Presenter Disclosure
Tamsin Morgana
•Relationships with commercial interests:
– No relationships with commercial interests
– Received an unrestricted educational grant greater than
$10,000 from Wyeth (2007, parent teaching resource)
Immunization
Communication
Enhancing our Effectiveness
using the ASK Approach
[email protected]
Western Canadian Immunization Conference
March 2014
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Thank YOU for the work you do!
Did you
know?
270
54,000
136,000
400,000+
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Learning Objectives
Growing our communication capacity
 Following the session you should be able to:
 Describe approaches to enhance effectiveness of oneto-one conversations
 Explain plain language concepts
 Understand how to tailor information to match your
client/patient’s needs
 Describe a tool to create communication skill building in
a safe practice setting
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Commit to making one
change in your practice
What is one way you can change to
improve your communication skills?
OR
What is one concept you can take to
your team?
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A Complex and Challenging
Communication Environment
Beyond our Control
Complexity of the
immunization program
Population diversity and
individual needs
The power of
multimedia to misinform
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Multimedia messages are
powerful and can have a
lasting effect
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So, what do we do about it?
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 Immunization providers need to
face these challenges head on
with effective communication
skills facilitated by good
resources.
“Communication works for those who work at it”
-John Powell
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 Recommend immunizations
with confidence and conviction.
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A Complex and Challenging
Communication Environment
Within our Control
How we
communicate
What we
communicate
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We capitalize on a powerful
advantage
What is our Power Advantage?
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Aim for Simplicity
“Simple can be harder than complex:
You have to work hard to get your
thinking clean to make it simple. But
it’s worth it in the end because once
you get there, you can move
mountains.”
- Steve Jobs
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Use Tools and Techniques to
Facilitate Your Conversations
 Apply plain language principles:
 Materials → diagrams, pictures, chunk information,
causal language (it’s vs it is; their vs he/she),
 Language → Causal language no jargon, speak to
“you”, stories
 Great resources: Use professional designers for
clear presentation – use  white space
 Tailor information to your client’s needs – that may
mean simple or higher level
 Be able to send online links/articles quickly
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Did You Know?
 “Even people who can read and write well
may not understand medical information,
depending on the context in which it is
presented to them and their stress or
anxiety levels at the time of receiving it”
(Shohet, Jan 2011)
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“Insanity: doing the same thing over
and over again and expecting
different results”.
- Albert Einstein
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Which Do You Prefer?
Send clients to: www.pertussis.com
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Benefit
risk
Fact/Truth vs Myth
What do people remember?
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The Power of Painting Mental Pictures
The Mother Teresa Effect
“If I look at the mass, I will never
act. If I look at the one, I will.”
Excerpt from book:
Made to Stick: Why some ideas survive and others die
Chip and Dan Heath 2007
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The Mother Teresa Effect Tested
Fundraising Initiative – Save the Children’s Fund
Group one heard:
Group Two heard:
•3 million Zambians
face hunger
•Please help Rokia, a 7
year old from Mali,
Africa.
•4 million Angolans
have been forced to
flee their homes
•11 million Ethiopians
need immediate food
Which
one had
more
appeal?
•She is desperately poor
and faces the threat of
starvation
•Your donation will help
feed ,educate & provide
basic medical care to
her and her family
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Develop Your Knowledge
 Know the answers to the common questions
 Know good websites and reading sources to
refer your clients
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Prepare an immunization
communication toolkit, ready
for use when the crucial
conversations arise
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xxxxxx
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One-to-one talks with
clients are powerful
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Communication Basics
 “What you say means nothing, but what they get
and understand is everything” (Bergman, 2007)
 Only answer what your patient asks, let them
direct the questions
 “People do not remember what you said but
they remember what they thought about what
you said” (Bergman, 2007)
 Use simple language and less words
Medical Education Network, June 2007
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Being an Effective Communicator
Takes Purposeful Practice
“Master the first seconds. They count”.
(Hume and Associates)
“Start with Heart” (Patterson et al.)
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Are you engaging in
purposeful practice?
Yes
X No
Practicing your communication skills
Mindless repetition
Striving for improvement
Watching an expert do it
Monitoring how you are doing
Staying in your comfort zone
Evaluating your success
Only doing the things you are
already good at
Working on aspects you are not good Passing off the difficult clients to
at
someone else on your team
Source: http://blog.zintro.com/2012/08/10/10000-hour-rule-malcolm-gladwells-10000hours-of-practice-theory-from-outliers-visualized/
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 “A great example of putting knowledge into
practical application” (PHN)
 “It’s great to have easy-to-use resources and
get tangible results” (PHN)
 “It will hopefully prevent me from wasting my
time with people who are firm about nonvaccination, and focus on those who just need
more education” (MD)
 “It was interesting to observe…how attentive
the participants were until the end” (PHN)
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4 Elements in the ASK Approach
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Match Your Client’s Needs
 Tailor your dialogue and time to match
the needs of your patient/client/parent
 Framework of 4 client types:




The believer
The relaxed
The cautious
The unconvinced/conscientious objector
Keane et al. (2005). Confidence in vaccinations: a
parent model, Vaccine 23, 2486-2493.
