Which Communicative Strategies Do Slovak Pediatricians Choose to Facilitate Parental Decision-Making about Childhood Vaccination?

IntroductionVaccination has long been considered one of the cornerstones of children's health (Brunson, 2013). However, immunization rates in Slovakia have been steadily declining over the past years for all mandatory childhood vaccines; in fact, for the MMR vaccine, they have declined below the critical level of 95% necessary for maintaining herd immunity. For pediatricians and epidemiologists, one of the recommended solutions has been to educate parents about the significance ofvaccination (IPH, 2015). The aim of this qualitative study is to identify how Slovak pediatricians make decisions regarding communicative strategies for parents about childhood vaccination, and which strategies they choose to use.One of the most common factors underlying delaying or refusing childhood vaccination are concerns about vaccine safety (Gust, Darling, Kennedy, & Schwartz, 2008; Smith, Chu, & Barker, 2004). Even parents who fully vaccinate their children report feeling worried about their possible side-effects and impact on the child's immune system (Kennedy, Basket, & Sheedy, 2011). For parents, making decisions about vac cination of their child can be a cognitively and emotionally demanding process (Casiday, 2005; Connolly & Reb, 2012). Often, they are susceptible to various cognitive shortcuts, such as overestimating the vaccine's adverse effects by relying on readily accessible information from vivid anecdotes, and not on more balanced statistical information. However, parents, even those who hesitate with vaccination because they consider vaccines unsafe, can be positively influenced by pediatricians (Smith, Kennedy, Wooten, Gust, & Pickering, 2006). Therefore, one way pediatricians could facilitate parental informed decision making would be learning to choose effective risk-communication strategies.Decision-making is a process of selecting or choosing among several alternatives, in order to ". maximize utility or expected utility" (Edwards, 1954). According to Hastie (2001, p.656), it has three main components: a) what action to take (what are one's options and alternatives); b) beliefs about objective states, processes, and events in the world (including what is the desired outcome and means to achieve it); and c) desires, values, or utilities describing the consequences, which are associated with the outcomes of each combination of actions and events. Based on this classification, the pediatricians' decision-making process about vaccine-related communication with parents may involve: a) considering their options regarding the possible outcome - e.g. whether to fully and timely vaccinate, or whether to space out, delay, or not administer vaccines to this particular patient at all. This decision involves assessing the patient's actual health, his/her genetic predispositions and environment, etc.; b)their beliefs about risks inherent in vaccinating vs. not vaccinating, with regard to achieving optimal health of the patient; and c) their desired consequence is achieving/maintaining a healthy child, as well as preventing VPDs and their spread among the population.With regard to the values mentioned in c), we presume that most pediatricians assume that vaccination is important and adhere to the recommendations of the main authority on public health, the Institute of Public Health (IPH, 2015); and, in line with that, they try to communicate that vaccination is important. However, "effective communication" does not mean coaxing or manipulating vaccine-hesitant parents into vaccinating their child. Rather, it means removing barriers to decision-making by helping them to make informed analysis based on available evidence, and not on insufficient or erroneous information, fear or misrepresented risks.All our respondents expressed a positive attitude to vaccination, and even in cases when they did not admit it openly, their implicit intention was to persuade parents to have their children immunized. …