By anticipating potential worries, nurses take that difficult task off their hands.  ‘The research is entirely based on real conversations,’ says VU communications scientist Lieve van Hengel. ‘We do not conduct interviews or surveys; instead, we analyse conversations recorded during home visits. We then examine how these conversations might be made to run more smoothly.’ 

Vulnerable Neighbourhoods 
Van Hengel’s research takes place in Amsterdam and Rotterdam, in neighbourhoods where vaccination uptake has traditionally been low,  too low to prevent outbreaks of infectious diseases. Although nurses were initially concerned that parents might not wish to participate, the opposite proved true. 'If the research is introduced in a very natural way, parents often do not find the recording a problem,' says Van Hengel.

Conversation Analysis 
The analysis focuses on how the information provided by the nurse is interpreted by parents, as this determines how the conversation ultimately unfolds. Researchers look not only at what is said, but also at how it is said: for instance, whether there are many pauses or whether responses come very quickly. What does this signify, and how is it understood by the other person? 

‘I discovered that nurses often anticipated parents’ potential concerns before these were even voiced. For example, they would say: “The vaccine is new to the programme, but not new in general; it has been administered in Belgium for some time.” In doing so, they immediately addressed doubts about the vaccine’s novelty.’ 

According to Van Hengel, this approach has both advantages and disadvantages. ‘Parents risk being perceived as anti-vaccination if they raise questions or express concerns themselves. By anticipating potential worries, nurses take difficult task off their hands. On the other hand, such a “neatly packaged” explanation can make it harder for parents to ask questions afterwards. Doubts are, as it were, smoothed away before they are expressed.’ 

Directly Applicable 
She continues: ‘Because the conversations come from everyday practice, the results can be applied immediately. We have developed training sessions for nurses. They often recognise themselves straight away in the examples. “Oh yes, that’s exactly how I do it,” they say.’ 

In a follow-up study, researchers will examine how a specific phrasing of questions can create more room for dialogue with parents. 'For example: "I don't know whether you’ve heard of rotavirus" or "I don’t know how you feel about vaccination." These questions are less directive and more open,' says Van Hengel.

In addition, group discussions are being organised, sometimes in languages other than Dutch, so that everyone can be involved in the research.

Van Hengel: ‘We do not want to persuade parents, but to ensure that conversations run as smoothly as possible and thereby contribute to trust. Perhaps that will help increase vaccination uptake, but of course many other factors are involved: trust in government, misinformation, social networks, or even the distance to the vaccination centre.’ 

Connecting with Existing Initiatives 
During the research, Van Hengel discovered something else. ‘In these neighbourhoods there are a great many research and intervention projects. Residents and healthcare professionals are regularly approached for new initiatives, which can lead to overload and mistrust. That is why we have consciously chosen not to set up yet another separate project, but instead to connect with existing networks and activities.’ 

The final component of the research: establishing a learning community, is one example. Healthcare professionals are linked with parents, key community figures and local organisations. ‘The aim is mutual learning, making a connection and strengthening trust. Not only knowledge about vaccinations is central, but also sharing concerns, experiences and solutions,’ says Van Hengel. ‘This aligns well with the neighbourhood-based approach that the GGD began in 2021. That approach appears to be working: for the first time in ten years, vaccination uptake has increased.’ 

The process is gradual; building trust takes time. But that is precisely the time the researchers are prepared to invest. The first meeting has now been scheduled and ties in with an existing neighbourhood initiative. 

Van Hengel concludes: ‘Ultimately, the research centres on one perspective: we know that conversations play a crucial role in vaccination decisions. But what truly happens in those conversations only becomes visible when you closely examine those real-life interactions themselves.’