In March 2024 the University of Bristol shared that a study in Health Psychology identifies the importance of empathetic engagement with healthcare professionals in influencing attitudes towards vaccination. The paper demonstrates that a kinder style of communication can build and maintain relationships with health professionals to increase trust and public confidence. The “Empathetic Refutational Interview” (ERI) is a “novel, multicomponent intervention” that can address false or misleading arguments with empathy and understanding. The authors find that the ERI can be used to “refute antivaccination misconceptions” without losing “trust and rapport” with patients.
Navigating challenging conversations
The authors state that communication with trusted healthcare professionals (HCPs) can be “highly effective” at addressing concerns and encouraging patients and caregivers to accept vaccination. This is particularly important as people “increasingly consume information online”, allowing misinformation to spread quickly and widely. Although misinformation can be countered with factual information, this can “fail if it does not provide a sufficient level of detail”.
A way of increasing detail is to “engage with an individual’s motivations for believing the misinformation”. A “tailored approach”, therefore, will be better able to correct misconceptions than “mass communication of information”.
“The challenge for HCPs is to navigate the conversation in a way that is perceived by patients as supportive and compelling.”
ERI
The paper presents a combination of psychological research that incorporates communication skills regarded as best clinical practice. The authors propose a new technique called the Empathetic Refutational Interview (ERI). This is “designed to guide a conversation in situations where patients express concern about being vaccinated” through four steps:
- Elicit concerns – inviting the patient to share their thoughts enables the HCP to identify a patient’s “attitude roots”. Furthermore, asking for an explanation of a patient’s position can reduce overconfidence and lessen the extremity of their views.
- Affirm – expressing empathy for the patient’s position acknowledges any valid concerns without endorsing the misinformed argument(s), allowing the HCP to show they understand and care, building trust.
- Offer a tailored refutation – explaining why a misconception is wrong and replacing it with facts is more effective in reshaping beliefs than a simple statement of facts. Refutations should be tailored to the misconception, and the motivation. Language that includes features like acknowledgement, first-person pronouns, or modal conditionals might be effective.
- Provide factual information – facts are known to be effective at increasing vaccine acceptance in mass communication studies.
The study
The paper presents a series of four randomised experiments in 2022, involving 2,545 people. The participants were “predominantly negative or on the fence” about vaccination. The results indicate that observing the steps of the ERI produced “small effects” on increasing vaccine acceptance and lowering support for antivaccination arguments. However, an HCP who affirmed patients’ concerns generated “significantly more support” for their refutations and subsequent information. Furthermore, participants found tailored refutations “more compelling” and were more trusting and open with the HCP giving them.
“Our results provide reassurance that fulfilling the basic function of discussing patients’ concerns and motivations can be done without inadvertently causing more entrenched antivaccination attitudes.”
The authors observed, as hypothesised, that responses that included the “tailored, empathetic response” were “consistently better received”. Additionally, the final experiment, which was conducted with participants who indicated “nonpositive” attitudes towards the COVID-19 vaccines showed that incorporating either Step 2,3, or 4, could “increase vaccine acceptance and reduce antivaccination argument support relative to the control”.
The findings are interesting because, on one hand they suggest that “affirming people seems not to enhance belief revision” but on the other, “it does improve how the refutation is perceived”. Thus, patient trust and rapport can lead to “improved patient outcomes”. Although the ERI still needs to be evaluated in real healthcare contexts, the results are “promising”.
Tackling misinformation with empathy is “vital”
Lead author is Dr Dawn Holford, Senior Research Associate in Psychology, who was surprised by “how much greater the preference” for an empathetic style of communication really was.
“The study highlights how the way misinformation is tackled, especially with vaccine adverse groups, can play a vital role in changing perceptions which can be hard to shift.”
Dr Holford commented that the findings “actively demonstrate the power of communication”.
“Our study shows it is possible to gain trust and change minds if we take people’s concerns seriously and tailor our approach to help them make informed decisions about their health. This is hugely encouraging, especially with the growing influence of misinformation and fake news worldwide.”
Co-author Professor Stephan Lewandowsky, Chair in Cognitive Psychology at the University of Bristol, added that it’s important to “understand the motivations underlying people’s vaccine hesitancy” so that we can “correct misconceptions without confronting people’s deeply held attitudes head-on”.
“By affirming and empathising with those deeply held attitudes we create a space where people are sufficiently comfortable to process corrective information, so they can make a better-informed decision.”
Communication is a key concern across several sessions at the Congress in Washington this April, so do get your tickets here to join us as we explore this in greater detail and don’t forget to subscribe for more insights here.
