Module 14 Communication Part 1: Principles

Module 14 Communication Part 1: Principles Module 14 Communication Part 1: Principles 1. Competency... 1 2. Learning Objectives... 1 3. Introduction... 1 4. Communication Concepts... 1 5. Assess the Audience... 3 6. Steer the Conversation... 4 7. Know your Stuff... 8 8. Summary... 10 9. Activity... Error! Bookmark not defined. 10. Required Reading... 10 11. Optional Reading... 10 12. References... 10 13. Quiz... 11 14. Quiz Answers... 13 15. Appendix A - Body Language Basics... 14

1. Competency Communicates effectively about immunizations. 2. Learning Objectives By the end of this module you will be able to: Explain the importance of risk perception for immunization decision-making. Respond appropriately following an assessment of client knowledge, attitudes, and beliefs regarding immunization. Deliver clear, concise messages about the risks of vaccine-preventable diseases and the benefits/risks of vaccines. Provide guidance to clients so they can correctly identify credible sources of information on immunization and vaccines. 3. Introduction Public concern regarding vaccine safety can reduce vaccine coverage and result in resurgence of vaccine-preventable diseases. As trusted information sources, health care providers have a vital role in the continued success of immunization programs. Providers must have skill and expertise, not only in the principles and practices of immunization but also in effective communications techniques. 4. Communication Concepts 4.1 Nurses: Trusted Sources of Information Figure 1 Leger Marketing 2006 Survey Professional Barometer A 2006 survey determined that Nurses are trusted by 95% of Canadians (Leger Marketing). Other surveys have shown that a recommendation by a health care provider is a significant factor for anyone making decision to immunize. As trusted information sources, you have a vital role in the continued success of immunization programs. Percentage of Canadians who trust... Leger Marketing, Montreal, Quebec 2006 Fire Fighters Nurses Farmers Doctors Teachers Police Judges Bankers Pollsters Journalists Lawyers Realtors Car Salespersons Politicians 96% 95% 92% 89% 88% 81% 78% 72% 63% 49% 48% 42% 19% 14%

4.2 How We Communicate Communication is not just what we say but how we say it. Page 2 Figure 2 How We Communicate Content 7% Content This is the actual words we use Non Verbal This is our Body Language Non Verbal 55% Tone 38% Tone This is how we say things For more information about body language see Appendix A. 4.3 Principles of Effective Communication Adopt a client centered approach Respect differences of opinion about immunizations Present clear, current, evidence based messages regarding vaccines and immunizations Represent the benefits and risks of vaccines fairly and openly Use plain language 4.4 The ASK Approach The ASK approach uses these principles of effective communication and provides a framework for talking with clients about immunizations. The rest of this module explores each component of the ASK approach: Assess the Audience and Acknowledge Concerns Steer the Conversation Know your Stuff

5. Assess the Audience In order to communicate about immunizations effectively, you must know how your client perceives the risk associated with immunizations. Clarify with client what their concerns are. This knowledge will guide you to choose the most relevant information for your client. 5.1 Perception of Risk An individual's perception of immunization risks is influenced by a number of factors. Experience Vaccine preventable diseases are reduced or wiped out and therefore the public does not need immunizations Personal Movement to a more natural and healthy lifestyle that stimulates the immune system naturally rather than artificially Mass Media Sensational reporting of an issue may not be grounded in science Information over-load Difficulty in deciding what vaccine information is correct 5.2 Risky Events Events can be described as less or more risky based upon the following categories: Table 1 - Risky Events Less Risky Events Risky Events Familiar Involve a natural process Under an individual s control Voluntary nature Involve a decision to avoid something Unfamiliar Man-made process Loss of control Mandatory Involve a decision to do something rather than avoid something A decision to have your child immunized falls into the "high risk" category for many parents because vaccines are: unfamiliar; man-made process; involve a decision to do something rather than avoid something. A higher perceived risk may lead to less commitment to immunizations.

