1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

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

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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. Center for Pediatric Research
R. Clinton Crews, MPH
Center for Pediatric Research
855 W. Brambleton Ave.
Norfolk, VA 23510