“Trust and confidence in any product — and here the vaccine is the product — starts with confidence in the process and safety.”
-Payam N., Vaccine Outreach Supervisor

While training over 1,800 vaccine outreach workers enrolled in the California Virtual Training Academy’s Vaccine Communications Training, the UCSF Center for Excellence in Primary Care developed a practical guide for engaging people who are skeptical of the COVID-19 vaccine in meaningful conversations.

When we hear skepticism, our first instinct may be to end the conversation. After all, why spend our time trying to convince someone who has made up their mind? Our second instinct may be to counter the person’s position without pausing to hear more about their perspective. Unfortunately, trying to force someone into getting the vaccine often results in defensiveness and anger.

Nicole H., a vaccine outreach worker in San Bernardino County, takes a different approach. She says, “My job is to provide education and outreach, but not to bully or pressure someone into doing what I think they should do. At the end of the day, the decision is theirs to make.”

Nicole uses the well-validated concept that arguing with someone is not an effective way to build motivation. A more useful technique is to ask questions that explore the person’s reasoning behind their decision.

We propose the HEAR technique, based on skills used in health coaching and motivational interviewing, to guide such a conversation. The HEAR technique is an acronym that stands for:

Hear: Could you tell me more about your concerns about the vaccine?

Express gratitude: Thank you for sharing that concern. You have been thinking carefully about this!

Ask about pros and cons: What would be the bad things about getting a vaccine? How about the good things?

Respond: Would it be OK to share some information about your concern?

Let’s look at a traditional way of telling someone to get vaccinated without the HEAR technique:

Old way:

Diana: Thanks for taking the time to talk today. We’re reaching out because you are eligible for the COVID-19 vaccine. Are you interested in receiving it?

Evelyn: I’ll pass.

Diana: Did you already get vaccinated?

Evelyn: Nope, and I’m not interested either.

Diana: It’s really important to get vaccinated! The vaccines help keep you and your community safe from COVID-19 infection!

[Immediately counters the person’s position.]

Evelyn: Right. Well, I’m just not interested.

Diana: OK, well that’s too bad. Bye.

[Hangs up without further exploration.]

Now, let’s see Diana effectively use the HEAR technique to defuse tension and respectfully offer information relevant to the person’s concerns.

New way:

Diana: Thanks for taking the time to talk today, Evelyn. My name is Diana. We’re reaching out because you are eligible for the COVID-19 vaccine. Are you interested in receiving the vaccine?

Evelyn: Yeah, I’ll pass.

Diana: Thanks for letting me know. Each person I talk to has a lot of things to consider when choosing to get vaccinated or not. Would it be OK to talk about what’s on your mind when you think about the COVID vaccine?

[H for hear: Acknowledges the person’s opinion and asks permission to discuss concerns.]

Evelyn: Sure. But you’re not going to change my mind!

Diana: Fair enough! It’s ultimately up to you, right?

Evelyn: Yeah, it is. OK, well, I feel like the vaccine was developed way too fast. I don’t like the idea of putting something in my body without understanding the effects.

Diana: Thank you for sharing that concern. Understanding the safety of the vaccine is important to you. Is there anything else that makes you not want to get the vaccine?

[E for express gratitude: Thank person for sharing. A for ask about pros and cons: Probes to understand the person’s “cons” to getting a vaccine.]

Evelyn: No. It really comes down to safety.

Diana: So, one reason that you don’t want to get the vaccine is your concern about safety. Are there any reasons that you might want to get it?

[A for ask about pros and cons: Asks an open-ended question to understand a person’s “pros” for getting the vaccine.]

Evelyn: Well, sure. I mean, I miss singing in the choir at my church, and I miss my grandkids.

Diana: So, on the one hand, you want to be sure that the vaccine is safe before you get it. On the other hand, you want to get back to singing in the choir and seeing your grandkids.

Evelyn: That’s right.

Diana: Would it be helpful for me to share what we know so far about safety for this vaccine? Just so you can consider it while you think about what’s best for you?

[R for respond: Asks permission to share additional information.]

Evelyn: Sure, I guess that would be OK.

If the person agrees to hear new information, that is something to celebrate! Diana could go on to share new information and assess the person’s reactions and motivations.

As demonstrated in this scenario, the HEAR technique is an easy-to-follow guide to engage patients, family, friends, and even the person in line behind you at the coffee shop in dynamic conversations about the vaccine.

These conversations, in turn, are the key to higher vaccination rates and ultimately the restoration of our social lives and the economy. As Nicole’s supervisor, Betsy T., says, “There is a lot of skepticism, and we cannot ignore it. It’s there, and we must be honest about that. Just call and talk to people. It’s as simple as that.”

Patricia Mejia and Rachel Willard-Grace collaborated on this article.

Alicia DiGiammarino is a health educator who blogs at her self-titled site, Alicia DiGiammarino. 

Image credit: Shutterstock.com