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Hesitancy on the Frontline: Lessons Learned in Preparing for and Responding to Health Care Worker Hesitancy

Authors: Regina Madanguit, Felicity Pocklington, Michael Coleman, Sherine Guirguis, and Amel Benzerga

To help you address specific vaccine hesitancy and demand issues in your country, you can sign up for a one-on-one meeting with Common Thread. Whether it’s a strategy, a crisis communication plan, or something you can’t quite define, our public health experts, communicators, and designers are ready to help you find a way forward. Email info@lnct.global to sign up.

Healthcare workers are critical for COVID-19 vaccine rollout. They are the backbone of routine immunisation services and highly influence whether a person will vaccinate or not. But the voices that carry the most weight are not automatically the biggest advocates.

The COVID-19 vaccine rollout has shone a spotlight on mistrust in vaccines among healthcare workers at a global scale. Healthcare workers, like the rest of us, worry about vaccine safety, fall prey to misinformation, and have varied levels of trust in the government.

Healthcare worker hesitancy to vaccinate is not a new challenge, but the COVID-19 pandemic has introduced new complexity: an aggressive vaccine roll-out, high-risk of exposure and more pressure for healthcare workers to have all the answers  for an increasingly skeptical public.

A literature review conducted in April of 2021 found that among 76,471 healthcare workers across the globe, 22.51% reported that they were hesitant to receive the COVID-19 vaccine. A survey of 6,043 Arabic-speaking healthcare workers living in and outside of Arab countries found that only 26.7% accepted the vaccine, with the leading barrier to acceptance being fear of side-effects. Another survey found concerns over vaccine risks and mistrust among healthcare workers in Romania, Croatia, Greece, and France – all the countries in the study.

These statistics are dangerous given the high level of public trust in healthcare workers.

How can immunisation programme managers better understand healthcare worker hesitancy in their contexts?

COVID-19 vaccine roll-out and preparing for the next pandemic starts with building demand for vaccination and increasing trust within our healthcare workforce. But measuring demand and hesitancy in the healthcare workforce and the wider population is complex. So how do you spot it?

By diving into the data. Social and behavioural data on healthcare workers offer clues as to what groups are more likely to be hesitant to the COVID-19 vaccine. Early data collection on 12,000 healthcare workers in the UK suggests that pregnancy, belief in COVID-19 conspiracies, lack of vaccination against the flu, a prior infection with COVID-19, lower health literacy, and higher economic security are all factors that can potentially make someone less likely to accept the vaccine to protect against COVID-19. These factors ring true for hesitancy in the general population as well. Data like this can help you identify potentially hesitant groups so that you can co-develop interventions tailored to their needs and concerns.

Understanding healthcare worker hesitancy in your own context starts with determining what you already know. Exploring previous research on general healthcare worker vaccine demand can provide a wealth of insight into what behaviours breed hesitancy in your context. Gathering lessons and indicators from previous health crises can also help you construct a better picture of what hesitancy looks like in your context.

Build on this existing knowledge by conducting your own research. You can explore different methodologies to fit within your budget – including rapid qualitative insights – or simply having regular conversations with healthcare workers. Whatever method you decide best suits your situation, ensure that you are collecting data regularly to stay on top of shifts in attitude.

Actions we can take NOW to build trust of healthcare workers and reduce healthcare worker hesitancy

Reducing hesitancy and building trust in vaccines and in the people providing them takes time with any group. Deep-seated beliefs and fears don’t just vanish overnight. Invest in building vaccine confidence now. When a pandemic strikes and anxieties soar, it’s often too late.

Below are some steps you can take now. Make sure you have an evidence-based understanding of the most critical barriers and opportunities influencing vaccination to choose the right solution for your context.

Capacity Building

To support demand for vaccination, our healthcare workers need to understand it. Thankfully, capacity and skills building interventions come in many different shapes and sizes to suit the needs of your health care workforce.

  • Interpersonal Communication training

Interpersonal Communication (IPC) training helps healthcare workers address their biases and misconceptions surrounding immunisation and gives them the tools to facilitate positive and meaningful communication with caregivers.

  • Motivational Interviewing

Motivational Interviewing (MI) is a form of counseling that health workers can use to inspire people to change through respectful and compassionate dialogue. Governments and external partners can train the healthcare workforce to use MI, so individuals can explore their own reasons to change. For example, here are 10 key MI strategies for patient engagement.

  • Gamification

Gamification has been shown to help people recall information, develop skills, and understand certain practices through game play. Encouraging workplace and training systems with points, competition, and rules can help healthcare workers recognise the value of vaccination and aid in their interactions with caregivers in a low-stakes, fun setting.

  • Job Aids
    Job aids are easy-to-use, short documents that healthcare workers can turn to for additional support and guidance while on the job. They should be clear, concise and help individuals avoid mistakes.
  • FAQs

Compiling a collection of Frequently Asked Questions that addresses common concerns is a simple way for healthcare workers to find answers for their burning questions.

  • Protocols

Establishing protocols, a standard set of behaviours for healthcare workers to abide by, can help ensure that your community of healthcare workers has a shared understanding of vaccination, its importance, and its successful delivery.

  • Supportive Supervision

Supportive supervision is a process of knowledge building and performance improvement where support staff provide guidance to healthcare workers where needed. The supervision is intended to be non-authoritarian and respectful, with aids checking in periodically rather than overseeing the work.

