Table 6

Example of dialogue with the hesitant parent
Health professional: Good morning Mrs Wilkinson. I understand you have brought Robbie for his first infant vaccinations today.
Mother: That’s right.
Health professional: OK, have you read the leaflet about the injections? What questions are on your mind? (build rapport, seek questions and concerns)
Mother: Well, I’m pretty nervous – he seems so young.
Health professional: You sound quite worried (empathic response), let’s talk it through together, tell me what you are concerned about? (further building rapport and eliciting concerns)
Mother: One of the mums in my mothers’ group said that one of the injections has got five ingredients and that’s too many for their immune systems to cope with. He does seem so young to be having injections against all these diseases at once. Won’t it make him ill?
Health professional: OK, we can talk about this (guiding) but do you have other worries as well? (eliciting further concerns)
Mother: Well I read also that they can get a sore leg afterwards, so that’s another worry.
Health professional: (pausing to allow mother to interject if she has questions and to observe body language) Right, let’s talk about the five ingredients and then we can talk about the chances of getting a sore leg (signposting and structuring of explanation). You’re right that the injection has got five ingredients which would protect Robbie from the diseases called diphtheria, tetanus, whooping cough, polio and Haemophilus influenzae b (Hib). It seems a lot doesn’t it (empathic response). Children, even newborn babies, have to deal with enormous amounts of bacteria and other foreign material every day, and the immune system responds to each of these in various ways to protect the body. Babies’ immune systems can handle this, and the vaccines these days are so refined that babies can easily cope with several vaccines in one go. (chunk of information provided followed by pause for mother to raise further questions and health professional to observe mother’s body language).
Mother: OK, and will he get a sore leg?
Health professional: Most children don’t have any reaction at all, other than having a cry with the injection, and even then they generally settle really quickly with a cuddle and some comforting words from mum (empowering). It’s true that a small number of children, about 10%, or 1 in 10, can get a redness or a sore area where the needle goes in (acknowledging) – but these reactions don’t usually distress the child, and only last a couple of days, then go away. So what I ask mothers to do is to watch their child and if they are concerned bring them back to the clinic so we can check them over. How does that sound? (avoid being overly persuasive, positive framing of risk)
Mother: Is there anything in particular I should watch for?
Health professional: Robbie may be a bit unsettled for a day or so after his injection but he shouldn’t be ill with it. The leaflet tells you about what to look out for and what to do if you are concerned.
Mother: Thanks – I’m still a bit nervous but I think we should get it done.

Leask et al.

Leask et al. BMC Pediatrics 2012 12:154   doi:10.1186/1471-2431-12-154

Open Data