1 Participant manual Interpersonal Communication for Immunization Training for Front Line Workers UNICEF Europe and Central Asia Region 2 Interpersonal Communication for Immunization. Participant manual Participant manual Interpersonal Communication for Immunization Training for Front Line Workers UNICEF Europe and Central Asia Region 4 Interpersonal Communication for Immunization. Participant manual Acknowledgements This training package was developed by the Johns Hopkins Center for Communication Programs, the UNICEF Europe and Central Asia Regional Office, and UNICEF Country Office staff in Bosnia and Herzegovina and Serbia. We would like to thank Sergiu Tomsa, UNICEF Regional Communication for Development Specialist, Mario Mosquera, UNICEF Regional Communication for Development Adviser and Svetlana Stefanet, UNICEF Regional Immunization Specialist, for their significant contributions to its conceptualization and development. We also thank Fatima Cengic, Health and Nutrition Specialist, UNICEF Bosnia and Herzegovina and Jelena Zajeganovic-Jakovljevic, Early Childhood Development Specialist, UNICEF Serbia, as well as Dragoslav Popovic, consultant, the representatives of Institutes of Public Health, academia, health workers, Roma community mediators and civil society organizations from both countries for their support and active engagement in pre-testing and finalizing the package. The materials are based on state-of-the-art resources from UNICEF, the World Health Organization (WHO), European and American Centers for Disease Control, academic journals and the immunization websites of a range of governments and foundations. Authors: Robert Karam, Johns Hopkins Center for Communication Programs Waverly Rennie, Consultant, Johns Hopkins Center for Communication Programs Stephanie Clayton, Johns Hopkins Center for Communication Programs Design: Benussi&theFish Cover Photo: © UNICEF/UN040868/Bicanski © United Nations Children’s Fund (UNICEF), 2019. Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO license (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). The opinions expressed in this guide are those of the authors and do not necessarily reflect the policies or views of UNICEF. 5 Table of Contents Introduction .................................................................................................................................... 12 Intended use and audience ................................................................................................... 13 Module 1. Introduction and overview .......................................................................................... 14 Session 1.1. Introductions and immunization challenges ................................................... 15 Session 1.2. Review of training objectives, agenda, and housekeeping ........................... 15 Session 1.3. Pre-test and distribution of Participant manuals ............................................ 16 Session 1.4. FLWs’ experiences with immunization ............................................................ 16 Session 1.5. Assignments for module summaries ................................................................17 Module 2. Immunization technical review ................................................................................... 19 Session 2.1. How vaccines work and health benefits ...........................................................19 Session 2.2. National coverage trends and vaccine schedule ............................................ 23 Session 2.3. Vaccine safety processes and protocols in Serbia ...........................................31 Session 2.4. Vaccine hesitancy .............................................................................................. 33 Module 3. Understanding behaviour and barriers ..................................................................... 38 Session 3.1. Understanding models of behaviour change ................................................. 38 Session 3.2. Perception biases .............................................................................................. 44 Session 3.3. Diagnosing your caregivers’ needs. Introduction ......................................... 50 Session 3.4. Mapping your caregivers on the Continuum of vaccine hesitancy .............. 53 Session 3.5. Common fears and beliefs about vaccines ..................................................... 56 Module 4. Active listening to understand your caregiver ........................................................... 62 Session 4.1. Dialogue creates understanding ...................................................................... 62 Session 4.2. Nonverbal communication. Giving it .............................................................. 63 Session 4.3. Nonverbal communication. Reading it ........................................................... 66 Session 4.4. Empathy ..............................................................................................................67 Session 4.5. Open-ended and other special questions ....................................................... 72 Session 4.6. Reflective listening .............................................................................................77 Session 4.7. Practice combining active listening techniques .............................................. 82 Module 5. Communication during immunization ....................................................................... 87 Session 5.1. Using the opt-out strategy .................................................................................87 Session 5.2. Algorithm for vaccination communication ...................................................... 90 Session 5.3. Assume they will vaccinate, but check ............................................................ 92 Session 5.4. If they are hesitant, give strong recommendation ......................................... 93 Session 5.5. Dealing with the very hesitant ..........................................................................97 Session 5.6. In the vaccination box. Decreasing pain ....................................................... 100 6 Interpersonal Communication for Immunization. Participant manual Session 5.7. In the vaccination box. Discussing side effects .............................................. 101 Session 5.8. Talking with refusers .........................................................................................106 Session 5.9. Final affirmation. The “door handle” phrase ..................................................112 Module 6. Communication in depth ............................................................................................114 Session 6.1. Establishing goals for acceptors and hesitaters ............................................115 Session 6.2. CASE approach .................................................................................................118 Session 6.3. Adverse Events Following Immunization ...................................................... 125 Session 6.4. Talking about contraindications and vaccine origin ...................................... 129 Session 6.5. Shortcuts for good communication ................................................................131 Session 6.6. Bringing it all together .................................................................................... 134 Module 7. IPC in communities ..................................................................................................... 138 Session 7.1. Using communication outside the health facility .......................................... 138 Session 7.2. Home visits ........................................................................................................141 Session 7.3. Working with groups with special concerns ................................................. 144 Session 7.4. Advocacy with community leaders ................................................................ 145 Session 7.5. Community groups .......................................................................................... 148 Session 7.6. Proactive rumour management ......................................................................151 Module 8. Review and next steps ............................................................................................... 155 Session 8.1. Review of content ........................................................................................... 155 Session 8.2. Reflecting and planning .................................................................................. 156 Session 8.3. Post-test and evaluation .................................................................................157 Session 8.4. Workshop evaluation ....................................................................................... 158 Session 8.5. Closing.............................................................................................................. 158 Elevator phrases ........................................................................................................................... 158 Annexes ..........................................................................................................................................161 Annex A: Misperceptions about contraindications .............................................................161 Annex B: Review of interpersonal communication for immunization