Vaccination: Convincing Jane
In the case of Jane, she employs a primary style of "bandwagoning" (or social peer pressure), with her secondary cognitive style being a fear-based heuristic. How might the clinician proceed in this case? First, it is important to comment upon and endorse the fact that she is a caring parent who is trying to make the best decisions for the health of her child. Affirm the goal of making healthy decisions for her child. (eg, "Jane, it is obvious that this is an important decision for you and your daughter, and I know how much you care about her health and want to make a good decision.")
Second, explore and understand her preferred cognitive style and explore the influence that blogs and others' opinions have had on her decision-making (eg, "Jane, what type of information have you read so far? Where did the information come from? Was it from qualified medical professionals? What does the information you read mean to you?"). Lead her to discover that the blogs she reads (perhaps even pull one up on the computer during your discussion) are written by people with limited medical knowledge and credentials. Discuss the qualifications of these bloggers and perhaps widen the umbrella, asking if she would accept medical opinions as fact from other nonmedical people, such as celebrities, sports figures, or politicians. This allows the individual to start thinking through where her trusted information comes from in decision-making.
Third, it might be helpful to discuss the possible ramifications of her daughter not receiving the vaccine, using her fear-based secondary decision-making style. Discussing the medical risks of contracting a vaccine-preventable disease and helping her to imagine the emotions surrounding possible complications (eg, "By not giving your daughter the vaccine, if she gets measles here is what happens to her health [consider showing photos or videos]. Are these acceptable risks to you?") may be a good way to begin this conversation. Ask questions to understand the patient's fears and the sources of these fears.
Using social norming in this and other situations would also probably be helpful. Social norming examines appropriate rules and behaviors within a defined group of people, so in this case it might be helpful to give information about the decisions that other moms make when they give their children the MMR vaccine. For example, point out that physicians—like you—give this vaccine to their own children. Point out that fears about MMR vaccine and autism are unwarranted and that the study suggesting this connection has been debunked, with the primary author stripped of his medical license, and judged to be unethical.
A self-efficacy approach may also be helpful in this situation. Albert Bandura, a well-known psychologist, said the following about self-efficacy: "People need enough knowledge of potential dangers to warrant action, but they do not have to be scared out of their wits to act, any more than homeowners have to be terrified to purchase fire insurance for their households. What people need is knowledge about how to regulate their behavior and firm belief in their personal efficacy to turn concerns into effective preventive actions. Thus, a shift in emphasis is required, from trying to scare people into health to providing them with the tools needed to exercise personal control over their health habits."