Risk Communication Skills for Vaccine Safety: A Training Program for Immunization Providers R. Clinton Crews, MPH, Amy Paulson & Frances D. Butterfoss, Ph.D. Center for Pediatric Research Norfolk, VA National Immunization Conference March 2003 Chicago, IL

Background Majority of parents with young children have no experience with vaccine-preventable diseases Media attention regarding vaccine safety Lack of specific training among providers of immunizations in risk communication New vaccines R. Clinton Crews, MPH Center for Pediatric Research

Background Healthy People 2010 Objective 11-3 states the need to increase the proportion of health communication activities that include research and evaluation Healthy People 2010: National Health Promotion and Disease Prevention Objectives. (US Department of Health and Human Services. Jones and Bartlett Publishers, Boston, MA; 2000; p 11-16) The 25th Edition of the Red Book devoted only 4 paragraphs on the subject of Risk Communication (2000 Red Book; p 5 -6) R. Clinton Crews, MPH Center for Pediatric Research

The Idea To develop a risk communication curriculum and training manual to educate providers and immunization advocates on techniques to communicate with patients and parents who have concerns about immunizations. R. Clinton Crews, MPH Center for Pediatric Research

Project was funded through a $10,000 grant from the Ambulatory Pediatric Association & Centers for Disease Control and Prevention R. Clinton Crews, MPH Center for Pediatric Research

Risk Communication Two-way dialogue of information and opinion concerning a risk or perceived risk to individuals or groups in communities Goals of Risk Communication Increase knowledge and understanding Enhance trust and credibility Resolve conflict R. Clinton Crews, MPH Center for Pediatric Research

Types of Risk Communication Care Communication: Informal; discussing risks that are generally understood Consensus Communication: Informing and encouraging groups to discuss risk and reach decisions on risk management Crisis Communication: Extreme, sudden danger, accidents, illnesses, emergencies Lundgren, R (1988) R. Clinton Crews, MPH Center for Pediatric Research

Parent Types and Environmental Factors Those who have Concerns about Vaccines (ESSENTIAL) High Concern – High Trust Those who Oppose Vaccines (ESSENTIAL) High Concern – Low Trust Those with no Questions about Vaccines (RECOMMENDED) Low Concern – Low Trust Those who are for Vaccines (OPTIONAL) Low Concern – High Trust Fulton Communications R. Clinton Crews, MPH Center for Pediatric Research

Study Design Develop a risk communication curriculum for vaccine safety Test pilot curriculum Develop a risk communication training manual and distribute to vaccine providers R. Clinton Crews, MPH Center for Pediatric Research

Risk Communication Curriculum Barriers to the communication process Types conflict and environmental factors that impact the communication process Techniques to communicate with patients and parents in a low trust and/or high concern environment about immunizations Ask – Tell –Ask Communication Model Role Plays Current Vaccine Issues in Virginia R. Clinton Crews, MPH Center for Pediatric Research

Pre-Test Results Training occurred in conjunction with an annual vaccines issue update sponsored by the Consortium of Infant and Child Health (April 2002, Norfolk, VA) 20 participants (physicians, nurses and public health officials) 17 participants completed the training program evaluation. The survey was organized into five sections: 1) judgment of the subject relevance 2) rating of the educational material 3) rating the effectiveness of the learning aids 4) rating the overall quality of the training 5) open-ended questions R. Clinton Crews, MPH Center for Pediatric Research

Pre-Test Results Con’t R. Clinton Crews, MPH Center for Pediatric Research

Pre-Test Results Con’t R. Clinton Crews, MPH Center for Pediatric Research

New Research In the May-June edition of Ambulatory Pediatrics (Volume 2, Number 3, 2002), Dr. Terry Davis et al concluded that nurses and physicians wanted professional education credit for vaccine risk/benefit communication training Davis TC, et al. Improving Vaccine Risk/Benefit Communication With an Immunization Education Package: A Pilot Study. Ambulatory Pediatrics, Volume 2, Number 3, May – June 2002 R. Clinton Crews, MPH Center for Pediatric Research

Study Re-Design Developed Risk Communication Program as CME program Recruited experts trainers in the fields of Risk Communication and Vaccine Safety R. Clinton Crews, MPH Center for Pediatric Research

Results Risk Communication for Vaccine Safety Training program was approved by the Eastern Virginia Medical School’s CME Office ($1,265): The Basics of Risk Communication Effective Communication Techniques and Tools Are Vaccines Safe? Consequences of Vaccine Fears Current Vaccine Issues in Virginia R. Clinton Crews, MPH Center for Pediatric Research

Results Con’t Expert Trainers ($3,043): Dr. Paul Offit, Vaccine Education Center Sandy Martinez, Risk Communication Consultant – Fulton Communications Clint Crews, Immunization Strategist R. Clinton Crews, MPH Center for Pediatric Research

Results Con’t Training occurred on January 25, 2003 ($584) 17 participants (7 physicians, 4 nurses and 6 vaccine advocates) Participants received a Training Manual, Vaccines and your Baby video, Seven Questions Posters, two meals and 4.25 CME hours R. Clinton Crews, MPH Center for Pediatric Research

Results Con’t Attendees were administrated a Risk Communication Knowledge Survey at the conclusion of the training 14 attendees completed the Risk Communication Knowledge Survey: - Scores ranged from 90% to 55% - Most common questions missed related to non-verbal communication R. Clinton Crews, MPH Center for Pediatric Research

Concluding Thoughts Offer training as a breakout or pre-conference training at annual provider/nurse conferences Conduct further research in the area of patient/provider trust and the impact of risk communication training on this relationship Adapt program as an in-office training and incorporate Infectious Diseases in Children’s program for credits R. Clinton Crews, MPH Center for Pediatric Research

Center for Pediatric Research R. Clinton Crews, MPH Center for Pediatric Research 855 W. Brambleton Ave. Norfolk, VA 23510 757.668.6430 ccrews@chkd.com