How do they affect vaccine selection?
Patients make the darnedest choices. They are often adamant that they receive one vaccine yet refusing another–in opposition to our medical recommendations.
Karen was in the office last week with her daughter who just turned 16. Madison eagerly awaited her driver’s permit and selected the Meningitis B vaccine. Once again they declined the HPV vaccine. Sigh.
Now I’m not saying that you shouldn’t give Meningitis B vaccine. I’m saying that data clearly show that HPV protection is more likely to save Madison’s life.
But patients don’t often see vaccine decisions that way. It has to do with hidden factors which influence their choices.
People’s ability to understand the factors that affect their behavior is surprisingly poor—Robert Cialdini, PhD
Dr. Cialdini an eminent psychologist and author has studied why me make the decisions we do. He has published widely in the both the academic and lay press. His book Influence summarizes the 6 drivers that affect our decisions:
- Commitment & Consistency
- Social Proof
How does influence and persuasion apply to vaccine selection?
It may seem a bit odd to think about persuasion, marketing and vaccine decisions together. However, Dr. Cialdini’s insights clarify a lot of the behavior we see everyday in the office.
Let me summarize his findings and how they apply to vaccine decision making:
Exchanges of even the smallest gift generates feelings of obligation. It is only fair to return the favor. This is present in every culture studied and the most powerful influencer in the group.
This can be a problem for us if we appear to be under the influence of vaccine companies. We must avoid even the appearance of impropriety.
That is why we do not accept gifts and favors from vaccine companies. Our patients want us to be advocating for their health and not obligated to the companies that make the vaccine. This underscores why transparency is so important.
Commitment and consistency:
Once we have made a decision internal forces shape our thinking to remain true to the original choice. We feel compelled to revert back to the original decision. Even in the face of opposing information.
If patients have decided not to vaccinate they hold fast to that decision. Even when presented with contradictory scientific data.
Likewise, if they have chosen to begin a series of vaccines, a simple recall/reminder that the next dose is due helps them to stay on track. It helps them stay consistent with their choice to vaccinate.
We like to appear poised and influential amongst others so we look to others for their behavior and reactions.
If others in our patient’s social groups have decided to vaccine, they will vaccinate. If however, friends and families advise against vaccination they will decline.
You, however, can share that you chose the vaccine for your child, or that patients similar to them made a choice to get protected. Our personal experiences can also act as social proof that it is a good decision to vaccinate.
I’ll admit at first I felt shy about sharing my family with my patients, I wanted to protect their privacy since I live in a close community.
My family assured me they didn’t mind my sharing some insights into our family life, as long as I didn’t ‘over-share’. And patients found it helpful to hear about our experiences.
We want to be associated with good news, beautiful people and famous people.
Celebrities have derailed the conversation around the science of vaccines. They are seen as knowledgeable due to their inherit status in society, not due their level of scientific understanding.
This is a toughie for me since I’ll never be famous or one of the beautiful people. But I can share the good news of vaccine efficacy. By aligning our patient’s choices with the good news of a lifelong of good health, we help them feel confident in their choice to vaccinate.
We assume that those in authority have good reasons for their recommendations.
This is often bestowed on us by our patients. They assume we have researched all the options and are recommending treatments to keep them safe. It is incumbent on us to look, to analyze, and to interpret scientific research so that we can provide the best advice to our patients.
We hate to loose opportunities more than we like to gain opportunities.
This is often the influencer that causes us to make a decision today. The familiar expiration date on coupons- you must purchase by a certain date or lose the discount is scarcity in action.
This has been hard to use when discussing vaccines as we have worked hard to make them easily available to our patients. People are not as concerned about preventing a problem as they are about missing out on treatments, particularly if vaccines are available everywhere all the time.
Now the new HPV recommendations do apply to this influencer. When you discuss HPV vaccination most patients won’t want to miss the 2-dose schedule that is only available before age 15. It’s really a ‘limited time offer’.
Karen was refusing HPV vaccine because her friends on facebook discouraged vaccination. This is especially hard to overcome, since the influence of friends is often seen as equal to the influence of authorities. After some discussion, based on the facts, but framed by authority, liking, and social proof she chose to start the vaccine series for her daughter.
“I understand your concerns, and those of your friends. The experts at the CDC are clear that HPV vaccine is a safe and vaccine, one designed to protect Madison. The good news is that by choosing HPV vaccination you can give her a lifetime of protection against a preventable cancer. I had to think carefully when my own children were old enough for the vaccine, I chose it because I wanted my children to be protected.”
Dr. Cialdini’s explanation of why we make the decisions we do has helped me understand my patients better. Powerful unseen forces are shaping their decisions everyday. As medical providers we can change our messaging to align with Commitment & Consistency, Liking, Social Proof, Authority, and Scarcity. We must appreciate that our patients experience these forces everyday, and empathize with how hard it is to make decisions with little understanding and powerful, often contradictory advice.
I have changed they way I talk about vaccines in the office to bring clarity to the discussion. Of course not every patient agrees with my recommendation, but at least I understand a bit more about why we disagree.