1. Communicating with caregivers about IPV and multiple injections
Training for the introduction of Inactivated Poliovirus Vaccine, Fractional Dose (fIPV)
Module 7
Communicating with caregivers about IPV and multiple injections

2. Learning objectives At the end of the module, the participant will:
Be familiar with ways and techniques of communicating with caregivers
Know the benefits of IPV and its importance to polio eradication, multiple injections, and routine immunization
Understand the safety of IPV when administered with other vaccines
Duration
40 minutes
Note: This module should be covered with a related UNICEF Curriculum on Interpersonal Communication (IPC; 2h minimum), available here from Oct. 2014:
Reference:
UNICEF IPC
curriculum

3. Health workers should use simple words and avoid technical terms
Key issues
Health workers need to provide information to caregivers, listen to their concerns and be prepared to politely answer their questions. 1
Health workers should use simple words and avoid technical terms
with caregivers. 2
A strong health worker recommendation for IPV and multiple injections is essential to increase caregiver acceptance. 3
To the facilitator:
Explain to the participants the key issues raised in this module.

4. Reference: UNICEF IPC curriculum
The importance of communicating effectively with caregivers about IPV and other vaccines
Health workers play important roles in parent and caregiver accepting vaccinations for their children.
Caregivers may not understand why their child needs an additional vaccine for polio and may be concerned about receiving multiple injections on the same visit.
By listening patiently, understanding, encouraging and communicating effectively with caregivers, health workers can ensure that children receive vaccines and return for future vaccinations.
For more information related to the importance of interpersonal communication, refer to page 25 of the IPC Curriculum
To the facilitator: Explain to the participants that health workers are an important part of caregiver acceptance.
Health workers play important roles in parent and caregiver acceptance. Caregivers may not understand why their child needs an additional vaccine for polio and may be concerned about receiving multiple injections on the same visit. Health workers need to listen, understand, encourage and effectively communicate with caregivers to ensure that they receive their vaccines and return for future vaccinations.
Reference: UNICEF IPC curriculum 4

5. How to communicate with caregivers? Reference: UNICEF IPC curriculum
Be respectful and compassionate
Provide reassurance
Use simple words and avoid technical terms
Listen to caregiver's concerns
Make sure the caregiver has understood your key messages
To the facilitator: Discuss communication skills with caretakers.
It is important to be respectful with parents and listen to their concerns.
Provide reassurance. Keep your messages simple: use simple words and avoid technical terms.
Make sure that the caregiver has understood your key messages.
For information on the GATHER approach (Greet, Ask, Tell, Help, Explain, Return), and using it to improve quality of outreach visits, refer to pages of the IPC Curriculum
Reference: UNICEF IPC curriculum 5

6. How to communicate with caregivers?
Be respectful and compassionate
Be warm and welcoming
Show respect
Smile
Praise them for bringing their child for immunizations and encourage them to continue bringing their child until fully vaccinated.
To the facilitator: Discuss communication skills with caretakers.
It is important to be respectful with parents and listen to their concerns.
Remember to be respectful and compassionate to parents and caregivers.
Be warm and welcoming.
Show respect.
Smile.
Praise them for bringing their child for their immunizations and encourage them to continue bringing their child until the child is fully vaccinated. 6

7. How to communicate with caregivers?
Provide reassurance
Explain to parents and caregivers that IPV is important and safe.
Reassure them that multiple injections are safe.
Remind them that it is better for the child to experience one, brief moment of discomfort than pain on two separate days.
Reinforce the importance of immunization overall
To the facilitator: Discuss communication skills with caretakers.
Provide reassurance
Explain to parents and caregivers that IPV is important and safe.
Reassure them that multiple injections are also safe.
Acknowledge their concerns about pain, but remind them that it is better for the child to experience one, brief moment of discomfort than pain on two separate days. 7

8. How to communicate with caregivers?
Use simple words and avoid technical terms
Keep your messages simple and clear. Avoid using medical words
Use words in a local language that caregivers can understand
To the facilitator: Discuss communication skills with caretakers.
Use simple words and avoid technical terms with caregivers.
Keep your messages simple and clear. Avoid using medical terminology and use words that caregivers can understand. 8

9. How to communicate with caregivers?
Listen to the caregiver's concerns
Allow the caregivers to talk, encourage them to ask questions
Give them your full attention
Listen to their concerns and respond to them politely. Correct any misconceptions they may have
Keep your body language positive
If you do not know the response to any question, tell the caregiver(s) that you will return with the correct information the next time you see them at the facility or outreach
To the facilitator: Discuss communication skills with caretakers.
Listen to caregiver's concerns
It is important to listen to caregiver’s concerns and respond to them. Correct any misconceptions the mother may have. 9

