The AIMS Approach: Regulating Receptivity in Patient-Provider Vaccine Conversations

"Evidence-informed approaches to vaccine conversation management that can be easily learned, practiced, remembered, and used by HCPs are needed....The AIMS framework is a relationship-oriented approach that has promise in accomplishing these goals."

Research suggests that healthcare professionals (HCPs) are often the most trusted source of information on vaccines, but an escalation in antivaccination messages across various social media platforms has contributed to the problem of vaccine hesitancy. Enhancing the capacity of HCPs to effectively respond to patients who are refusing vaccines is a critical approach to the problem of under-vaccination. This essay introduces an intervention framework, referred to as AIMS (Announce, Inquire, Mirror, Secure), that is designed to help HCPs facilitate a productive conversation with patients/caregivers about vaccination.

The essay begins by reviewing relevant research, including on strategies such as motivational interviewing (MI), use of empathy, and "Ask, Acknowledge, Advise". Overall, there has been a shift from a "tell and sell", message-focused communication strategy to a more relationally aware approach to vaccine hesitancy. The evidence is clear: Simply giving hesitant patients/caregivers "the facts" to persuade them to vaccinate is inadequate.

In contrast, AIMS is a systemic way of thinking about the complexity of the vaccination decision process for the patient/caregiver. Within that frame, it intentionally focuses on trust-building to create a relationship that increases the possibility of a positive vaccination decision - preferably during the visit, but if not, sometime in the future. AIMS offers a user-friendly vaccination conversation algorithm based on a conceptual integration of multidisciplinary scientific theory and research linking social, mental, and biological processes. AIMS moves beyond the notion of simply "being empathic" in the interaction, to thinking about how particular conversational patterns, enacted verbally and nonverbally, between the HCP and the patient/caregiver can activate neurobiological processes in both parties that help shift the communication ecology to one of receptivity rather than reactivity.

Specifically, the AIMS process is directed by the HCP and can fit within the time constraints of the typical clinical visit. After greeting the patient/caregiver, the HCP should take a slow, deep breath to activate the calming parasympathetic nervous system - intentionally putting themselves into their most receptive mode. Next:

• They should then announce that it is time for vaccination in a friendly, non-paternalistic, matter-of-fact professional manner. Research supports such a presumptive approach because the majority will go ahead and vaccinate with that simple intervention. Once they are vaccinated, the HCP can complement them on making a good choice, recommend they encourage others to do so as well, and proceed with the rest of the exam.
• However, if the patient/caregiver pauses or expresses any concern or hesitation, the conversation should immediately turn to inquire. At this point, it is important that the HCP talk with the patient/caregiver rather than at them. Throughout the conversation, the HCP is encouraged to convey an attitude of curiosity and respect to even the most resistant patient/caregiver to create a relational frame that can best support a positive vaccination decision. The HCP should ask open-ended "how" and "what" questions that elicit their reasons for hesitancy. Such an inquiry contributes to a conversation that strengthens trust in the relationship - e.g., by engaging them, the HCP is signaling respect for the person, which fosters receptivity.
• Next, the HCP should mirror the response to demonstrate both to the patient/caregiver and to themselves that they fully understand the person from that person's own perspective.
• At this point, the HCP moves to secure trust by responding to concerns with information that fits the needs of the patient/caregiver and is presented in a way that is reflective of their perspective. If the person is still hesitant or refusing, then the HCP can say that, while in their professional opinion they disagree with the patient/caregiver, they both share a concern for the health of the patient/child. By moving to secure trust and mutual respect, the HCP enables a future conversation where the issues can be revisited in a potentially more productive manner. "Secure", then, is about the relationship, not about persuading the person regarding vaccination.

As outlined here, the approach can be used by different types of HCPs, thus increasing coverage, and training can take as little as 3 hours. Furthermore, AIMS can be adapted to context and culture. One study of AIMS worked with 1,200 participants from over 100 countries. The researchers found that, 3 months post training, 61% of HCPs reported increased empathy toward patients/caregivers, confidence while counseling, and increased vaccine acceptance. Ninety percent of participants who participated in a follow-up survey reported a change in their approach when dealing with caregivers, patients, and others as a result of training. More than two-thirds of survey respondents have held conversations with patients and/or caregivers related to vaccine hesitancy and advocated for key individuals or institutions to promote the value of vaccines.

In conclusion: "AIMS is a next generation algorithm that simplifies the application of a complex mix of science to focal conversations that research suggests are key to increasing vaccination among the hesitant and opening the door to future dialog with those who currently refuse. It represents a promising step forward in our collective effort to respond to this global health threat."