Over the past few months, AHCA/NCAL and other sources have shared consistent information about the importance and value of getting vaccinated this respiratory virus season.
Unfortunately, even with this information readily available, many facilities continue to face challenges when encouraging vaccination among staff and residents. Some individuals remain hesitant, others are outright resistant, and many are fatigued by the topic. For the 2024-2025 season, an estimated 28% of Americans have already received the updated COVID-19 vaccine, while 44% have received the flu vaccine. In long term care (LTC), COVID-19 vaccination rates among residents align with the general population at 28%, but staff vaccination rates lag at just 9%.
However, the evidence is clear. Vaccination against influenza (flu), COVID-19, and RSV reduces the likelihood of serious illness, hospitalization, or death. Due to age and underlying health conditions, LTC residents are at higher risk for these serious outcomes from respiratory viruses, making it even more important that they stay up to date with their vaccinations. LTC providers play an important role in encouraging their residents and staff to protect themselves against these respiratory viruses.
In this four-part series, we take a fresh approach by moving beyond presenting facts and focusing on strategies for meaningful conversations. Here is what we’ll cover:
- Part 1 – The Science of Behavior Change
- Part 2 – How to Engage in Vaccine Conversations
- Part 3 – Tackling Misinformation
- Part 4 – Following Up and Additional Resources
In this first part of the series, we introduce the Transtheoretical Model (TM) of Behavior Change, also known as the Stages of Change model. This framework helps us understand how individuals progress through different stages when changing behavior—such as deciding to get vaccinated. The model includes six stages:
- Precontemplation: Individuals in the precontemplation stage are not considering making a change and may not recognize or believe they need it.
- Contemplation: Individuals in the contemplation stage acknowledge the need for change but have not committed to taking action.
- Preparation: Individuals within the preparation stage plan to act soon and may start making small changes.
- Action: Individuals in the action stage actively modify their behavior and engage in new behavior, such as getting vaccinated.
- Maintenance: Individuals in the maintenance phase work to sustain the behavior and prevent relapses.
- Relapse: The relapse stage occurs if/when the individual reverts to previous behavior, such as avoiding vaccination.
Tailoring Conversations to the Stages of Change
Anticipate your staff and residents being at different stages of this model, meaning some may be ready to act, while others may fall into the precontemplation or contemplation stages. Tailoring your approach to each individual’s stage is critical to success. Many current strategies to improve vaccine uptake assume all individuals are in the preparation or action phase, but many more are in precontemplation or contemplation stages.
The table below explains how you might identify where an individual falls within the stages of change, along with practical approaches to use with individuals at each stage:
| Potential Behavior or Attitudes | |
| - Do not see the benefits of vaccination.
- Ignores vaccine-related messages.
- Believes the vaccine may be harmful.
| - Use gentle education and awareness strategies.
- Ask open-ended questions to explore concerns
- Share resources without pressure for immediate action.
- Ask permission to follow up.
- I'm curious—what do you think about the vaccine? Can you tell me more?
- [You may want to end thanking them for sharing their thoughts and depending on the conversation say something like]
- I came across some interesting articles about how vaccines help prevent serious illnesses.
- Have you heard about the benefits of the flu shot?
- [The goal of this initial conversation is not to change their mind or decision but to figure out their current thinking and see how you might move them into a contemplative phase.]
|
| - Aware of vaccines but hesitant.
- Concerned about side effects.
- Researches information and discusses with friends or family.
| - Encourage open dialogue, ask open-ended questions, and listen without judgment.
- Ask what concerns or values they associate with vaccinations. Look for areas that may allow you to talk about their specific concerns, ideas, or understanding.
- Encourage reflection on the benefits of vaccination. Use testimonials, facts about community immunity, and address specific fears or misconceptions.
- I understand you have some questions about vaccines. What specific concerns do you have? Let’s talk about the information you’ve found.
|
| - Planning to get vaccinated soon (e.g., making an appointment).
- Gathering information about the process (e.g. where to get vaccinated or what to expect).
| - Help with logistics by identifying a vaccination location and setting a date.
- Address any final concerns.
- That’s great you’re planning to get vaccinated! Would you like help finding a nearby clinic or setting up an appointment?
|
| - Actively getting vaccinated.
- Sharing their vaccination experience on social media to encourage others.
| - Provide easy access to vaccines and reminders.
- Offer positive reinforcement and celebrate their decisions.
- Thank you for getting your shot! How did it go? It’s awesome that you’re protecting yourself, your fellow staff and our residents.
|
| - Stays current with vaccinations.
- Advocates for vaccines in their community, promoting awareness and addressing concerns.
| - Follow up regularly and encourage advocacy.
- Recognize vaccine champions in the facility/community.
- Encourage them to help advocate for vaccination within the facility by serving as champions.
- Build trust through ongoing dialogue.
- You’ve been doing so well keeping up with your vaccines! Have you thought about scheduling the updated vaccines?
- You could also help spread the word about vaccinations in the facility community.
|
| - Stops staying up to date with vaccinations.
- Becomes skeptical after exposure to misinformation, but open to discussion.
| - Engage with empathy and explore their concerns, without judgment.
- Discuss what led to their doubts and relapses.
- It’s completely understandable to have doubts after hearing different opinions. Let’s talk about what you’re feeling and see if there’s new information we can look into together.
|
By tailoring messages and interventions to each individual’s stage, as well as to the individual’s understanding, feelings, and concerns, you can improve vaccine uptake and support staff and residents throughout their vaccination journey. Remember that each conversation is an opportunity to build trust and empower individuals to make informed health decisions.
Stay tuned for part two of the four-part series on having conversations about vaccines. Next, we explore How to Engage in Vaccine Conversations.