About the Guide

What is the VH Guide?

The Guide presents advice, scripts, and resources to help navigate conversations about COVID-19 vaccines with hesitant patients. These have been developed with clinicians from across Canada. In the Guide you'll find:
  • Clinician-to-clinician adviceon how to counsel patients about their ‘types’
    ‘Type’
    In this guide, a ‘type’ is a way of grouping together concerns about vaccines or vaccination that share a common psycho-social origin.
    . Below you’ll find examples of dialogue from other clinicians who have addressed this type of hesitancy.
  • Examples of approaches that work for undifferentiated vaccine hesitancy; and
  • Aflowsheetfor identifying, differentiating, and addressing common ‘types’
    ‘Type’
    In this guide, a ‘type’ is a way of grouping together concerns about vaccines or vaccination that share a common psycho-social origin.
     of vaccine hesitancy
Inside the Guide you will find practical scripts and resources gathered from fellow clinicians that are adapted to each ‘type’ of vaccine hesitancy.
The advice, general principles, and scripts in the guide are grounded in the techniques ofMotivational Interviewing . Motivational Interviewing encourages both the clinician and the patient toidentify positive motivations for vaccination.This happens in the course of open, affirming, conversations about options rather than closed, judgmental, pronouncements of expertise.

How do I use the VH Guide?

The Guide can be used either during an appointment with a vaccine hesitant patient, or outside of patient contact hours. As the Guide includes potentially sensitive scripts, you will want to familiarize yourself with its content and organization prior to using it synchronously with patients.
The Guide is built around examples of typical presentations of vaccine hesitancy. These ‘types’
‘Type’
In this guide, a ‘type’ is a way of grouping together concerns about vaccines or vaccination that share a common psycho-social origin.
 of vaccine hesitancy can be browsed through an interactive flowsheet. The types may also incorporate further sub-types, each of which describes a more specific presentation of vaccine hesitancy. Once you have worked through the menus and identified the ‘type’ that most closely resembles your patient's hesitancy, you will have access to three tabs of information:
  • An ‘Overview’ tab which includes common phrases or concerns related to this type of hesitancy, as well as some options to consider during consultations;
  • An ‘Advice’ tab which provides successful scripts as used by fellow clinicians; and
  • A ‘Resources’ tab which provides links to external sources of relevant information.
The advice, scripts, and resources in the Guide are being updated in response to developments in the COVID-19 pandemic, vaccine rollout, and user feedback. If you have any comments or suggestions,

The EAASE Steps Explained

Using the principles ofMotivational Interviewing , our team developed the ‘EAASE’ steps to help guide conversations with vaccine hesitant patients: Engage, Affirm, Ask then Share, and Evoke. We call them steps, but you don't need to follow them as a sequence. You can begin and end on any step.
The EAASE approach improves conversations by focusing on the trust relationship between you and your patient. Rather than focusing on getting your patient to say ‘yes’ to vaccination, the first aim of an EAASE conversation is to build an alliance and set a foundation for vaccine confidence.

  • Engage with open questions:Actively start the conversation about vaccination with your patients. Asking open questions can help demonstrate your interest, and create a safe space for them to share real concerns.
  • Affirm and reflectively listen:Affirm your patient’s worldview, and situate yourself as an ally. You can do this by:
    • Emphasizing your patient's autonomy — they will be a good person regardless of the decision they make.
    • Offering to work together, as equals, to understand available vaccine information.
    • Emphasizing the importance of individual decisions for protection of the broader community.
    • Ensuring they feel heard. A patient who feels misheard and mis-interpreted is unlikely to trust you. Reflective listening is important in overcoming gaps in our understandings of others.
  • Ask for permission, then Share information:Check that you understand where your patient is coming from, then ask permission to share your knowledge and perspectives. This places the two of you on the same team, with a shared goal of protecting them and/or their community.
  • Evokeand evaluate options:
    • Encourage patients to imagine different outcomes or scenarios based on their choice to either vaccinate or remain unvaccinated.
    • Explore desired positive futures, rather than unwanted negative outcomes.
    • Examine vaccination options together to achieve, or avoid, these imagined scenarios.
Across the rest of the Guide we use the EAASE steps to organize advice for each type of hesitancy.
Screenshot of Undifferentiated Hesitancy overview page

For tips from fellow clinicians on how to conduct these conversations, head over to theClinical Pearlspage.

Ironically, EAASE conversations can often be difficult to have. Remember: the goal is to support your patient's decision-making, rather than convincing them to get a vaccine.
Terms & Notices
 2022 Vaccine
 Hesitancy Guide