Introduction
In the fight against infectious diseases, vaccination stands as one of our most potent defences. Yet, the challenge of vaccination hesitancy is a significant hurdle, hindering public health efforts. For healthcare directors and policymakers, the question is not just of disseminating information but of fostering genuine understanding and trust within their communities. This blog post proposes a novel approach to this challenge, utilising the Gibbs Reflective Cycle, a model for self-improvement through reflection, as a cornerstone in communication strategies aimed at enhancing healthcare literacy and countering vaccination hesitancy.
Understanding vaccination hesitancy
Vaccination hesitancy is a complex issue, rooted in a multitude of intersecting factors ranging from mistrust to misinformation to cultural beliefs to fear and to information overload. It is a spectrum of indecision that requires more than just information to overcome – it requires empathy, understanding, and the building of trust – all of which can’t be measured easily and are difficult to instill in vast swathes of the population across age groups, socio-economic groups and so forth.
The critical nature of addressing vaccination hesitancy cannot be overstated, particularly when considering diseases like measles, which can rapidly spread in unvaccinated populations, leading to severe health outcomes and even fatalities. Measles serves as a stark reminder of the fragility of public health achievements and the ease with which they can be undone by rising vaccine hesitancy. In a world where international travel can quickly transform localised outbreaks into global health emergencies, the stakes of failing to counteract vaccination hesitancy are exceptionally high. In addition, as we look to the future, the potential for new infectious disease outbreaks only underscores the urgency of this issue. Effective public health strategies must preemptively address hesitancy to ensure widespread immunity and prevent the resurgence of eradicated diseases or the emergence of new health crises. Addressing vaccination hesitancy is not just about addressing current diseases but about future threats.
The ascent of vaccine hesitancy can be attributed to a complex interplay of factors, significantly influenced by the changing landscape of communication and public sentiment and exarcebated by the COVID-19 pandemic. In an era dominated by digital platforms, the proliferation of silos of information has facilitated echo chambers, where misinformation and unfounded fears regarding vaccinations can spread unchecked – this factor is on the radar of almost all government institutions. These silos often challenge traditional health communication strategies, making it difficult for accurate, science-based verified information to affect these self-contained bubbles of belief. Additionally, there’s a noticeable erosion of trust in public figures and institutions, fueled by instances of mixed messages, perceived conflicts of interest, or historical missteps in public health management. This decline in trust can and has complicated efforts to communicate the importance and safety of vaccines effectively. As such, vaccine hesitancy is not merely a result of insufficient information but a symptom of broader societal shifts in how information is consumed, trusted, and acted upon. Addressing this issue requires a nuanced understanding of these dynamics and a concerted effort to rebuild trust and tailor communication strategies to bridge the informational divides.
The Gibbs Reflective Cycle
Developed by Graham Gibbs in 1988, the Gibbs Reflective Cycle is a model of reflection that encourages a systematic process of thinking about phases of an experience or activity. It consists of six stages:
- Description of the experience
- Feelings and thoughts about the experience
- Evaluation of the experience, both positive and negative
- Analysis to make sense of the situation
- Conclusion about what you learned and what you could have done differently
- Action Plan for how you would deal with similar situations in the future, or general changes you might find appropriate.
Applying Gibbs to vaccination communication
The adoption of the Gibbs Reflective Cycle in communication about vaccinations can serve as a transformative tool for healthcare directors. Here’s how:
- Description and feelings: Start by acknowledging the public’s concerns and fears openly. By reflecting on these emotions, healthcare providers can craft messages that are not only informative but also empathetic.
- Evaluation and analysis: Reflect on past communication efforts—what has worked, and what hasn’t? This stage encourages a critical look at the effectiveness of current strategies in addressing hesitancy.
- Conclusion and action plan: Derive lessons from the analysis and develop a revised communication strategy. This might involve more personalised communication, community engagement, leveraging local influencers, or employing more transparent and empathetic messaging.
A shift in paradigm
Incorporating the Gibbs Reflective Cycle into the strategy for communicating about vaccinations represents a paradigm shift. It moves the focus from a one-size-fits-all information diffusion model to a more nuanced, reflective, and empathetic approach. It acknowledges that overcoming vaccination hesitancy is not just about providing information but about building relationships, understanding, and trust.
For the public, messaging could be structured as follows and used by healthcare educators in the community or wider when speaking to groups:
- Description: What is your understanding of the vaccine? What have you heard or read about it?
- Feelings: How do you feel about the information and the decision to get vaccinated? Are these feelings based on facts or hearsay?
- Evaluation: What are the positives and negatives you see in getting vaccinated?
- Analysis: Why do you think you have these positives and negatives in mind? What might be influencing your perspective?
- Conclusion: What can you conclude from your reflections? Are there gaps in your knowledge that need filling?
- Action Plan: What will you do next? Will you seek more information, talk to a healthcare professional, or take time to think over your options?
Conclusion
As we continue to navigate the complexities of public health in the 21st century, the principles of reflection, understanding, and empathy must underpin our communication strategies. Adopting the Gibbs Reflective Cycle is one strategy that healthcare directors and policymakers can use to pioneer a shift in how vaccination hesitancy is addressed – a shift that could make all the difference in achieving our public health goals. By guiding individuals through a reflective process, community workers and others in healthcare could empower them to make a vaccination decision that is well-considered and aligned with their values and community responsibilities. This method fosters a deeper understanding of the personal and social implications of their health choices, which could ultimately lead to more thoughtful and confident decisions.
Reading
Gibbs, G. (1998) Learning by Doing: A Guide to Teaching and Learning Methods. Oxford Brooks University, Oxford.
Ruggeri, K. et al. (2024) Behavioural interventions to reduce vaccine hesitancy driven by misinformation on social media, BMJ (https://www.bmj.com/content/384/bmj-2023-076542)
UNICEF (2023) New data indicates declining confidence in childhood vaccines (https://www.unicef.org/cuba/en/press-releases/state-of-the-world-children-vaccination-2023)
World Health Organization (2023) Global measles threat continues to grow as another year passes with millions of children unvaccinated (https://www.who.int/news/item/16-11-2023-global-measles-threat-continues-to-grow-as-another-year-passes-with-millions-of-children-unvaccinated)
King Advisory 