5.3 Know your Audience Assess the level of commitment to immunization. Page 4 Figure 3 Know your audience Commitment to Immunization Believers Highest commitment Relaxed High commitment Cautious Moderate to low commitment Unconvinced or Conscientious Objector (CO) No commitment Low Risk Perception of Immunization Risk High Risk 6. Steer the Conversation Steer the conversation based upon your assessment of the client: - Believer - Relaxed - Cautious - Unconvinced/Conscientious Objector (CO)

6.1 Believer Page 5 Beliefs Vaccines are safe Vaccines are important What they might ask? Safety Side Effects Believers Highest Commitment to Immunizations Follows full immunization recommendations Lowest need for information Resources Actively seeks information when needed Provide take home material Encouraging Dialogue Stress that benefits outweigh the risks

6.2 Relaxed Page 6 Beliefs Vaccines are safe Don t feel guilt or worry about immunizations What might they ask? Less likely to ask questions Relaxed High commitment to immunization Low/moderate information needed Resources Less likely to ask for detailed/research information Let them know about resources Encouraging Dialogue Don t overlook unasked questions Stress vaccine benefits

6.3 Cautious Page 7 Beliefs Sceptical Wonder if disease protection necessary What might they ask? Benefits of natural diseases Need to get all vaccines? Cautious Moderate to low commitment to immunizations High information needs Resources Actively seeks information Offer more reading Encouraging Dialogue Needs extra reassurance Emphasize benefits of immunization Present a balanced view

6.4 Unconvinced/Conscientious Objector (CO) Beliefs Unlikely to change mind May influence other parents decision What might they ask? May not ask questions Unconvinced/Conscientious Objector (CO) No commitment to immunization Resources Ask if wants more information Inform if outbreak situation re: exclusion from school Encouraging Dialogue Discuss risks of not immunizing Be cautious in engaging in lengthy debate; be prepared to stop the conversation Never too late to immunize if you change your mind 7. Know your Stuff 7.1 Evaluating health resources There is a rich source of information on child and youth health, but this information can also be a source of confusion and contradiction. High-quality information should be objective and based on scientific evidence. For tips on evaluating information refer to the following resource: A Parent's Guide to Health Information on the Internet (CPS, Caring for Kids) http://www.cps.ca/caringforkids/healthybodies/internetinfo.htm

Credible Print Information: The following book may be available at your local library or Public Health office. You can order from the Canadian Pediatric Society Bookstore: http://www.cps.ca/english/publications/bookstore/yourchildsbestshot.htm Gold, R. (2006). Your child's best shot. Canadian Pediatric Society, Ottawa. Internet Page 9 In a recent survey, close to 30% of BC parents identified the internet as their primary source of immunization information (Immunize BC Campaign Marketing 2008). Studies have provided the following information regarding information on the internet. the single keyword "vaccination" yielded 40% pro-vaccination sites and 60% anti-vaccination sites. the single keyword "immunization" yielded 98% pro-vaccination sites and 2% anti-vaccination sites. The following are trusted internet sites:

8. Summary The risks that scare people and the risks that kill people are very different. Careful and timely counselling can help people to weigh the benefits of vaccines and the risks of the disease that the vaccine will prevent. 9. Required Reading Public Health Agency of Canada (2006). Canadian immunization guide (7th ed.). http://www.phac-aspc.gc.ca/publicat/cig-gci/pdf/cig-gci-2006_e.pdf Part 1: General Guidelines Communicating Effectively about Immunization, pages 29-32 10. Optional Reading Gold, R. (2006). Your child's best shot. Canadian Pediatric Society, Ottawa. Chapter 21: Resources, pages 347-354 Gerber, J.S. & Offit, P.A. (2009). Vaccines and autism: A tale of shifting hypotheses. Clinical Infectious Diseases, 48, February 15, pages 456-461. http://www.journals.uchicago.edu/doi/pdf/10.1086/596476 11. References Barone, Stephen (2003). An Ounce of Prevention: Communicating the Benefits and Risks of Vaccines to Parents. Matching communication styles with Parent personalities. Infectious Diseases in Children. January 2003. Gold, R. (2006). Your child's best shot. Canadian Pediatric Society, Ottawa. Leger Marketing (2007). Professional barometer. (May 15, 2007) Public Health Agency of Canada (2006).Canadian immunization guide (7th ed).

