Evaluation Report for the Training Module "Communicating with Patients about COVID-19 Vaccination"

"After the training, I started to use open-ended questions....I also try to be more empathetic, to show that I understand what they are going through, to affirm their strengths and provide encouragement, even in [vaccine] refusers - something that I hadn't been doing before." - physician

The Vaccine-preventable Diseases and Immunization Programme (‎VPI)‎ of the World Health Organization (WHO) Regional Office for Europe developed a training module to provide health workers with the knowledge, skills, confidence, and resources necessary for responding to patients' concerns about COVID-19 vaccination. This report shares the details of an evaluation of the training module and its implementation in Greece.

The module, described and available at Related Summaries, below, provides a structured approach to starting a conversation about COVID-19 vaccination with patients and to recognising and responding appropriately to various positions (accepting, hesitating, or refusing). The training, which is delivered online takes approximately 180 minutes to complete, introduces health workers to motivational interviewing skills using scenarios and role-play. At the time of this report's publication, VPI had facilitated this training 32 times across 13 countries, including more recently via offline sessions. Additional countries had also facilitated the training on their own.

In total, 118 health workers recruited from all over Greece took part in the online training that is the subject of the present evaluation. Conducted jointly by VPI and the Behavioural and Cultural Insights (‎BCI)‎ Unit of the WHO Regional Office, the evaluation took place between May and September 2022 and drew on: pre- and post-training questionnaires, in-depth interviews, focus group discussions, and observations of how participants used the communication skills in simulated consultations. To assess potential broader or indirect outcomes of the training, the evaluation framework includes indicators required for assessing the impact of the intervention alone as well three additional factors: well-being, social cohesion, and trust.

In brief, the impact evaluation revealed that the training in Greece largely achieved its objectives. As quotations in the report demonstrate, health workers' self-reported confidence in their ability to use some of the communication skills was strengthened as a result of their participation. For example, the training provides a communication algorithm that describes patient positions on the continuum of vaccine acceptance, from acceptance to hesitancy to refusal, with corresponding conversation pathways to guide health workers through discussions with patients in each of the positions. The participants found this algorithm easy to follow, noting that it saved them time and energy, empowered them to make conversation decisions, and minimised the likelihood of ineffective responses. (Some participants had printed the communication algorithm or saved it on their smartphones to help them remember the techniques and familiarise themselves with these skills in clinical practice.) It was therefore highly appreciated by most participants and associated with an increase in self-reported confidence in communication.

Participants used some communication skills more frequently than others with unvaccinated patients, but they declared the intention to continue using the skills and strategies shared in the training, as they perceived them to be helpful in surmounting communication challenges with patients.

The highest level of confidence in all eight tasks the training sought to help health workers accomplish (e.g., establishing an ongoing dialogue with patients when they decide to delay or decline COVID-19 vaccination) was found immediately after the training. The decrease in confidence over time, though not falling to pre-training levels, indicates the possible need for additional follow-up training sessions. In fact, one month after the training, 64.5% of participants requested an additional follow-up session; three months after the training, 81% did so.

With regard to potential broader or indirect outcomes of the training, participants said that some aspects of well-being and social relations at work were strengthened when applying the new communication skills with patients - thereby reducing feelings of isolation or failure when facing communication challenges with unvaccinated patients, for example. More broadly, participants perceived the training's patient-centred approach as a way to increase social cohesion in society by bringing health workers and the public together. The evaluation also revealed that, while participants felt the training had contributed to building trust with patients, it did not contribute to any change in trust with any other groups, such as health authorities.

The evaluation suggests that the training could be improved through more interactivity, localisation, scenarios, and video examples; furthermore, in-person sessions could improve interaction and enable more role-play. It also shows that access to the training materials is critical, as it allows participants to continue improving their skills after the training and to share their new knowledge with colleagues.

In conclusion: "Training is often considered a critical element in supporting health workers and strengthening their capacities, but is rarely based on behavioural and cultural insights or evaluated using rigorous methods. Developing training modules informed by behavioural and cultural insights, such as the one described in this report, and evaluating them with a view to learn and improve continuously, are investments in the skills and well-being of health workers as well as in effective policy implementation."