Facilitator guide Interpersonal Communication for Immunization Training for Front Line Workers UNICEF Europe and Central Asia Region Facilitator guide Interpersonal Communication for Immunization Training for Front Line Workers UNICEF Europe and Central Asia Region 4 Interpersonal Communication for Immunization. Facilitator guide 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/UN0302002/Filippov © 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 Ta ble of Contents Introduction .................................................................................................................................... 13 Training package adaptation and use ........................................................................................... 15 Guiding principles and framework .............................................................................................15 Steps in the adaptation process ...............................................................................................17 Trainer’s notes ..................................................................................................................................21 The importance of interpersonal communication for immunization ..........................................21 About this resource: overview of training package ...................................................................22 Resources for carrying out training of trainers .......................................................................... 23 Training approach ...................................................................................................................... 23 Intended audience ................................................................................................................... 24 Training objectives ..................................................................................................................... 24 How to use the Facilitator guide: instructions for trainers ....................................................... 25 Using the slides ........................................................................................................................ 26 Preparation for the training .......................................................................................................27 Module 1. Introduction and overview .......................................................................................... 30 Session 1.1. Introductions and immunization challenges .........................................................31 Session 1.2. Review of training objectives, agenda, and housekeeping .................................. 34 Session 1.3. Pre-test and distribution of Participant manuals ................................................. 36 Session 1.4. FLWs’ experiences with immunization ............................................................... 38 Session 1.5. Assignments for module summaries ................................................................... 40 Module 2. Immunization technical review ................................................................................... 44 Session 2.1. How vaccines work and health benefits .............................................................. 45 Session 2.2. National coverage trends and vaccine schedule ...................................................52 Session 2.3. Vaccine safety processes and protocols in Serbia ................................................62 Session 2.4. Vaccine hesitancy ................................................................................................ 63 Module 3. Understanding behaviour and barriers ...................................................................... 72 Session 3.1. Understanding behaviour ......................................................................................74 Session 3.2. Perception biases ............................................................................................... 88 Session 3.3. Diagnosing your caregivers’ needs. Introduction ............................................... 95 Session 3.4. Mapping your caregivers on the Continuum of vaccine hesitancy ..................... 98 Session 3.5. Common fears and beliefs about vaccines ........................................................102 Module 4. Active listening to understand your caregiver ..............................................................112 Session 4.1. Dialogue creates understanding .........................................................................113 Session 4.2. Nonverbal communication. Giving it ...................................................................116 6 Interpersonal Communication for Immunization. Facilitator guide Session 4.3. Nonverbal communication. Reading it ................................................................121 Session 4.4. Empathy ..............................................................................................................124 Session 4.5. Open-ended and other special questions ...........................................................130 Session 4.6. Reflective listening ..............................................................................................135 Session 4.7. Practice combining active listening techniques ...................................................141 Module 5. Communication during immunization ..................................................................... 150 Session 5.1. Using the opt-out strategy ..................................................................................151 Session 5.2. Algorithm for vaccination communication ..........................................................154 Session 5.3. Assume they will vaccinate, but check ...............................................................157 Session 5.4. If they are hesitant, give strong recommendation ..............................................160 Session 5.5. Dealing with the very hesitant ..........................................................................166 Session 5.6. In the vaccination box. Decreasing pain ............................................................ 171 Session 5.7. In the vaccination box. Discussing side effects .................................................. 174 Session 5.8. Talking with refusers ...........................................................................................182 Session 5.9. Final affirmation. The “door handle” phrase ....................................................... 189 Module 6. Communication in depth ........................................................................................... 194 Session 6.1. Establishing goals for acceptors and hesitators ..................................................196 Session 6.2. CASE approach .................................................................................................. 200 Session 6.3. Adverse Events Following Immunization ........................................................... 208 Session 6.4. Talking about contraindications and vaccine origin .............................................212 Session 6.5. Shortcuts for good communication ....................................................................215 Session 6.6. Bringing it all together ........................................................................................219 Module 7. IPC in communities ..................................................................................................... 228 Session 7.1. Using communication outside the health facility ................................................ 229 Session 7.2. Home visits .........................................................................................................232 Session 7.3. Engaging