Interpersonal Communication

for Immunization
Training of Trainers on IPC for Front Line Health Workers
Session 1
Welcome and Introductions
 Topics to be covered in this session
Objective: Understand the role and importance of IPC as well as the determinants of vaccine hesitancy
1. Icebreaker
a. Introductions
b. Housekeeping
2. Framing workshop Content
3. Vaccine hesitancy in Eastern Europe and Central Asia
.
4. Knowing your audience
a. Provider perceptions
b. Caregiver/vaccine recipient knowledge, attitudes and practices
c. Continuum of vaccine hesitancy
5. Understanding provider bias
a. Provider bias
b. Cultural attributes
 Topics to be covered in this session
1. Icebreaker
a. Introductions
b. Housekeeping
2. Framing workshop Content
3. Vaccine hesitancy in Eastern Europe and Central Asia
4. Knowing your audience
a. Provider perceptions
b. Caregiver/vaccine recipient knowledge, attitudes and practices
c. Continuum of vaccine hesitancy
5. Understanding provider bias
a. Provider bias
b. Cultural attributes
Videos On!

Videos On!
Workshop Participant Introductions
Please turn on your camera and introduce yourself to your colleagues by
telling us:
• Your name
• The country where you work
• If you could have any superpower, what would it be?

SUPERHERO SUPERHERO SUPERHERO

Housekeeping
 Topics to be covered in this session
Objective: Understand the role and importance of IPC as well as the determinants of vaccine hesitancy
1. Icebreaker
a. Introductions
b. Housekeeping
2. Framing workshop Content
3. Vaccine hesitancy in Eastern Europe and Central Asia
.
4. Knowing your audience
a. Provider perceptions
b. Caregiver/vaccine recipient knowledge, attitudes and practices
c. Continuum of vaccine hesitancy
5. Understanding provider bias
a. Provider bias
b. Cultural attributes
 Vaccine Hesitancy in
Eastern Europe and Central
Asia
 Sergiu Tomsa – Regional Behaviour and Social Change
Specialist, UNICEF Regional Office for Europe and
Central Asia
Sergiu Tomsa is the Behaviour and Social Change Specialist with UNICEF
Regional Office in Europe and Central Asia, providing technical advice,
guidance and support to 22 UNICEF country offices in designing and
conducting research and developing and implementing behaviour and
social change strategies in the areas of immunization, early childhood
development, inclusion of children with disabilities and Roma children,
prevention of violence against children, parenting and other.
In his 13 years with UNICEF, Sergiu has also worked with UNICEF Office
in Kosovo (UNSCR 1244) and UNICEF in Moldova. Prior to joining
UNICEF, Sergiu has worked with the Organization for Security and
Cooperation in Europe (OSCE) on human rights and anti-trafficking, and
with a child’s rights non-government organizations in Moldova. Sergiu is
a national of the Republic of Moldova. His background is in Political
Sciences and Law and Social Psychology.
 Topics to be covered in this session
Objective: Understand the role and importance of IPC as well as the determinants of vaccine hesitancy
1. Icebreaker
a. Introductions
b. Housekeeping
2. Framing workshop Content
3. Vaccine hesitancy in Eastern Europe and Central Asia
.
4. Knowing your audience
a. Provider perceptions
b. Caregiver/vaccine recipient knowledge, attitudes and practices
c. Continuum of vaccine hesitancy
5. Understanding provider bias
a. Provider bias
b. Cultural attributes
Understanding Hesitancy

Convenience

Confidence Complacency
Understanding Hesitancy

Convenience Vaccine Deniers Safety Concerns Politics

Low risk of illness/ Cultural and socio-

Free-riding
infections economic disparities
 The COVID-19
vaccine can
affect
women’s
fertility.
The COVID-19 If I’ve already
vaccine enters had COVID-
your cells and 19, I don’t
changes your need a
DNA. vaccine.

The side
Myths Researchers rushed
the development of
effects of the the COVID-19
COVID-19 vaccine, so its
effectiveness and
vaccine are safety cannot be
dangerous. trusted.

