Not taking “no” for an answer: the interactional organization of accepting and refusing childhood vaccination in the Netherlands

Communication-intervention strategies for reducing vaccine hesitancy have been primarily based on survey and interview data. Virtually absent is an understanding of how vaccine hesitancy is organized interactionally in its primary, natural environment of medical consultations between parents and healthcare providers. This article uses conversation analysis to describe the sequence organization of the action of providers soliciting parents’ vaccination intent. We demonstrate that parents’ acceptance is “preferred” and sequence-closure relevant and that refusal is “dispreferred” and sequence-expansion relevant. Regarding vaccine refusal, we describe three different sequence-expansive actions, including soliciting an account, cautioning about the consequences of vaccine refusal, and “keeping the door open” to future vaccination. Data are 62 videotaped interactions between providers and parents of newborns in the Netherlands. Findings have implications for the design of communication-intervention strategies involving understanding parents’ perspectives and providing them with information toward the goal of reducing their vaccine hesitancy.