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Did You Know?
“Parents who have
limited knowledge are
highly influenced by
parents who have any
information regardless of
accuracy”
Peer Influence
Karyo Focus Testing Report, April 2005 and October 2004, BC Immunization Promotion Committee
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• Audiences with little familiarity with
vaccination issues, for example, new
parents, may more readily accept as
mainstream, theories which are outlandish
in scientific terms….
J. Leask, J. & McIntryre, P. (2003). Public opponents of vaccination: a
case study. Vaccine, 21, 4700-4703
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Time Matching
Spend LESS Time
Spend MORE Time
Time Traps
Overselling
Debating
xxxxxx
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Reposition Your Time
3-5%
Unconvinced
15%
Cautious
80%
Believer/Relaxed
xxxxxx
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What Parent Type?
Writer takes issue
with multiple shots at
one visit shocking a
baby’s immune
system.
“seems logical to me
that the immune
system of a twomonth old baby is not
developed”
Give them separately,
give them older
Vancouver Sun
February 2009
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A: Acknowledge your Client’s Concerns
and Clarify Your Understanding of Your
Client’s Needs
 “I hear what you’re saying. That’s a common question I
get. Tell me more about what you know.”
 “That’s a scary story. I can see how you would be
worried. Tell me more about your concerns.”
 “It sounds like you want to do the right thing for your
child. I’m hearing you say that you have concerns
about….”
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Helpful “Tell” Words
 “Tell me how you arrived at your choice?”
 “Tell me why you feel that way?”
 “Tell me what worries you?”
 “Tell me what you know about…”
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S: Steer your Conversation.
First refute the myth(s), then continue…
 “Actually, that’s a common myth. Flu vaccines protect
you from the flu, they cannot give you the flu.”
 “Unfortunately the internet can have inaccurate
information depending on where you look. The HPV
vaccine prevents cancer and is very safe.”
 “When something like that happens it’s natural to look for
a reason. Vaccines do not cause autism.”
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S: Steer your Conversation.
First refute the myth(s), then continue…
Two steering choices
OPEN
your conversation to
ensure your client’s
questions and concerns
are addressed.
SKILLFULLY CLOSE
your conversation for now.
OR
Rational: your client is a
conscientious objector and
has firmly made up their mind
not to immunize at this time.
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The Unconvinced/
Conscientious Objector
 These clients choose the risk of getting
the disease versus the risk of getting
immunized.
 In their context, they feel this choice is
the safer choice for them.
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Unconvinced
 Steer your conversation to a close versus
getting into a lengthy debate
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Unconvinced
• Closing ideas:
– “Thanks for letting me know you are choosing not
to immunize your child right now..”
– “I’m sensing that you’re choosing not to immunize
your child right now. Is your decision final? Is there
anything more I can say? I want to reassure you
that immunizations are a healthy choice for
children. Are you open to talking about this again
next year?
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Unconvinced
 Explain their responsibilities if unimmunized
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Unconvinced
 Keep the door open for future conversations.
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K: Knowledge – Know the Facts Well
Use plain
language pyramid
Start
Here
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Top Misconceptions
http://www.historyofvaccines.org
The “overloaded immune system”
The “disappeared diseases”
More vaccinated than unvaccinated people get sick
Hygiene and better nutrition are responsible for the
reduction in disease rates, not vaccination”
Natural immunity is better than vaccine-acquired immunity
xxxxxx
x
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Top 20 Questions
http://www.historyofvaccines.org
#1
How do vaccines work? Do they work against viruses and bacteria?
#2
Why aren’t all vaccines 100% effective?
#8
Can babies’ immune systems handle so many vaccines?
#10 What is herd immunity? Is it real? Does it work?
#12 Do vaccines cause autism?
#14 Why is vaccination recommended if it causes so many side effects?
#15 Do we do enough safety testing with vaccines
xxxxxxx
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K: Knowledge – Know the Facts Well
1.
Provide further knowledge tailored to your clients
needs.

Give-listen-clarify as needed

Use your toolkit
2.
To close, reinforce discussion with a benefit
statement
3.