Getting the Getting the COVID-

COVID-19 19 vaccine means I
can stop wearing my
vaccine gives mask and taking
you COVID- coronavirus
19. precautions.
Common concerns around vaccinations and looking at trends

Past Trends
Future Trends

Current Trends
 Reflecting on the history of childhood
vaccination in my country: Discussion
• Comparing the past and the present, are things better or worse
in the present?
• Comparing the present and the future, are things better or
worse in the present than they will be in the future?
 Future of COVID 19 vaccination in my
country: Discussion
• In your opinion what proportion of the adult population in your
country will be “hesitant” to get the COVID 19 vaccination?
 Topics to be covered in this session
Objective: Describe barriers, facilitators, motivators, and bottlenecks, and identify where caregivers/vaccine
recipients are on the continuum of vaccine hesitancy and move them towards acceptance
1. Icebreaker
a. Introductions
b. Housekeeping
.
2. Framing workshop Content
3. Vaccine hesitancy in Eastern Europe and Central Asia
4. Knowing your audience
a. Provider perceptions
b. Caregiver/vaccine recipient knowledge, attitudes and practices
c. Continuum of vaccine hesitancy
5. Understanding provider bias
a. Provider bias
b. Cultural attributes
Provider Perceptions
Video Reflection
• How does the information in this video apply to vaccinations
(childhood and COVID19)?
• How can you use the information in this video as a training tool for
frontline health care workers in your context?
• What does this video tell us about understanding your audience?
Activity: Perception Counts
Lunch Orders
 What will
this
person order
for lunch?
 Reflecting on perception: Discussion
• Let’s see what you thought about his lunch order.
 What will
this person
order for
lunch?
 Reflecting on perception: Discussion
• Let’s see what you thought about her lunch order.
 What will this
person order for
lunch?
 Reflecting on perception: Discussion
• Let’s see what you thought about his lunch order.
 What will he
order for lunch?
 Reflecting on perception: Discussion
• Let’s see what you thought about his lunch order.
 Reflecting on perception: Discussion
• What cues did you use to understand what these individuals would order
for lunch?
• How do frontline health care providers typically make decisions about
caregivers and vaccine recipients who are acceptors, hesitating/delaying,
or refusing vaccination?
 Caregiver/Vaccine
recipient knowledge,
attitudes and practices
Activity: Caregiver Knowledge, Attitudes and Practices
Caregiver and provider barriers and facilitators
I would like my child to get vaccinated…
I would like to get the COVID 19 vaccination…

Yes, And… Yes, But…

(Facilitators) (Barriers)
Expectations vs Reality: Empathy Mapping

Know: what the “typical health

Feel: what is the “typical health
provider” knows throughout the
providers” emotional state
experience

Expectations of a
typical frontline health
care worker

Say: what the “typical health provider” Do: what actions the “typical health
says out loud during IPC provider” takes
Continuum of Vaccine
Hesitancy
Diagnosing Caregiver/Vaccine Recipient Needs
Remember the steps in a caregiver’s/vaccine recipient’s vaccination journey are:

Deciding (or not) to

Getting answers to Navigating their
Learning about get their
their basic way through their
vaccines child/themself
questions healthcare system
vaccinated at all

Accepting, delaying
Getting their
Consulting with or refusing to get Dealing with side
concerns and fears
their providers their child/themself effects
dealt with
immunized

Returning for next Following up with

doses schedules, etc.
 Vaccine Hesitancy Continuum

Hesitancy

Accept Accept Some, Refuse

Refuse
Accept All But Delay, and But
All
Unsure Refuse Some Unsure
Vaccine Hesitancy
Continuum as a
Stoplight
 Vaccine Hesitancy Continuum

Hesitancy

Accept Accept Some, Refuse

Refuse
Accept All But Delay, and But
All
Unsure Refuse Some Unsure
 Vaccine Hesitancy Continuum

Hesitancy

Accept Accept Some, Refuse

Refuse
Accept All But Delay, and But
All
Unsure Refuse Some Unsure
Breakout room: Provider reactions to caregivers/vaccine recipients on the Continuum of Vaccine Hesitancy
 It is time reflect on how typical frontline health workers respond
to clients based on where they are on the continuum.
Provider
responses on 1. What does a typical provider say to caregivers/vaccine
recipients at the middle of the vaccine hesitancy continuum?
Continuum of 2. What does a typical provider do to caregivers/vaccine
recipients at the middle of the vaccine hesitancy continuum?
Vaccine
Hesitancy
 Plenary

