Table 1.

Table adapted from Poland CM, Poland GA. Vaccine education spectrum disorder: the importance of incorporating psychological and cognitive models into vaccine education. Vaccine. 2011 Aug 26;29[37]:6145–8 with permission from Vaccine.

Preferred Cognitive Styles Communication and Approaches
Cognitive style	Main effect	Verbal expression	Approach
Denialist	Disbelieves accepted scientific facts, despite overwhelming evidence. Prone to believe conspiracy theories	“I don’t care what the data show, I don’t believe the vaccine is safe”	Provide consistent messaging repeatedly over time from trustworthy sources, provide educational materials, solicit questions, avoid “hard sell” approach, use motivational interviewing approaches
Innumerate	Cannot understand or has difficulty manipulating numbers, probabilities, or risks	“One in a million risk sounds high, for sure I’ll be the 1 in a million that has a side effect, I’ll avoid the vaccine”	Provide nonmathematical information, analogies, or comparators using a more holistic “right brain” or emotive approach
Fear-based	Decision making based on fears	“I heard vaccines are harmful and I’m not going to get them”	Understand source of fear, provide consistent positive approach, show risks in comparison to other daily risks, demonstrate risks of not receiving vaccines, use social norming approaches
Heuristic	Often appeals to availability heuristic (what I can recall equates with how commonly it occurs	“I remember GBS happened in 1977 after flu vaccines, that must be common, and therefore I’m not getting a flu vaccine”	Point out inconsistencies and fallacy of heuristic thinking, provide educational materials, appeal to other heuristics
Bandwagoning	Primarily influenced by what others are doing or saying	“If others are refusing the vaccine there must be something to it. I’m going to skip getting the vaccine”	Understand primary influencers, point out logical inconsistencies, use social norming and self-efficacy approaches
Analytical	Left brain thinking, facts are paramount	“I want to see the data so I can make a decision”	Provide data requested, review analytically with patient