Provide further resources as needed
4.
Provide your recommendation and immunize now,
book an appt, or ask what they plan to do
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Plain Language Pyramid
Q: Does MMR cause autism?
Start Here
“The MMR vaccine is very safe and protects
children, it does not cause autism.”
“The MMR vaccine is very safe and protects children. There is no
increased risk of autism with MMR vaccine. Because children are
often diagnosed with autism at around the same time as they get
their shots people sometimes think it’s related to the shots.”
“The MMR vaccine is very safe and protects children. The controversy about a
possible link started with a small study of 12 (8 had autism) children that appeared
in the Lancet. Most of the authors later retracted their findings. In May 2010 the
lead author, Dr. Andrew Wakefield, was found guilty of serious professional
misconduct over “unethical” research and struck from the medical registry in the
UK. 23 studies refute this myth. One study looked at over 500,000 children and
concluded there was no difference in rates between unvaccinated and vaccinated
children. You may wish to review the safety reviews posted at the IOM.”
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Community papers
Local nutritionist supports
immunization but……
 Never give to sick child
 Never give to child with a serious
adverse event
 Multiple vaccines place undue
stress
 Never get a vaccine with thimerosal
 12 year olds don’t’ get STIs, don’t
need the vaccine
 Vitamins reduce negative effects
xxxxxxx
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Knowledge Activity
Reviewing the common
misconceptions and questions
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4 Elements to the Role Play Scenario
xxxxx
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Facilitating Communication Practice
 One person is the client, one person is the HCP
 The client picks 4 cards
 The client reveals the setting only and role plays the other
elements
 The HCP practices responding to the scenario
 Close discussion
 HCP declares what the 4 cards were
 Switch positions and pick 4 more cards
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The ASK Approach
Small group activity
Work in pairs
Group by your area of work
Experienced with inexperienced
Spend 5-10 minutes per scenario
Work through 3-4 scenarios
Report back to larger group
Example One
xxxxx
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Client Says…
Client: “I think vaccines are good and my
other children have been vaccinated, but
what I read recently concerned me. I read
on the National Vaccine Information
Center website that it’s better to get my
daughter’s 2 month shots one at a time
over 4 visits instead.
Baby daughter is
scheduled for 4
immunizations at 2
month visit
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You Say…
HCP: “So what I am hearing you say is that
you are concerned that receiving them all
at once is unsafe.”
Client: “Yes, I’d like to hear your opinion.
I’m leaning towards only getting the
meningococcal vaccine today.”
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The Conversation
Continues…
HCP: “I often hear your concern from parents. Actually,
what you read is a common misunderstanding. I have a
lot of experience giving 4 shots at the same visit, it’s our
standard of practice. I can reassure you that it’s very
safe and babies handle them well. For today, I would
recommend your child receive the meningococcal
vaccine and also their pneumococcal, rotavirus, and
InfanrixHexa vaccines.”
Client: “Well, I think it would be best if she just gets the
meningococcal vaccine today.”
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The Conversation Continues…
HCP:“So you are still unconvinced. Tell me more about your
concerns.”
Client:“ Well yes, what about the side-effects? I read they are greater
with so many and I don’t want to put my daughter through that or
put her at risk.”
HCP: “Actually, that’s a common misunderstanding too. The possibility
of side-effects will be similar whether it’s one or four. Getting all 4
shots now is the best way to protect your daughter as early as
possible when they are most at risk of serious complications of
these diseases.”
Client:“Ok, thanks for reassuring me. Let’s get her all 4 today.”
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Cautious Dad
Take the time to talk it out.
“Thank you so much for spending the time to
answer all my questions – I really appreciate it ”
(A.R., Personal Communication, October 2010)
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Purposeful Practice
Specific
• Dedicated time to focus on
communications
Observation
Feedback
• Opportunity to be observed
and get feedback
Mindful
Application
• Opportunity to practice a
variety of scenarios
Adapted from Educational Primer for Clinicians: Train the Trainer
session. Dr. Leslie Sadownik, 2014.PowerPoint.
Celebrating the Work You Do!
 Taking the time to speak with parents and
clients is highly effective
 It’s important to understanding immunizations and
making an informed choice
 Clients ask you because they believe you are
the expert and the trusted source
Thank you for the immunization
work you do!
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Self Reflection Questions
1.
Are you confident about answering complex
immunization questions? Why or why not?
2.
Do you feel defensive when answering questions
about vaccines? Why or why not?
3.
What does making a recommendation mean to you?
4.
Are you comfortable using personal stories?
5.
What could you have said differently (in a talk that
didn’t go so well)?
6.
What is one thing you can change to improve your
communication skills?
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