dimensions: motivational interviewing for hesitancy mi1_0 6.pdf · motivational interviewing...

32
DIMENSIONS:     Motivational Interviewing for Vaccine Hesitancy Pamela Murray, MD, MHP Neil Copeland, MD Timothy Lefeber, MD 

Upload: others

Post on 01-Oct-2020

14 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

DIMENSIONS:     Motivational Interviewing for Vaccine Hesitancy

Pamela Murray, MD, MHPNeil Copeland, MD Timothy Lefeber, MD 

Page 2: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Training Objectives1) Learn about the MI heart set, processes, skills, and strategies 

2) Recognize parental disposition; 

3) Demonstrate skill in answering common vaccine specific questions;

4) Demonstrate skill in applying the three Cs intervention approach;

5) Demonstrate skill in using the MI style of communication in conversations with hesitant and vaccine refusing parents.

Page 3: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Motivational Interviewing

Motivational interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change. 

It’s a way of being versus a way of doing. 

Page 4: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

Vaccine         Recommendations

Page 5: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

ACIP Recommendations (2018)

Page 6: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Why a Presumptive Recommendation? 

Who initiated the vaccine recommendation or plan specifically? (n=111)

No plan verbalized (3%; n=3) Parent (13%; n=15)

Provider (84%; n=93)

Presumptive (74%; n=69) Participatory (26%; n=24)

Resists (26%; n=18) Resists (83%; n=20)

Accepts (74%; n=51) Accepts (4%; n=1)

Provides own plan (13%; n=3)

How does the PROVIDER initiate the vaccine recommendation? (n=93)

How does the PARENT respond to the provider’s initiation?

Presumptive recommendation drives consent

Opel et al, Volume 132, Number 6, December 2013

Page 7: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

The Key to MI

Adopt the right “heart‐set.” This includes:

PartnershipActive collaboration

AcceptanceNon‐judgmental

CompassionFocus on well‐being

EvocationStrengths and resources

Page 8: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Primary Goal of MI

Interact with a person in a way that increases motivation to change and evokes change talk

Change talk is a person’s own statement that favors change

Page 9: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Four Processes in MI

Engaging

Planning

Evoking

Focusing

Page 10: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Four Processes in MI: Engaging

The process of positive engagement involves: ① Establishing a trusting and mutually respectful 

working relationship② Agreement on treatment goals③ Collaboration on ways to achieve these goals 

Engaging

Page 11: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Four Processes in MI: Focusing 

Focusing in MI is an ongoing process of seeking and maintaining direction

Focusing

Page 12: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Four Processes in MI: Evoking  

Evoking is the process of eliciting a            person’s own motivation for change by   

resolving ambivalence to change

Evoking

Page 13: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Strategies for Evoking Importance

Page 14: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Strategies for Evoking Importance

Querying extremes

Looking back

Looking forward

Exploring goals and values

Imagine your child does not get the HPV vaccine, what’s the worst that can happen?

What do  you remember about him getting three shots at once when he was a baby?

If you decide on this vaccine, what do you hope will be the benefits to your daughter?

What are your goals for your child’s health?

Page 15: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Strategies for Evoking Confidence

Page 16: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Strategies for Evoking Confidence

Reviewing past success 

Personal strengths/supports

Hypothetical change

In the past, what has helped you make up your mind when you felt uncertain?

What supports do you have that can help you make this decision ?

Suppose you opt for the recommended vaccines today. Looking forward, what might you see as the 

benefits for her?

Page 17: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Four Processes in MI: PlanningPlanning involves commitment to change and the formulation of a concrete change plan

Planning

Page 18: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Signs of Readiness for Planning

Increased change talk

Taking steps

Diminished sustain talk

I’m open to getting the vaccine.

I’ll talk about the HPV vaccine with my husband.

I would like my child to be healthier.

Page 19: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Signs of Readiness for Planning

Resolve

Envisioning

Questions about change

I really do want to do all we can to prevent cancer.

When the time comes for her to engage in intimate relationships, she will be protected.

What’s the best way to explain this to my husband?

Page 20: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

O

A

R

S

Open questions

Affirming

Reflecting

Summarizing

OARS

Page 21: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

The “Expert” TrapWhen a HCP persuades, lectures, or offers excessive scientific data to parents or patients who are: Hesitant, especially when ambivalence 

is associated with a core value In discord with the established medical 

recommendations Firm about their decision not to 

vaccinate

Page 22: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

OARS Coding Sheet

Page 23: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Open Questions

Difficult to answer with brief replies or simple “yes” or “no” answers

Allow for a fuller, richer discussion Conversational door‐openers that encourage 

people to talk, using their own words Keeps the conversation focused on the 

individual

Page 24: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Closed Questions

Do you want your child to be healthy? You do know that boys need the HPV vaccine 

too?  Are you going to get all three vaccines today, 

as I’ve recommended?

What do you need to change to make this an open‐ended question?

Page 25: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Affirmations

Statements or gestures that recognize a person’s strengths

Lead in the direction of positive change Confidence‐builders Must be genuine and congruent Use sparingly — a little goes a long way

Page 26: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

You are making the best choice for your 

child

You want the best for your child

Your commitment to your child’s health is obvious

You are thoughtful in your decision‐making

You are doing an excellent job

Page 27: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Reflections

Reflective Listening: Is listening to the words that are said and the meaning behind them

Keeps people thinking and talking Demonstrates that you seek to understand what has been shared

Forces you to listen carefully—you can’t reflect if you are not paying attention

Page 28: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Reflections

Reflections allow the person to: Voice thoughts or feelings they may not have talked about before

Feel understood Feel accepted without judgment Hear their thoughts and feelings restated

Page 29: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Summarizing

Summaries allow people to: Recall the conversation Think of new ideas Transition from one theme to another Plan their next steps Feel more confident moving forward

Page 30: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Intervention Schema

PresumptiveRecommendation

Assess ParentalDisposition

1

2

TailoredIntervention3

Acceptor

Cautious Acceptor

Hesitant

Refuser

Vaccinate

AnswerQuestions

Vaccinate

Vaccinate

Vaccinate

ArrangeFollow‐Up

Arrange Follow‐Up

AnswerQuestions/MI

Reassess

MI

Reassess

Page 31: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Motivation

Page 32: DIMENSIONS: Motivational Interviewing for Hesitancy MI1_0 6.pdf · Motivational Interviewing Motivational interviewing is a collaborative conversation style for strengthening a person’s

© 2018 BHWP

Discord Management 

“What does it matter?”

“Yes, but…”

“You don’t know what it’s like to be in my shoes.”