12. Quiz Page 11 Question #1 What percentage of our communication comes from non-verbal clues? A. 7 % B. 28% C. 55% D. 75 % Question #2. The risk of encephalitis from Measles disease is 1 in 1000 cases. A. True B. False Question #3 Because immunization is unfamiliar, it is perceived as a non-risky event. A. True B. False Question #4 A client states: I know vaccines are harmful because of what my naturopath says. I ve done my own research on the internet and from books and I am convinced vaccines are hurting children. No one can convince me to immunize my child. Which one of the following types describes this client? A. Believer B. Relaxed C. Cautious D. Unconvinced

Question #5 A client states: Page 12 I heard the other day something about natural infection is better than immunization. I know it is probably not true, but can you tell me what all the fuss is about? In responding to this question, which one of the following dialogues would be most effective? A. Provide extra reassurance and spend time refuting misinformation B. Stress that the benefits of vaccinations outweigh the risks C. Be cautious in engaging in lengthy debate; be prepared to stop the conversation D. Provide client with reading material and make an appointment to review information Question #6 A client states: I am really anxious about vaccines and autism. I have a lot of questions. I ve searched the internet and the information scares me. Tell me why I should vaccinate my child? Which one of the following types describes this client? A. Believer B. Relaxed C. Cautious D. Unconvinced Question #7 When evaluating health information on the internet, a website should present information that is objective and based on scientific evidence where available. A. True B. False

13. Quiz Answers Question #1 Answer: C Communication is not just what we say but how we say it. Body language includes the most subtle of movements. Question #2 Answer: True Acute encephalitis, which often results in permanent brain damage, occurs in approximately 1 of every 1000 cases. The risk of encephalitis from Measles vaccine is approximately 1 case per 1, 000,000 doses. Question #3 Answer: False Unfamiliar events are perceived as more risky than familiar events Question #4 Answer: D Unconvinced/Conscientious Objectors can be described as: - Having no commitment to immunization - Unlikely to change their mind - Potentially influencing other parents decision Question #5 Answer: B This is a "Believer" client type. This client will actively seek out answers to questions. They believe that vaccines are safe and important. Question #6 Answer: C Cautious Clients can be described as: - Having moderate to low commitment to immunizations - Needing a large amount of information - Actively seeking information Question #7 Answer: True A reliable health information internet site should have high quality, objective, scientific information. When advice can t be backed up by solid evidence, the next best option is the opinion of experts in that field of health care.

14. Appendix A - Body Language Basics Body Language Basics Body language includes the most subtle of movements many people are not aware of, including winking and slight movement of the eyebrows and facial expressions. 55% of the impression we get from someone comes through their body language 38% is from the tone, speed and inflection of their voice 7% is from what they are actually saying! Today, a renewed interest in deciphering every last bit of human movement can be found. Here is a primer. Non Verbal Behaviour Hands folded on table Tapping pencil or foot Wrists exposed Open palm Chin on hand Hand to cheek Fingers stroking chin Touching, slightly rubbing nose Rubbing the eye Pinching bridge of nose, eyes closed Hand in pyramid in front of face Rubbing hands Sitting, legs wide apart Sitting, legs crossed, slight foot kicking Sitting, legs slightly apart Sitting, knees together, feet on ground Sitting, legs twisted around ankle Locked ankles Brisk, erect walk Standing with hands on hips Arms crossed on chest Hands in pockets, shoulders hunched Hands clasped behind back Sitting hands clasped behind head Patting/fondling hair Tilted head Looking down, face turned away Biting nails Pulling or tugging at ear Interpretation Neutral Anxious, ready to leave, impatience Trusting and open, vulnerable Sincerity, openness, innocence Boredom Evaluation, thinking Pensive, contemplative, trying to make a decision Rejection, doubt, lying Doubt, disbelief Negative evaluation Self-confidence, authoritative Anticipation Predatory, secure, sexual Boredom Open, relaxed Tidy, punctual, meticulous Double twist: creativity Apprehension Confidence Readiness, aggression Defensiveness Dejection Anger, frustration, apprehension Confidence, superiority Lack of self-confidence; insecurity Interest Disbelief Insecurity, nervousness Indecision Courtesy of Andrew Hume, Andrew Hume and Associates, Vancouver