HealthDay News — Telling parents that their children need a vaccination was associated with less resistance than asking if they wanted one, researchers found.

“How providers initiate and pursue vaccine recommendations is associated with parental vaccine acceptance,” Douglas J. Opel, MD, MPH, the University of Washington School of Medicine in Seattle, and colleagues reported in Pediatrics.

Only 26% of parents were resistant to vaccine recommendations when healthcare providers used a “presumptive approach” to vaccination — assuming parents will immunize their child — whereas 83% resisted vaccination when clinicians use a “participatory” approach that involved parents in the decision making process, the researchers found.

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Previous studies have shown reassurance from a healthcare provider is most common reason vaccine hesitant parents follow through with immunizations despite fears.

To better understand how specific provider communication practices influences vaccine uptake, Opel and colleagues enrolled 16 pediatric providers from nine primary care practices in the Seattle area. They video-taped 111 vaccine discussions with parents of children aged 1 to 19 months during check-up visits.

In questionnaires completed before the visit, 55 parents indicated vaccine hesitancy and 56 were vaccine-receptive. The majority of parents (77%) were older than 29 years. Most were married or cohabitating with a partner, college educated and white.

Overall, 74% of providers initiated vaccine recommendations with presumptive communication rather than participatory methods, using phrases such as “We have to do some shots,” versus “What do you want to do about shots?”

Significantly more vaccine-hesitant parents resisted than non vaccine hesitant parents (54% vs. 38%; P=0.009), the researchers found. Among  parents who voiced resistance (41%), the majority did so by explicitly rejecting some or all of the provider’s recommendations (53%). 

The odds of a parent resisting vaccine recommendations increased significantly if the provider used a participatory versus a presumptive initiation format (adjusted odds ratio 17.5, 95% Cl: 1.2–253.5) after controlling for parental hesitancy and demographic characteristics. 

When parents resisted vaccination, half of providers continued to pursue their original recommendation, at which point 47% of vaccine-hesistant parents accepted recommendations.

Significantly more providers pursued their original recommendation when parents resisted with an explicit rejection than when parents used a less explicit type of resistance (80% vs 17%; P<0.001).

“These results provide foundational information to help guide the development of quality improvement interventions aimed at increasing vaccination rates among vaccine-hesistant parents,” the researchers wrote.

They called for more longitudinal studies with more diverse patient populations to further explore the issue. 


  1. Opel DJ et al. Pediatrics. 2013; doi:10.1542/peds.2013-2037.