What really happens in conversations about childhood vaccination

Interview Lieve van Hengel Communication and information scientist

Vaccination rates among babies and young children are falling. Particularly in vulnerable neighbourhoods, the percentage of vaccinated children is sometimes alarmingly low. Various studies are investigating why parents do not have their children vaccinated. One such study focuses on ‘real-life’ conversations between public health nurses and new parents. The results are being put into practice immediately.

“The research is entirely based on real conversations,” says communication and information scientist Lieve van Hengel. “We don’t conduct interviews or surveys, but analyse conversations recorded during home visits. We then look at whether we can make those conversations run even more smoothly.”

Van Hengel’s research is taking place in Amsterdam and Rotterdam, in neighbourhoods where vaccination rates are traditionally low; too low to prevent outbreaks of infectious diseases. Although nurses were initially afraid that parents would not want to participate, the opposite proved to be true. “If the research is presented in a natural way, parents often have no problem with the recording,” says Van Hengel.

“Because the conversations are drawn from everyday practice, the results are immediately applicable.”

Conversation analysis

During the conversation analysis, the study examines how parents interpret the nurse’s explanation and how this shapes the rest of the conversation. It also looks at the manner in which something is said: for example, are there many pauses, or are responses given very quickly? What does that mean, and how does the other person interpret it?

“I discovered that nurses often anticipated parents’ potential concerns even before they had been expressed. For example, they would say: ‘The vaccine is new to the programme, but not new in general; it has been administered in Belgium for some time.’ In doing so, they immediately pre-empted doubts about how new the vaccine was.”

According to Van Hengel, this has both advantages and disadvantages. “Parents run the risk of being seen as anti-vax when they ask questions or express concerns themselves. By anticipating potential concerns, nurses spare them that difficult task. On the other hand, such a ‘pre-packaged’ approach can actually make it harder for parents to ask questions later on. Doubts are, as it were, brushed aside before they are even voiced.”

Immediately applicable

She continues: “Because the conversations are drawn from everyday practice, the results are immediately applicable. We have developed training sessions for nurses. They often recognise themselves in the examples. ‘Oh yes, that’s exactly how I do it,’ they say.”

A follow-up study will examine how specific phrasing can create more space for discussion with parents. “For example: “I don’t know whether you’ve heard of rotavirus,’ or ‘I don’t know how you feel about vaccination.’ That is less leading, more open,” says Van Hengel. In addition, group discussions are being organised, also in languages other than Dutch, so that everyone can be included in the research.

“The aim is mutual learning, building relationships and strengthening trust.”

“We don’t want to persuade parents, but to ensure conversations run as smoothly as possible and help build trust. Perhaps that will help increase vaccination rates, although of course there are many other factors at play: trust in the government, misinformation, social networks, or even the distance to the vaccination centre.”

During the research, Van Hengel discovered that residents and healthcare professionals are regularly approached about taking part in new initiatives. “That can lead to overload and mistrust. That is why wehave made a conscious decision not to set up yet another standalone project, but to seek to link up with existing networks and activities.”

Learning community

Setting up a learning community is one example of this. Healthcare professionals are linked with parents, key figures from the neighbourhood and local organisations. “The aim is mutual learning, building relationships and strengthening trust. The focus is not only on knowledge about vaccinations, but also on sharing concerns, experiences and solutions”, says Van Hengel. “This ties in nicely with the neighbourhood-focused approach the GGD launched in 2021.”

The process is slow; building trust takes time. But it is precisely that time the researchers want to take. The first meeting is now scheduled and ties in with an existing neighbourhood initiative.

Van Hengel: “Ultimately, one idea is central: we know that conversations play a crucial role in vaccination decisions. But what actually happens in those conversations only becomes clear when you examine those real-life interactions yourself.”

About Lieve van Hengel

Lieve van Hengel (b. 1998) studied Health and Life Sciences and completed a master’s in Dialogue, Health and Society at VU Amsterdam. In her research, she examines conversations about childhood vaccination in Dutch neighbourhoods where vaccination rates are low. She analyses interactions between parents and healthcare professionals and is working on a learning community in which parents, professionals and key figures exchange knowledge.