Intended for healthcare professionals

Rapid response to:

Practice Practice Pointer

Covid-19 vaccination hesitancy

BMJ 2021; 373 doi: (Published 20 May 2021) Cite this as: BMJ 2021;373:n1138

Read our latest coverage of the coronavirus pandemic

Rapid Response:

Re: Covid-19 vaccination hesitancy

Dear Editor

I am very happy to respond to John Stone and Noel Thomas to clarify what motivational interviewing is, and how it can be entirely compatible with supporting patients to make informed decisions that feel right for them.

Simply trying to persuade or browbeat people into changing their behaviour to improve their health (for example to lose weight, do more exercise, or stop smoking), however well intentioned, feels uncomfortably doctor - rather than patient - centred and often doesn’t work very well. In the vaccine hesitancy field for example, confronting people with facts designed to correct misunderstandings has not met with much success, and might even backfire (Nyhan et al 2014). There are a few limited interventions that do seem to make a difference (Briss et al, 2000).

The great strength of motivational interviewing is that it does not seek to persuade or coerce patients into having the vaccine. It offers a different approach, where the practitioner comes “alongside” the patient, tries to understand their views, and offers rather than imposes information that might help them weigh up the risks and benefits for themselves, and make a decision that makes sense to them. It is absolutely not a technique for making people do what they might not otherwise want to do. Rather, the patient is encouraged to examine the pros and cons of change and to make an informed decision that they think could lead to improvement in their health and wellbeing.

Motivational interviewing has been the subject of over 1600 randomised controlled trials (Stephen Rollnick, personal communication). Recently this has been explored in the vaccine hesitancy field (Gagneur, 2020) and one recent study in a paediatric setting found an increase in vaccine uptake as a result (Gagneur, 2018).

Nyhan et al, 2014:

Briss et al, 2000: Briss PA, Rodewald LE, Hinman AR, Shefer AM, Strikas RA, Bernier RR, et al. Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. The Task Force on Community Preventive Services. Am J Prev Med. 2000;18:97–140.

Gagneur 2020: Gagneur A. Motivational interviewing: A powerful tool to address vaccine hesitancy. Can Commun Dis Rep 2020;46(4):93–7.

Gagneur et al 2018: Gagneur A, Lemaître T, Gosselin V, Farrands A, Carrier N, Petit G, Valiquette L, De Wals P. A postpartum vaccination promotion intervention using motivational interviewing techniques improves short-term vaccine coverage: PromoVac study. BMC Public Health 2018 Jun;18(1):811. DOI PubMed

Competing interests: No competing interests

12 June 2021
Graham Easton
GP and Professor of Clinical Communication Skills
Barts and the London School of Medicine and Dentistry, Queen Mary, University of London
Robin Brook Education Centre, West Smithfield London EC1A 7BE