Now it is time to discuss your

responses:
1. How can frontline health workers
utilize the vaccine hesitancy
continuum in practice?
Energizer
 Topics to be covered in this session
Objective: Understand provider bias and recognize bias as healthcare workers.
1. Icebreaker
a. Introductions
b. Housekeeping .
2. Framing workshop Content
3. Vaccine hesitancy in Eastern Europe and Central Asia
4. Knowing your audience
a. Provider perceptions
b. Caregiver/vaccine recipient knowledge, attitudes and practices
c. Continuum of vaccine hesitancy
5. Understanding provider bias
a. Provider bias
b. Cultural attributes
Overview of Provider Bias
Bias
Knowledge alone does not change behaviour. People make
choices based on internal and external factors.

The way we present information, help caregivers/vaccine

recipients understand that information, and the way we
convey this information can influence how
caregivers/vaccine recipients weigh the perceived threat and
perceived barriers and benefits.

Humans make decisions based on facts, emotions and

perceptions. We are almost inevitably influenced by various
cognitive biases. Our communication needs to use emotions
as well as facts, to generate the momentum needed to move
people into action and change behaviours.
Bias
Explicit Bias
•An explicit (or conscious) bias is when
the person is very clear about their
feelings and attitudes, and related
behaviours are conducted with intent.
•Explicit bias is processed
neurologically at a conscious level as a
memory and in words.
Implicit Bias
• An implicit (or unconscious) bias is
an attitude or stereotype we hold
without being fully aware of it.
• Implicit bias operates outside of the
person’s awareness and can be in
direct contradiction to a person’s
espoused beliefs and values.
• Implicit bias can interfere with
clinical assessment, decision-making,
and provider-patient relationships.
Video Reflection
• What does this video tell us about blind spots?
• How can the information in this video be used to help
frontline health care workers understand their blind-spots?
Riddle

I see what you see, feel what you feel, and hear
what you hear. I know all of your moves before you
make them. I even know the moves you didn’t make.
What am I?
 Cognitive Bias Index
What should we remember? Too much information.
• We discard specifics to form • We notice when something has
generalities. changed.
• We edit and reinforce some • We notice things already primed in
memories after the fact. memory or repeated often.

Need to act fast.

• To stay focused, we favor the
immediate, relatable thing in
Not enough meaning.
front of us. • We think we know what
• To act, we must be confident other people are thinking.
we can make an impact and • We project our current
feel what we do is important. mindset and assumptions
onto the past and future.
Do you see what I see?
Cultural Attributes
Breakout room: Cultural attributes to determine “hierarchy of privilege”
 Activity: Cultural
attributes to determine
“hierarchy of privilege”
Typical Health Provider Typical Hesitant
*Caregiver*
Race
Ethnicity
Skin Color
Hair color
Gender
Sexual Orientation
Education Health Provider
Marital Status
Age
Physical ability
Medical Status
Religion
Economic status Caregiver
Profession
Employment
Nationality
Geographic Location
Military Background
Language
Plenary

Now it is time to discuss your

responses:
1. What were some cultural attributes you
noted for ‘typical hesitant caregiver or
typical vaccine hesitant recipient’?
2. What were some cultural attributes you
noted for ‘typical field level health
workers‘’?
Overview of Session 2

IPC Techniques
• Open-ended Questions
• Elevator Phrases
• Door Handle Phrases
• Expressing Empathy
• Nonverbal Communication
• Reflective Listening
Key Takeaways from
Session 1
Sanjin Musa is a medical doctor and epidemiologist,
currently working as Head of the Department of
Epidemiology in the Institute for Public Health of the
Federation of Bosnia and Herzegovina and as Associate
Professor of Epidemiology in the Sarajevo Medical School of
the Sarajevo School of Science and Technology University.
Since 2013 he has been working as immunization program
manager in the Federation of Bosnia and Herzegovina.

Dr Musa participated in numerous research and health

projects related to HIV, tuberculosis, immunization and
vaccine preventable diseases. Also, he coordinated a
Tailoring Immunization Programmes (TIP) project in the
Federation of Bosnia and Herzegovina with the aim of
identifying the factors related to sub-optimal vaccination
uptake in order to inform a long-term strategy to increase
vaccination uptake, supported by the World Health
Organization. He is a trainer in Interpersonal
Communication on Immunization with experience in
implementing trainings in Bosnia and Herzegovina,
supported by UNICEF BiH.