10. How to communicate with caregivers?
Make sure the caregiver has understood your key messages
Explain and check for understanding – ask questions to find out if the caregiver understood you
Remind the caregiver to bring the child for the second dose of IPV and for all other future vaccinations as per the schedule
To the facilitator: Discuss communication skills with caretakers.
Make sure the caregiver has understood your key messages
Explain and check for understanding – ask questions to find out if the caregiver understood you. 10

11. Health Workers need to be prepared to inform parents/caregivers about:
Benefits and safety of IPV
Benefits of continued use of OPV for polio eradication
Missed/upcoming vaccines in the schedule
The importance of returning for the second dose of IPV
The importance of bringing their vaccine card to every session
If applicable:
Benefits and safety of multiple injections
Questions about pain from multiple injections
To the facilitator:
Health Workers need to be prepared to educate parents/caregivers about:
Benefits of IPV
Safety of IPV
Benefits of multiple injections
Safety of multiple injections
Questions about pain from multiple injections
Importance of returning for the second dose of IPV 11

12. Reference: UNICEF IPC curriculum
Benefits of IPV
It is important to emphasize to caregivers the importance of combining IPV and OPV. IPV and OPV each play different roles in making the child stronger – they each cause a different kind of immune reaction.
Combining these vaccines protects children even more and gives them the benefit of both vaccines.
Facilitator:
Countries will introduce IPV to their routine immunization schedules to be given along with bOPV. IPV will continue to protect against the type 2 poliovirus after the type 2 component of OPV has been removed. It will also boost immunity to types 1 and 3.
Until polio is eradicated globally, OPV is still the main preventative measure against polio. IPV is recommended in addition to OPV and does not replace OPV.
Combining these vaccines protects children even more and gives them the benefit of both vaccines.
For more information on the benefits of IPV and OPV, refer to page of the IPV Curriculum.
Reference: UNICEF IPC curriculum 12

13. How to explain the benefits of IPV
Health workers can tell parents and caregivers:
“Combining IPV and OPV provides stronger protection against polio. These 2 doses of IPV will help protect your children against polio disease even more – and will give your child the benefits of both vaccines.”
“IPV strengthens immunity in the blood, while OPV strengthens immunity in the gut”
“Using both vaccines together provides the best form of protection from polio – it protects your child and helps protect our community.”
To the facilitator: This slide gives an example of how health workers can explain the benefits of IPV to parents or caregivers.
Health workers can tell parents and caregivers:
“Combining IPV and OPV provides strong protection against polio. The 2 doses of IPV will help protect your children against polio disease even more – and will give your child the benefits of both vaccines.
Using both vaccines together provides the best form of protection from polio – it protects your child and helps protect our community.”
Emphasize the importance of returning for the second dose of IPV (at the DTP3/OPV3 visit) 13

14. How should you respond to typical questions from caregivers?
Why does my child need two different vaccines for polio?
To the facilitator: Ask participants: “How would you respond to this caregiver’s question":
Suggested response:
Using both vaccines together provides the best form of protection from polio. IPV and OPV each cause a different kind of immune reaction, and together strengthen your child’s protection. Adding IPV will help protect your child against polio disease even more – and will give your child the benefits of both vaccines.
For more examples of questions, refer to Session 3.2 of page 22 of the IPV Curriculum.
Reference: UNICEF IPC curriculum 14

15. Safety of IPV
IPV has been used in over 60 countries worldwide, over decades
IPV is a very safe vaccine, whether used alone or in combination vaccines
No serious side effects have been reported, only minor side effects
Minor local reactions may occur following IPV, as can sometimes happen with other vaccines. But a child will recover
To the facilitator: Explain to the participants that IPV is safe
IPV has an extensive track record of safety from use in over 60 countries worldwide, many for a decade or longer.
IPV is a very safe vaccine, whether used alone or in combination vaccines.
No serious adverse events have been reported, only minor side effects.
Minor local reactions may occur following IPV. 15

16. How should you respond to typical questions from caregivers?
Does IPV have any side effects?
To the facilitator: Ask participants: “How would you respond to this caregiver’s question":
Suggested response:
After the vaccine, there might be a little bit of redness and the skin may feel tender.
For the facilitator:
Two role plays can take place with other participants observing and providing feedback. A "good practice" and "bad practice" example each can be provided. 16

17. Talking to caregivers about the safety of IPV
Health workers can tell parents and caregivers:
“IPV is a very safe vaccine.”
 “With this type of injection, a small bump will appear on the skin, but this is normal and will disappear with time.”
“After the vaccine, there might be a little bit of redness and the skin may feel tender.”
To the facilitator: This slide gives an example of what health workers can tell parents or caregivers about the safety of IPV.
Health workers can tell parents and caregivers:
“IPV is a very safe vaccine.
With this type of injection (intradermal) a small bump (bleb or wheal) will appear on the skin, but this is normal and will disappear with time. Do not rub the injection site, the bump will go away on its own”
After the vaccine, there might be a little bit of redness and the skin may feel tender.” 17

