. 2020 Apr 2;46(4):93–97. doi: 10.14745/ccdr.v46i04a06

Table 3. Example of traditional approach and use of motivational interviewing in a dialogue about immunization.

Traditional approach based on education and counselling	Motivational interviewing approach
HCP: It’s important to immunize your child. If not, you’re putting him in danger. Do you know there are still cases of measles in Canada? This disease could be very dangerous. And what about meningitis? It could be fatal, you know? You should update your child’s vaccinations as he is already late according to the schedule. We could do that now if you want. Mother: I don’t see the urgency. And autism is worse than measles! There are more problems than solutions with this vaccine. Moreover, it’s completely unbelievable to give so many vaccines at the same time! HCP: Studies have demonstrated that there is no link between autism and the measles vaccine. The vaccine is safe, I assure you. You should be aware of the information that you could find on the Internet. Giving several vaccines at the same time is safe and is not associated with more pain. We should update his vaccines now. Mother: I’ve heard something else and not only on the Internet. I’ve read a lot, and vaccination is not mandatory, I can do what I want. HCP: Yes, you’re right, it’s not mandatory, but you’re putting him and other children who cannot receive vaccines in danger. The risks of diseases are much higher than the risks of vaccines. If I take this time to speak with you, it’s because it’s very important. Mother: It’s easy for you! Quick, quick! But what if he gets autism? I’m worried about the risk of the vaccines but you don’t seem to be worried about the health of my child. HCP: Of course I am! And I’m worried about the fact that he could get diseases that could be prevented by vaccines. Mother: I think we do not understand each other. Let’s talk about this another time.	HCP: What do you think about the advantages of vaccination? [Open-ended question] Mother: Well, I know that vaccines protect children against several diseases that we don’t see anymore. My child received all his first vaccines but I’m worried that the measles vaccine could cause autism. For other vaccines, I have fewer doubts but I’m still hesitating. HCP: As you said, vaccines have reduced diseases in such an important way that they are now much less frequent. It’s why you have vaccinated your child when he was a baby. If I understood you correctly, with the exception of measles vaccine, other vaccines seem safe to you. [Summary; Complex Reflection] Mother: Yes, I know it’s a good thing to prevent those infections. But about measles, I’m conflicted. You know, I’ve read a lot of books and articles. Lots of people are worried about the link between the measles vaccine and autism. HCP: So, you find that it’s important to protect your child against diseases when the vaccines are safe, but you’re worried about what you’ve heard regarding autism and measles vaccine. [Summary] I see that you’ve done a lot of research about the subject. [Affirmation] If you agree, I could give you some additional information for studies on autism and measles. [Elicit] Mother: Sure! I want to know exactly what happened. HCP: In fact, you’re right. One study had hypothesized a link between measles vaccine and autism, but this study was fake and the author lost his medical licence. More than 500 additional studies around the world have demonstrated that there is no link between the vaccine and autism. The frequency of autism is the same in vaccinated children as in nonvaccinated children. [Share] What do you think? [Elicit, last step of Elicit–Share–Elicit] Mother: Well, so I’m not crazy to be worried about that? HCP: Of course not, you’re totally right. [Affirmation] Mother: Thank you for taking the time to understand my concerns. I think it’s a bit clearer now.
Summary: The HCP adopted the role of the expert and used a directive intervention approach based on argumentation and righting reflex. This type of intervention led to an opposition.	Summary: MI allowed the mother, in a nonjudgmental way, to express her concerns and her ambivalence. Using an Elicit–Share–Elicit method allowed the HCP to give solicited information that could be accepted by the mother.

Traditional approach based on education and counselling

Motivational interviewing approach

HCP: It’s important to immunize your child. If not, you’re putting him in danger. Do you know there are still cases of measles in Canada? This disease could be very dangerous. And what about meningitis? It could be fatal, you know? You should update your child’s vaccinations as he is already late according to the schedule. We could do that now if you want.
Mother: I don’t see the urgency. And autism is worse than measles! There are more problems than solutions with this vaccine. Moreover, it’s completely unbelievable to give so many vaccines at the same time!
HCP: Studies have demonstrated that there is no link between autism and the measles vaccine. The vaccine is safe, I assure you. You should be aware of the information that you could find on the Internet. Giving several vaccines at the same time is safe and is not associated with more pain. We should update his vaccines now.
Mother: I’ve heard something else and not only on the Internet. I’ve read a lot, and vaccination is not mandatory, I can do what I want.
HCP: Yes, you’re right, it’s not mandatory, but you’re putting him and other children who cannot receive vaccines in danger. The risks of diseases are much higher than the risks of vaccines. If I take this time to speak with you, it’s because it’s very important.
Mother: It’s easy for you! Quick, quick! But what if he gets autism? I’m worried about the risk of the vaccines but you don’t seem to be worried about the health of my child.
HCP: Of course I am! And I’m worried about the fact that he could get diseases that could be prevented by vaccines.
Mother: I think we do not understand each other. Let’s talk about this another time.

HCP: What do you think about the advantages of vaccination? [Open-ended question]
Mother: Well, I know that vaccines protect children against several diseases that we don’t see anymore. My child received all his first vaccines but I’m worried that the measles vaccine could cause autism. For other vaccines, I have fewer doubts but I’m still hesitating.
HCP: As you said, vaccines have reduced diseases in such an important way that they are now much less frequent. It’s why you have vaccinated your child when he was a baby. If I understood you correctly, with the exception of measles vaccine, other vaccines seem safe to you. [Summary; Complex Reflection]
Mother: Yes, I know it’s a good thing to prevent those infections. But about measles, I’m conflicted. You know, I’ve read a lot of books and articles. Lots of people are worried about the link between the measles vaccine and autism.
HCP: So, you find that it’s important to protect your child against diseases when the vaccines are safe, but you’re worried about what you’ve heard regarding autism and measles vaccine. [Summary] I see that you’ve done a lot of research about the subject. [Affirmation] If you agree, I could give you some additional information for studies on autism and measles. [Elicit]
Mother: Sure! I want to know exactly what happened.
HCP: In fact, you’re right. One study had hypothesized a link between measles vaccine and autism, but this study was fake and the author lost his medical licence. More than 500 additional studies around the world have demonstrated that there is no link between the vaccine and autism. The frequency of autism is the same in vaccinated children as in nonvaccinated children. [Share] What do you think? [Elicit, last step of Elicit–Share–Elicit]
Mother: Well, so I’m not crazy to be worried about that?
HCP: Of course not, you’re totally right. [Affirmation]
Mother: Thank you for taking the time to understand my concerns. I think it’s a bit clearer now.

Summary:
The HCP adopted the role of the expert and used a directive intervention approach based on argumentation and righting reflex. This type of intervention led to an opposition.

Summary:
MI allowed the mother, in a nonjudgmental way, to express her concerns and her ambivalence. Using an Elicit–Share–Elicit method allowed the HCP to give solicited information that could be accepted by the mother.

Abbreviations: HCP, health care provider; MI, motivational interviewing