David Kopald

Disagreement on Immunization Recommendations: An Analysis of Lay-Clinician Interaction:

Although the health benefits of vaccines have been well established, immunization rates among adults at risk for complications of viral and bacterial infections falls far short of federal recommendations. Various factors have been attributed to this problem. In this paper we consider an understudied factor, that of clinician-lay interactions on and disagreements over immunizations. We draw on data collected as part of a larger study of vaccine uptake among chronically ill adults. Qualitative methods were used to analyze transcripts of audio recordings of lay-clinician interactions made during health visits of patients eligible for influenza and or pneumococcal pneumonia vaccines. Our analysis revealed that lay expressions of discord over immunization recommendations centered on vaccine delivery, health beliefs, and personal experiences. Strategies used to quell disagreements included posing questions, providing information, and giving advice. Impediments to bringing about agreement over vaccines involved organizational policies and lack of clinician engagement with patient resistance. Settled disagreements resulted in immunization delivery; patients were not immunized under conditions of unresolved disagreement. We suggest that clinicians may wish to remain alert to sources of disagreement and seek to resolve discord in the service of increasing immunization rates and preventing illness in high-risk adults.