most accurate information, but to change our approach to communication and change.

If you are an occupational therapist and especially at a lost for ways to bring about change such as talking to a patient who is vaccine-hesitant, consider using motivational interviewing techniques and encourage your team to do the same. If we can guide someone in the right direction, that is one step closer to making a decision. And of course, it is not all up to use as healthcare professionals to evoke change, it comes from within the individual themselves.