Shots at Stake: Facilitating Interactions between Professionals and Parents about Childhood Vaccination

Vaccines, whether they are against childhood diseases or COVID-19, touch upon many issues that people deeply care about: Trust, expertise, health and healthcare, freedom of choice and autonomy, parenthood and more. As such, they are a continuous source of polarization and controversy among scientists and laypeople, governmental actors and citizens, or simply among friends or family members. This dissertation presents an analysis of real-life conversations between healthcare professionals (HCPs) and parents talking about childhood vaccination. It explores how such discussions are initiated at the Well-Baby Clinic (WBC), how concerns are raised and addressed, and how parents construct their identities in relation to their vaccination decisions. This research provides a framework for improving vaccination communication strategies. Chapter 2 presents an important socio-political aspect of the Dutch vaccination context at the time of data collection, namely the public controversies surrounding the first COVID-19 vaccines that became available in early 2021. The dominant framing of COVID-19 vaccines in governmental press conferences is contrasted with messages that were presented as challenges to that framing in social media posts on X (formerly Twitter). Chapter 3 represents a pilot study of 15 (separately and previously collected) home visits, in which one nurse talks to parents about childhood vaccination. The chapter describes how one initiating format (“Have you already thought about vaccination?”) makes relevant displays of a ‘good parent’ identity. Chapter 4 documents how HCPs solicit parents’ vaccination intent in 62 regular (i.e., non-anthroposophical) WBC visits and argue that this kind of solicitation is a dispreferred initiating action. Rather than asking directly, HCPs solicit vaccination intent by using at least one pre-sequence in two-thirds of the visits. In cases wherein HCPs (eventually) solicit vaccination intent directly, the base action is designed in ways that index its dispreferred status. Chapter 5 examines the sequence-organizational trajectories of vaccine acceptance and refusal in regular WBC visits. Accepting vaccines progresses the sequence to the next course of action, with minimally expanded sequences. In contrast, the refusal trajectory is routinely expanded by at least two, and sometimes three, additional actions: (1) soliciting an account; (2) cautioning about the consequences of vaccine refusal; (3) and ‘keeping the door open’ to future vaccination. Chapter 6 analyses how one physician (a specialist in talking to vaccine-hesitant parents) addresses parents’ concerns about childhood vaccination in anthroposophical WBC visits. The physician regularly prefaces her vaccine-related advice with a multi-unit turn that resembles a refutational two-sided message. In the final Chapter 7, the theoretical and practical implications of this dissertation are discussed. Based on this dissertation’s findings, a communication training for HCPs talking to parents about childhood vaccination has been designed. This chapter gives the reader an overview of the training curriculum and teaching method.