Table 2.

PIVOT with MI intervention components

Intervention component	Description
Online video module	Introduces the PIVOT with MI communication strategy and its rationale.
One 60 min in-person interactive clinician training session	Includes (A) a brief didactic session on vaccine hesitancy, how the PIVOT with MI strategy addresses vaccine hesitancy, and practice data on vaccination coverage and vaccine hesitancy prevalence, (B) baseline assessments of clinician skills using the presumptive format and MI, and (C) modelling of elements of the PIVOT with MI intervention followed by clinician rehearsal through role-playing and coaching by the study team. An online version of this session is available when clinicians are unable to attend the in-person session.
Reference sheets	Provides brief and accessible summaries of the communication behaviours that comprise PIVOT with MI, along with example statements for key steps in the PIVOT with MI communication strategy.
Two 30–60 min in-person refresher trainings at 3–6 and 9–12 months after the start of the intervention	Includes a question and answer session regarding barriers to implementing the PIVOT with MI intervention followed by role-playing and coaching, with the 9–12 months of refresher training also including a review of videotaped encounters of intervention clinicians with VHPs to provide feedback for how to improve incorporation of PIVOT with MI into the vaccine discussion. Online versions of these sessions are available when clinicians are unable to attend the in-person sessions.
Practice study champion	Will routinely solicit feedback from intervention clinicians regarding the PIVOT with MI intervention and liaise with the study team at regular intervals to communicate and help address implementation issues.

MI, Motivational Interviewing; PIVOT with MI, Presumptively Initiating Vaccines and Optimizing Talk with Motivational Interviewing; VHP, vaccine-hesitant parent.