Give a Strong Immunization Recommendation

Evidence base

Several studies have linked making a strong immunization recommendation to increased vaccine confidence and acceptance, thus increasing immunization coverage. This strategy is not exclusive to the prescriber; all provider staff who communicate with patients can be part of this strategy.

Provider office setting

• One 2018 study showed that vaccine-hesitant parents were more likely to accept immunizations when their child's provider used language that presumed parents are ready to accept immunizations during the visit.1
• A 2022 study found that motivational interviewing to address vaccine hesitancy was associated with significantly higher immunization coverage rates among patients aged 0 to 6 years.2
• Adolescents in a 2022 study were more likely to receive HPV immunization if their child's doctor provided consistent messaging on cancer prevention.3
• Providers trained to use the presumptive announcement approach for HPV immunization saw more significant increases in HPV immunization coverage among their patients relative to coverage among control clinics in a 2017 randomized clinical trial.4

Birthing hospital setting

• A multidisciplinary approach including standardizing the process of offering HepB vaccine via scripting and timing, engaging and educating parents, and educating physicians and nurses regarding the importance of HepB vaccination and strategies to discuss HepB vaccination with vaccine-hesitant parents resulted in increased and sustained HepB vaccination rates by hospital discharge from a baseline of 52.4% to 72.5%.5

Evidence-based best practices

Provider office setting

• Use effective communication approaches when recommending immunizations including presumptive language, motivational interviewing, the bundling approach, and sandwiching recommendations (see resources below).
• Listen to parents and seek to understand the concerns behind their questions before responding. Willingness to listen and acknowledge parents' concerns plays a role in building trust.
• Recognize and acknowledge the reasons that some parents are hesitant about immunizations.

Birthing hospital setting

Patient-centered

• Train Labor & Delivery and post-partum staff to actively ask about immunizations.
• Train and encourage obstetricians to discuss Hep B and RSV vaccination during prenatal visits.
• Counsel parents and caregivers on which immunizations the infant received or did not receive while at the birthing hospital. Make a strong recommendation for the infant to receive immunizations during their first well child visit if they did not receive them at the birthing hospital.

Healthcare provider-centered

• Train all providers who interact with the patient to make a strong immunization recommendation.

Strategy resources

Motivational interviewing

• Motivational Interviewing for Vaccine Hesitancy: A Training Module for Health Care Providers (North Dakota State University)
• Change the Conversation: Motivational Interviewing and Vaccine Hesitancy (North Dakota State University)

Use effective communication approaches

• CDC's How I Recommend Videos - YouTube (CDC)
• The ARM approach: Making vaccine conversations easier (Immunize.org)
• Vaccine Confidence & Addressing Concerns (Immunize.org)
• Five Ways to Boost Vaccination Rates | HPV (CDC)
• HPV Vaccination Resources for Health Professionals (American Cancer Society)
• Tools to Improve HPV Vaccination in Primary Care (HPVIQ.org)
• Video Series: Help Answering Parents' Questions | HPV (CDC)