18. Talking about the benefits of multiple injections
If applicable:
Talking about the benefits of multiple injections
Parents/caregivers may have concerns about their child receiving three vaccines at one visit. Health workers can address this by saying:
“Giving a child several vaccinations during the same visit allows your child to be immunized as soon as possible. They are protected against multiple diseases during the most vulnerable early months of life.”
“In addition, giving multiple vaccinations at one time means fewer vaccination visits for parents and caregivers.”
To the facilitator: This slide gives an example of how health workers can explain the benefits of multiple injections to parents and caregivers.
Parents/caregivers may have concerns about their child receiving three vaccines at one visit. Health workers can address this by saying:
“Giving a child several vaccinations during the same visit allows your child to be immunized as soon as possible. This provides protection during the vulnerable early months of your child’s life.
In addition, giving multiple vaccinations at one time means fewer vaccination visits for parents and caregivers.” 18

19. Talking to caregivers about the safety of multiple injections
Inform parents and caregivers that:
 “It is safe for your child to receive multiple injections at once In many countries, children receive more than one vaccine injection in one visit.”
“Early vaccinations mean early protection for the child”
To the facilitator:
Many years of monitoring children in countries that have received multiple injections in one visit have shown that it is safe to have multiple vaccination injections. Globally, most middle and high-income countries have been safely using multiple injections for more than a decade. The IPV vaccine is effective when taken alone or with other vaccinations and does not effect a child’s immune system if taken with other vaccines.
Health workers need to inform parents and caregivers that it is safe for their child to receive multiple injections at one time.
They can say: “It is safe for your child to receive multiple injections at once. Many countries have immunization schedules where children receive multiple vaccine injections at one visit.” 19

20. How should you respond to typical questions from caregivers?
Is it safe to give multiple vaccine injections at one visit?
To the facilitator: Ask participants: “How would you respond to this caregiver’s question":
Suggested response:
It is safe for your child to receive multiple injections at once. Many countries have immunization schedules where children receive multiple vaccine injections at one visit. Numerous studies have shown that giving multiple vaccinations during the same visit does not result in an increase in significant adverse events. 20

21. Talking to caregivers about the pain associated with multiple injections
Health workers should acknowledge that children will likely experience slightly more pain or discomfort when there are multiple injections.
However, they should remind caregivers that having to return for additional vaccines forces the child to experience pain on two visits.
Address concerns about pain by saying: “It is better for the child to experience one, brief moment of discomfort than pain on two separate days.”
To the facilitator:
Health workers should acknowledge that children will likely experience slightly more pain or discomfort when there are multiple injections. However, they should remind parents the pain or discomfort from vaccination is very brief – and that even one injection can cause pain or discomfort, with children often not noticing the pain or discomfort caused by subsequent injections. If more immunization visits are used to provide children with needed vaccinations that means there will be more times when children will experience pain or discomfort from vaccinations.
It is important to remember that additional vaccination visits mean children will have more stressful and painful vaccination experiences – not fewer.
Address concerns about pain by saying: “While receiving multiple injections at once is painful, having to return for additional vaccines forces the child to experience pain on two visits. It is better for the child to experience one, brief moment of discomfort than pain on two separate days.” 21

22. How should you respond to typical questions from caregivers?
Will my child experience more pain or discomfort?
To the facilitator: Ask participants: “How would you respond to this caregiver’s question":
Suggested response:
While receiving multiple injections at once is painful, having to return for additional vaccines forces the child to experience pain on two visits. It is better for the child to experience one, brief moment of discomfort than pain on two separate days. 22

23. Things to remember: key messages
Vaccinations are important for the overall health of the child
IPV and OPV together provides stronger protection against polio
Even after the child receives IPV, caregivers should continue to accept OPV whenever it is offered.
IPV is safe and effective
It is safe to give multiple vaccine injections in one visit. In many countries, children receive more than three vaccines in one visit.
It is better for the child to experience one brief moment of discomfort from multiple vaccines, than pain on two separate days/visits.
By listening patiently, understanding, encouraging and communicating effectively with caregivers, health workers can ensure that children receive vaccines and return for future vaccinations.
To the facilitator:
Explain to the participants that this is the main information to keep in mind.
IPV is very safe and effective – and needed for polio eradication
It is safe to give multiple vaccine injections at one visit. Many countries have successfully introduced multiple vaccine injections into their routine immunization schedule
Health workers need to listen, understand, encourage and effectively communicate with caregivers to ensure that they receive their vaccines and return for future vaccinations.
Remind caregivers of the full vaccination schedule and the importance of returning for the second dose of IPV. 23

24. End of module
Thank you
for your attention!
To the facilitator: