Strategies to convince hesitant patients to get the COVID-19 vaccine

Despite the rollout of COVID-19 vaccine doses since mid-December 2020, there have been numerous logistical issues and ethical questions about how best to distribute those doses.

One question looms large for healthcare organizations: How do you convince patients to get the vaccine if they don’t want it? Already there are signs of many different segments of the population with hesitancy.

Who doesn’t want their shot?

The Kaiser Family Foundation (KFF) December 2020 vaccine monitor survey found 27% of Americans said they probably (12%) or definitely (15%) would not get a vaccine, even if it were free and deemed safe by scientists.

That same KFF survey found the top five groups most hesitant to getting a shot were:

1. Republicans (42%)
2. People age 30-49 (36%)
3. Rural residents (35%)
4. Black adults (35%)
5. Essential workers (33%).

The top five concerns among those saying they would not get a vaccine were:

1. Worries about possible side effects (59%)
2. Distrust of the government regarding safety and effectiveness (55%)
3. Wanting to wait and see how it works on others (53%)
4. Politics playing a role in the vaccine process (51%)
5. Belief that COVID-19 risks are exaggerated (43%).

Drew Altman, president and CEO of KFF, noted at the time of the survey results that “[i]t will take effective messaging and information efforts utilizing credible messengers and digital communications techniques to reach these different groups, targeting their different worries about the vaccine. No one message or single messenger is likely to be effective.”

• Read more about efforts by hospitals and health systems to cross cultural divides to educate patients in underserved areas and build trust in COVID-19 vaccination (via Modern Healthcare, subscription required).
• Learn how a “return to normalcy” is a main factor for many Americans, based on a survey about how different media are effective in sharing vaccine education messages.

Effective messages and messengers for rural patients

While rural patients are just as likely to know someone who tested positive for or died from coronavirus as urban and suburban patients, KFF data shows about four in 10 rural Americans (39%) are not worried they or someone in their family will get sick from coronavirus. More so than urban and suburban patients, rural Americans believe the seriousness of the coronavirus is exaggerated, and they also view getting vaccinated as mostly a personal choice at a higher rate than urban and suburban Americans.

However, the same survey found most rural Americans (86%) trust their own doctor or healthcare provider to provide reliable information about COVID-19 vaccines, whereas lower levels of trust are reported for the Centers for Disease Control and Prevention (66%), Dr. Anthony Fauci (59%) and state government officials (55%).

Altman suggests that healthcare workers should adopt messaging regarding the seriousness of the pandemic that likens immunization efforts to the Second Amendment: “[T]he vaccine is a way to protect you, your family and your way of life,” he writes, which can help undo the damage caused by disinformation to convince those patients that the fight against the pandemic is intended to take away personal liberties or “deny them their way to make a living.”

Know what your patients are thinking

Beth Wrobel, chief executive officer of HealthLinc, said that a lot of the work in recent weeks for the federally qualified health center (FQHC) — with 11 clinics, two telehealth clinics and one mobile medical clinic in northern Indiana — is to get answers directly from patients concerning how they felt about the vaccine for when they will be able to offer it to the public, estimated to be in February.

“We are starting to make a list of patients who would be interested when we do get the vaccine,” Wrobel said. “We were able to start to understand why our patients were concerned and identify that and start patient education.”

Wrobel noted that there seems to be a degree of hesitancy because of the speed with which the vaccine was readied for use. “This whole Operation Warp Speed, I wish they had named it something else,” Wrobel added. “People just felt that it was really fast.”

Early success in immunization rollout

John Kleyla, assistant vice president of information services at Ochsner Lafayette General, said that the nonprofit health system serving south central Louisiana has been at the forefront of the state’s efforts to immunize patients with the Pfizer vaccine.

To ensure efficiency, Kleyla’s team worked to digitize as much pre-visit work as possible, including self-scheduling, consent forms, review of fact sheets and information about possible contraindications. Part of this was born out of necessity, as the group is facing limitations on nursing staff due to many being out from exposure to COVID-19. With four nurses rotating through, the group aims for eight vaccinations every five minutes.

Building out sections for that documentation to flow into the group’s EHR was vital, not just for the patients’ records, but also to simplify transmitting data to the state’s immunization registry, which is used to coordinate second doses and accurate reporting of vaccine administration, Kleyla said. “We didn't want to have that dual entry,” he added.

Wrobel echoed the need for vaccination data in the EHR, especially for FQHCs, as HRSA is seeking reporting on vaccinations by race and ethnicity, as well as first and second dose administration. “If we didn't do it in the EHR, I don't think we would be able to get all that data and know how we were doing and being good stewards of the vaccine that we are getting,” Wrobel said.

Other issues and best practices

• Though patients could self-schedule for a first dose, Kleyla said the group uses the 15-minute window after a patient gets a shot — used to observe for any possible allergic reactions — to schedule the second dose directly with someone in registration.
• Wrobel added that her organization surveyed her clinical and nonclinical staff regarding their feelings about the vaccine. At the time, only 51% of the clinical staff said they would get it, and the rate for nonclinical corporate staff was even lower, at 39%. “We knew that if we couldn't convince our employees, trying to convince our patients,” Wrobel added, the one position that might have significant influence was front desk registration, since they have high volumes of patient interactions.
• If a patient doesn’t want to join a waitlist for the vaccine when it becomes available, consider asking to put them on a list for outreach so that a trusted member of the team can call them or otherwise share education on the benefits and safety of the vaccine. For patients who refuse the outreach list, ensure someone listens to their stated objections to get a firm sense of what common issues are being raised so you can develop better scripting and education.
• Have a list of reasons to get the vaccine that will resonate with patients, which can be communicated by trusted physicians and other clinical providers, such as the desire to hug family members or to go on vacation later this year.

Additional resources

• The National Association of Broadcasters (NAB) and the Reynolds Journalism Institute (RJI) offer a vaccine education toolkit with sample messaging and suggested tactics that broadcast journalists use to craft vaccine education messaging that will resonate with their audiences.
• AAFP offers an FAQ for family physicians (PDF) to guide patient conversations about the COVID-19 vaccine.
• Visit the familydoctor.org vaccines page for easy-to-download messaging to share with patients regarding common questions about the COVID-19 vaccine.
• Read more best practices and access other tools in the MGMA COVID-19 Recovery Center.