Increasing immunization confidence

The first time learners use Bodyswaps, an onboarding sequence familiarises them with the features of the app, takes them through an avatar selection and embodiment activity, and prepares them for the experience to come. 

In the onboarding, learners will: 

• Find out how this training is different from the rest
• Select their avatar
• Discover their virtual journal
• Learn how to navigate and use the tools and settings

Dr Hopkins welcomes the learner to their team at Mill View. She tells the learner how excited she is to have them at the clinic and to be able to show them around. The team at Mill View has been doing lots of work around boosting immunization confidence among patients and families, and are excited to spread the word.

Dr Hopkins talks a little about the importance of infection prevention, not only through immunization but also through basic infection prevention control practices, and asks the learner to look out for examples of this throughout the module.

Then, she asks the learner to answer a few questions to indicate their current levels of confidence in the key learning areas.

• Establishing a culture that promotes immunization confidence
• Opening the conversation with a strong recommendation
• Responding with empathy to concerns about immunization using motivational interviewing
• Tailoring your communication to different individuals and situations

These self-reflection questions will be repeated in the debrief at the end, to assess how the learner’s confidence levels have changed.

Note: If you wish to receive data about how the learner’s confidence levels have changed as a consequence of the training, it’s important that they complete this introduction and the debrief at the end. 

Distraught father Anton arrives at Mill View, worried that his young daughter Zara may have been exposed to measles after a visit to a friend’s house. As Anton’s story begins to unfold, the learner sees for themselves how each member of the Mill View team has an important role to play in increasing his immunization confidence.

First, learners watch as Anton talks to Christina at the front desk. Christina doesn’t overstep her role but reassures him that the doctor will do everything they can to keep Zara safe.

Then, the learner accompanies Medical Assistant Ella to the patient intake area, where she is about to take Zara’s vitals ahead of her appointment with the pediatrician. In this observation activity, learners witness a conversation between Ella and Anton, and must identify the efforts being made to increase Anton’s immunization confidence, either by Ella or by the wider Mill View team.

The eight efforts that are made include: Ella’s body language, posters in the waiting area, honest and open communication, an attitude of empathy and collaboration, bringing up immunization, taking the time to listen, soliciting and welcoming questions, and using trusted sources of information (in this case, the pediatrician).

In this diagnostic activity, Dr Hopkins and Ella share a few situations where they’ve needed to provide immunization recommendations. The learner then chooses what they would say in each case from a list of three multiple-choice options, which fit a common theme:

1. Recommendation in the presumptive format (desired)
2. Recommendation using the participatory format
3. Instruction

A gauge shows how well the learner is doing overall in real-time. At the end of the activity, Dr Hopkins and Ella give the learner some final summary feedback on how strong and effective their recommendations tended to be on a mostly As, Bs, Cs basis and explain why the presumptive format is the most effective format to use.

Dr Hopkins prepares learners for talking to parents and caregivers who are still hesitant even after receiving a strong immunization recommendation, by using five motivational interviewing techniques – open-ended questions, affirmations, reflections, asking permission before sharing, and autonomy support.

The learner then heads to the exam room where they come face-to-face with Anton and his daughter Zara to practice using the five skills in a scaffolded conversation.

In each exchange, the learner chooses what to say from three given options. Each option elicits a different response from Anton and a pop-up containing some additional information. An incorrect response provides feedback before trying again, so all learners will get to see the positive impact that each of these techniques can have when used effectively.

By the end of the conversation Anton’s confidence has increased enough that he agrees to vaccinating Zara today.

Now, it’s time for learners to put what they’ve learned into practice. 

Learners meet another family, chosen at random from a list of three. Each parent or caregiver has a different reason for feeling hesitant about immunization for their child.

• Diya – Concerned about the number of vaccines being offered to her 6-month-old daughter Fatima at the same visit.
• Katya – Concerned about the side effects of live vaccines for 12-month-old son Ando.
• Oliver – Doesn’t think the HPV vaccine is necessary for his 14-year-old daughter Natasha.

In each of these LLM-powered freeform conversations, learners must respond to the parent or caregiver’s immunization hesitancy in their own words as the scenario unfolds.

Each scenario is comprised of two stages: 

1. Immunization recommendation – the learner must provide an immunization recommendation using the presumptive format to proceed.
2. Motivational interviewing – the learner must help the parent or caregiver to explore their motivations, using each of the five techniques at least once to proceed.

This activity is designed to encourage learners to replay and try to achieve different outcomes. But just like in real life, not all the conversations will end in acceptance. A key learning point here is that even a refuser with no intention of changing their mind still deserves empathy.

After each conversation, the learner gets a short debrief with Dr Hopkins before being given the option of meeting another parent or continuing to the module debrief.

Dr Hopkins thanks the learner for taking the time to learn about increasing immunization confidence, and reinforces the key point that when the whole team works together to build confidence through strong immunization recommendations and effective motivational interviewing, immunization uptake increases.

Then, she shares the examples of different infection prevention control best practice that were present in the module (signage, masking, hand hygiene, and cleaning) and asks the learner if they spotted them all in the environments.

Finally, Dr Hopkins once again asks the learner to complete the same, short, likert-style self-reflection activity from the beginning of the module, to indicate whether their confidence levels have changed. 

Before the learner leaves the module, they are asked to complete a short survey about their experience. 

This survey is not compulsory, but the data helps us to assess the effectiveness of our product and identify any areas that need improvement. Clients also find it beneficial when assessing ROI. 

They are asked to mark whether they agree or disagree with the following statements, on a 10 point scale: 

• I would recommend this experience to others.
• The experience helped me identify elements of immunization communication that I could improve upon.
• I now have a better understanding of how to communicate with immunization-hesitant parents or caregivers.