Treating patients who are hesitant about getting vaccines or even refusing them has always been a component of immunization care, but it became a major issue in the administration of the COVID-19 vaccine. Throughout the pandemic many Community Health Center patients have had conversations with their providers and members of the care team expressing concerns, confusion over public health guidance, and unanswered questions about the COVID-19 vaccine for themselves and their children. Often referred to as “avoidance narratives” these conversations can be challenging for providers because they often require time to respond to numerous concerns, address misinformation, and listen with empathy beyond just restating medical data and facts.
Last year, NACHC, in partnership with Emory University’s Rollins School of Public Health, recruited 10 health centers to take part in patient and staff interviews of mostly unvaccinated individuals, as part of the CDC-funded COVIED Program coordinated by Global Health Crisis Coordination Center – (GHC3). Additionally, GHC3 members, including Morehouse School of Medicine, Georgia College of Rural Studies Institute, and Alive & in Color also led interviews in Black and rural communities for a total of 52 focus groups. The project’s goal involved the following:
- more clearly identify community concerns and define avoidance narratives around the COVID-19 vaccine
- develop accurate and trusted resources to reduce the disproportionate negative impact of COVID-19
- provide guidance on how providers can respond to these narratives with an effective counter narratives
Most common concerns cited in focus groups about the COVID-19 vaccine
The qualitative research analysis from the focus groups uncovered these six avoidance narratives:
- Government is pushing this (raising trust issues with government)
- It’s not worth the risk (people think vaccines could be worse than the disease)
- My freedom is threatened (people don’t like feeling coerced, so they refuse)
- Vaccines aren’t necessary (people believe COVID is mild and the threat is overstated)
- What’s the point? (we’re still getting COVID, despite vaccines)
- There isn’t enough information (the virus and our understanding of the vaccine keeps changing)
As with all concerns and conspiracies, there are grains of truth. Busting avoidance narratives isn’t easy
How counter-narratives can help people in the “moveable middle” change their views
During a recent webinar, Counter-narratives as a Strategy for Promoting COVID-19 vaccination with patients webinar, presenters shared their insights based on their focus group research into how Care Team members can help people contemplating getting the COVID-19 vaccine.
Webinar presenters included James Lavery, PhD, MSc, Rollins School of Public Health, Center for Ethics, Emory University, and Wanda Montalvo, PhD, RN, FAAN, Senior Fellow and Team Lead, Public Health Integration, NACHC.
They explained that there are two main types of vaccine skeptics: (1) those who are confused (the “uncertain” group), and (2) those who are defiant and resentful (the “resistant-defiant” group). Counter-narratives are most successful if they target the “uncertain” group, or as many refer to them, the “moveable middle.”
Counter-narratives are narratives that explicitly try to displace or undermine the social currency of another narrative (e.g., of COVID-19 vaccine avoidance) and address content that is false, incomplete, or imprecise. They can help to move people to change their minds and feel less fearful about something like a vaccine. To present effective counter-narratives, it important to know your audience – who you are talking to and why they have concerns. It also is important to examine the content of information delivered as an argument, and how it was delivered (i.e., social media, conversations with family, friends, clergy or co-worker).
Developing counter-narratives is a creative and collaborative process that can be done with other health center care team staff wanting to help respond to mis- and disinformation about COVID-19 vaccines or fill in gaps of knowledge that can cause doubt and uncertainty about the vaccine. To identify the best counter-narrative, it helps to “know your audience.” Who are you talking to and why do they have concerns? Then:
- Ask them questions to learn more about their concerns
- Use active listening to address their avoidance narrative, then present counter facts
- Target attitudes that are changeable, without threat
This process has many facets. Health centers can discuss and share ideas about possible counter-narratives and how they might apply to specific patients or patient groups. This can help provide ideas, concepts, and language to use in communications with individual patients. All health center staff can provide ideas that speak to the heart of a patient’s (or population’s) concern. If a staff member finds success with a specific counter-narrative for a common avoidance narrative, then they should share it with other staff members.
Health centers are trusted places in their communities, and the nurses and pharmacists who work there are consistently ranked as the most trustworthy professionals. Delivering counter-narratives is within the scope of everyone’s position and can be delivered best by trusted professionals.
For great resources and counter narrative ideas, and addressing misinformation, consider some of these resources:
- Alive & In Color: COVIED – aliveandincolor : The COVIED Project Library
- Peer Ambassadors using counter-narrative: Peer-Ambassador-Counter-Narrative-Approach-and-Keys.pdf
- Trusted Messengers using counter-narrative: Trusted-Messenger-Counter-Narrative-Approach-and-Keys.pdf
- COVIED + The BLK+Cross COVID-19 BIPOC Master Messaging Grid: Covied – aliveandincolor
- Global Health Crisis Coordination Center: Global Health Crisis Coordination Center – Vaccine Equity (globalhealthc3.org)
- HHS We Can Do This Campaign’s Addressing COVID Vaccine Misinformation Resources
- American Academy of Pediatrics virtual seminar on how to counter vaccine misinformation. Weathering the Vaccine Vortex. Non AAP members, create a free AAP PediaLink account to access the free seminar.
Check out NACHC’s podcast on how to address the benefits of COVID-19 vaccination and common parent concerns.