Regardless of which method you choose, it’s important to include both hard facts and soft skills throughout the training. Learning how to actively listen, build rapport, trust, and facilitate meaningful conversations is just as important as providing concrete evidence as to why the vaccine is safe and effective. Training interventions supplemented by supportive supervision and regular communication will help keep hesitancy at bay, and ensure that these teachings are showing through in their work and their interactions with vaccine hesitant individuals.

Resources and tools:

Building Trust

Trying to uproot mistrust in science and institutions can feel like an uphill battle, especially when it comes to topics like vaccination. Here are two ways that you can begin to build confidence in vaccination in the context of COVID-19:

  • Increasing the availability of vaccine safety and efficacy data.

To cut through the noise of misinformation, vaccine safety and efficacy data needs to be shared and more importantly, explained and understood. But transparency about the COVID-19 vaccine shouldn’t stop when the information does. Being honest about what is known, as well as what is unknown will go a long way. More often than not, it’s the “unknowns” that drive safety concerns amongst healthcare workers. Supplementing unknowns around COVID-19 vaccination with facts about vaccines, and their incredibly high efficacy and safety rates, can help ease some of the anxiety surrounding unknowns.

  • Involving Healthcare Workers

Like all people, healthcare workers want to feel respected, heard, and informed. Engaging healthcare workers early on to help shape vaccination efforts can empower them to champion immunisation. Inviting healthcare workers into the decision-making process for vaccine recommendations, policies, and the design of health communications around new vaccines gives healthcare workers a place to learn and have a stake in the process.

Resources and tools:

Advocacy and Communication

Communication strategies can be a powerful tool to influence behaviour when used in tandem with other interventions. In the context of COVID-19, communications with health providers should aim to:

  • Remind people why vaccination is important
  • Increase health literacy for vaccination
  • Spread awareness of COVID-19 and boost self-efficacy and response efficacy
  • Provide information on eligibility, accessibility and affordability of vaccines
  • Make positive vaccination stories visible and aligned with existing social norms
  • Respond to common questions or new concerns
  • Dispel myths about COVID-19 and the vaccine

Resources and tools:

Creating an enabling environment

Enabling environments for vaccine decisions make it easy for healthcare workers to choose to get vaccinated. Enabling environments can be created by:

Using behavioural interventions

By leveraging cognitive biases, the natural ways in which people frame decision-making, we can make vaccination the easy choice. Some successful behavioural interventions include:

  • Making vaccination the default by automatically scheduling vaccine appointments for healthcare workers. This way, going through the trouble of scheduling your own appointment disappears. Similarly, a person who doesn’t want the vaccine would need to go through the trouble of opting out.
  • Harnessing social influence can make vaccination more socially desirable than not vaccinating. This could be a bulletin board in a hospital that celebrates vaccinated healthcare workers.
  • Creating competition can motivate individuals to vaccinate. For example, health centres could internally announce the percentage of team members who are vaccinated in each department.

Making vaccination convenient

The fewer barriers to immunisation, the more likely people will get their shot. Vaccination locations and appointment times need to be convenient for everyone. Appointments during lunch breaks and before and after working hours at locations within or nearby health centres can ensure vaccination reaches healthcare workers with non-flexible and busy schedules.

Reminding people to get vaccinated

When vaccines are in supply, research shows that sending people messages and reminders as their appointment nears can increase their likelihood to vaccinate.

Resources and tools:

Regulation

Regulatory interventions such as incentives for taking and disincentives for refusing the vaccine have been proven to increase uptake. Here are a few common examples:

Financial incentives

Research shows that money can motivate people to get vaccinated, but it’s all about setting the right price. A large financial incentive can make people question the safety of the vaccine.

Declination statements

A declination statement is a form of disincentive, that requires those who choose not to vaccinate to sign a statement saying they are choosing not to vaccinate. A study conducted during the 2006-2008 influenza season found that requiring individuals who refused the vaccine to fill out a declination form led to a 55% increase in influenza vaccination. Here’s an example of a declination form for the COVID-19 vaccine.

Regulatory Policy Measures

Mandates and restrictions for vaccinated and unvaccinated people are being introduced in an effort to increase vaccination rates. Some workplaces and educational institutions have required their staff and students to get vaccinated, while certain restaurants and entertainment venues require proof of vaccination to enter. These sorts of restrictions effectively move people to get the COVID-19 vaccine because otherwise they’d be barred from activities and resources they need and desire. Punitive policies like penalties and legal repercussions for unvaccinated individuals have also worked to disincentivize vaccine refusal, however there are also risks that such measures may cement anti-vaccine views given the push for government authority and control.

Resources and tools:

Conclusion

We hope this article serves as a reminder to prioritise the hesitancy crisis and open your arms and ears to those most equipped to address it: healthcare workers. To combat hesitancy, support the rollout of the COVID-19 vaccine, and prepare for our next pandemic, we need to empower our people on the frontlines with the knowledge and confidence that vaccines save lives.

As noted earlier, to help you address specific vaccine hesitancy and demand issues in your country, you can sign up for a one-on-one meeting with Common Thread. Whether it’s a strategy, a crisis communication plan, or something you can’t quite define, our public health experts, communicators, and designers are ready to help you find a way forward. Email info@lnct.global to sign up.

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