P2B233: Presumptive Approach and Motivational Interviewing Training to Address Pediatric Vaccine Hesitancy in Japan and the Philippines: Physician Perspectives on the Use of Evidence-based Communication Techniques in a Global Context

Background: The presumptive approach and motivational interviewing (MI) are evidence-based physician-patient communication techniques for addressing vaccine hesitancy. The presumptive approach presumes acceptance of vaccination in order to facilitate vaccine discussions; whereas MI employs empathy, open-ended questions, and patients’ intrinsic motivations to guide vaccine decision making. However, little is known about the application of these techniques in clinical settings outside of the United States. We aimed to implement and evaluate a simulation-based workshop with pediatricians in Japan and the Philippines to assess physician perspectives on the application of these communication techniques in a global context.

Methods: Trained physicians from the Japan and Philippines Pediatric Societies each facilitated one 8-hour vaccine hesitancy simulation workshop with vaccinators in their respective countries. Participants were (1) trained in presumptive approach and MI techniques and (2) practiced these skills by interacting with pre-recorded standardized patients. Workshop participants completed post-workshop evaluation surveys with quantitative and qualitative components measuring perceptions of these communication tools for addressing vaccine hesitancy.

Results: Forty-two physicians from Japan and 56 from the Philippines participated in the workshops. Thirty-two (76.2%) and 47 (83.9%) participants completed a post-workshop survey, respectively. All participants were physicians with an average of 17.5 and 16.6 years of practice experience. Only 9 (28.1%) participants from Japan and 28 (59.6%) from the Philippines reported familiarity with MI prior to participation. After completion of the workshop, 30 (93.8%) participants from Japan and 46 (97.9%) from the Philippines felt confident in their ability to use MI techniques. Novel skills identified by participants included using the presumptive approach and asking permission to share more vaccine information. When asked about barriers to using MI to address vaccine hesitancy, 8 participants (25.0%) from Japan and 10 (21.3%) from the Philippines reported needing more practice with MI; and 9 (28.1%) and 7 (14.9%) participants were concerned about clinical time constraints, respectively. One participant explicitly noted the workshop would help them establish and maintain trusting relationships with vaccine-hesitant families; another stated that MI techniques would allow them to demonstrate respect for caregivers’ autonomy in vaccine decision making. Participants agreed the workshop should be conducted in the local language rather than in English to be most effective. Some participants from both countries questioned the cultural relevance of motivational interviewing techniques.

Conclusion: Presumptive approach and MI are acceptable to physicians practicing in Japan and in the Philippines. Pediatric vaccinators are likely to benefit from longitudinal training to reinforce these techniques and improve confidence in applying them. Tailoring simulation cases to real-world scenarios and using local languages may improve outcomes. Further study is needed to measure and understand the cultural appropriateness of applying presumptive communication and MI techniques in global contexts and to assess the potential impact on vaccination rates.