Addressing concerns of vaccine-hesitant parents: Prefacing medical advice with a refutational two-sided message

Soliciting and addressing parents' concerns about childhood vaccination is a fundamental task of healthcare professionals (HCPs) talking to vaccine-hesitant parents. Prior research showed that parents' vaccination intent is a recurring topic at Dutch Well-Baby Clinics (WBCs), but vaccination questions or concerns are rarely discussed. To study how parental concerns are presented and addressed in naturally occurring conversation, we collected 11 vaccination consultations at an anthroposophical WBC. This clinic attracts vaccine-hesitant parents with various concerns about vaccination, despite the physician having an essentially pro-vaccination attitude. We begin our analysis by briefly outlining the nature of parents' concerns and find that those concerns are rarely addressed directly. Instead, the physician uses an advice-prefacing practice that can be likened to a refutational two-sided message, typically consisting of four components: (1) projection; (2) presentation of the vaccination proponent's position; (3) presentation of the vaccination opponent's position; and (4) refutation of the opponent's position. We discuss the important role of projection and show how parents may orient to a stand-alone refutation as doing persuasion. We conclude by arguing that the two-sided preface appears to be designed to present medical advice as being impartial and trustworthy.