Using Values-based Communication to Address Vaccine Hesitancy

Introduction

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As a quick background about our speaker, we're so excited to welcome Deborah Thompson. She is a public health advocate with experience in persuasive communication from her role as a legislative liaison for the Iowa Department of Public Health. Deborah founded DHT Consulting and Training to support health and human services professionals. She is actively involved with the Iowa Public Health Association, the Iowa Immunizes Coalition, and volunteers locally. Without further ado, I'm passing this over to Deborah.

Deborah Thompson: Introduction

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Thanks, Dayna. I'm really happy to be here and deeply appreciate the opportunity to share my experiences and insights. Let me start by sharing a little about where I developed my professional skills. This is the Iowa State House—it’s a beautiful building, and anyone visiting Des Moines, Iowa, should take a tour.

I always joke that I was "raised" in this building. My first position was as a Senate intern in 2004, while finishing up at Drake University. Since then, I’ve worn many hats at the State House and enjoyed diverse employment opportunities. For seven and a half years, I served as the legislative liaison for the Iowa State Health Department.

In this role, I acted as the point of contact between state legislators and professionals at the department. I navigated discussions about legislation, public health, and ideas shaping both—essentially functioning as the department’s salesperson.

Evolving Messaging Strategies

When I began, the legislature was structured differently. Over time, as Iowa’s political landscape shifted toward conservatism, I realized I needed to adapt my approach to public health messaging. Data-centric talking points that once worked well began to fall flat with the emergence of Tea Party Republicans in 2010.

Coincidentally, some public health professionals and their partners in North Carolina had discovered a messaging framework that helped them gain buy-in from traditionally skeptical audiences, like sheriffs, to support syringe services programs. Seeing their success inspired me to investigate this framework further—and it worked.

Framework: Values-Based Communication

This framework emphasizes prioritizing morals and values in persuasive communication over pure data, facts, and graphs. To clarify: factual information still serves as the foundation of advocacy and education, but it takes a back seat in the actual messaging process, especially when trying to gain buy-in.

To illustrate the application of this framework, I’ll focus on vaccine hesitancy—a timeless challenge for public health professionals. Vaccine hesitancy has existed since the first smallpox vaccination in the late 1600s and will likely continue to persist. Through this framework, vaccine hesitancy can serve as a case study, though the approach applies to other topics as well.

By the end of this presentation, I aim for you to understand values-based communication, how to check your "elephant" (more on this shortly), remain present during difficult conversations, and embrace the idea that changing minds often requires a long-term commitment. This framework is a skill that takes practice—expect it to take time to fully internalize.

Level Setting: Values vs. Morals

Values and morals are often used interchangeably, but they are distinct concepts:

• Values are beliefs, principles, or goals that individuals work toward. These guide life choices and often define personal identity or group belonging.
• Morals are rules that differentiate right and wrong, shaped by societal or cultural beliefs. Think of morals as the soil from which values grow. For example, as a parent, I teach my son about societal norms, allowing him to develop his own values along the way.

Vaccine Hesitancy

The World Health Organization defines vaccine hesitancy as the delay or outright refusal of vaccines despite their availability. This hesitancy stems from factors such as complacency, confidence, and convenience. Today, we focus on strategies to strengthen confidence in vaccinations.

False information significantly impacts vaccine confidence and comes in three forms:

1. Misinformation: Incorrect information unintentionally shared.
2. Disinformation: Fabricated or intentionally manipulated information, like conspiracy theories, created with malicious intent.
3. Malinformation: Personal information intentionally shared to harm an individual. This type, known as "doxing," involves publishing factual but harmful details.

Disinformation is particularly insidious because it spreads quickly via social media, designed to look credible, often leading people to believe false claims.

Vaccine Hesitant vs. Opponents

Dr. Arthur Caplan, a bioethics professor at NYU, explains:

• Vaccine Opponents: Hate vaccines and won’t change their minds, no matter the evidence.
• Vaccine Hesitant: Fearful but open to discussions.

Building vaccine confidence requires understanding an individual’s moral foundations and engaging in multiple conversations over time.

Jonathan Haidt’s Moral Psychology Framework

Social psychologist Dr. Jonathan Haidt’s work on moral psychology provides tools for understanding divergent views. His book, The Righteous Mind: Why Good People Are Divided by Politics and Religion, outlines three principles:

1. The Elephant and the Rider Analogy
   People react first based on intuition (the "elephant") and rationalize these reactions afterward with logic (the "rider"). Intuition often outweighs rational thought, shaping individual truths.

2. Six Moral Foundations
   Humans react to six moral foundations:

   • Care vs. Harm
   • Fairness vs. Cheating
   • Loyalty vs. Betrayal
   • Sanctity vs. Degradation
   • Authority vs. Subversion
   • Liberty vs. Oppression

3. Morality’s Dual Nature: Binding and Blinding
   Morality brings groups together but can blind individuals, creating self-righteous indignation and irrational responses when moral foundations are violated.

Application: Practical Tips

When discussing controversial topics, such as vaccines:Avoid Escalation

• Avoid Escalation
  • Listen without judgment; avoid patronizing or alienating others. Insulting rarely changes minds.

• Recognize Your Triggers
  • Understand your own moral foundations and gut reactions before engaging.

• Engage Constructively
  • Ask questions like:
    • "Why is this issue important to you?"
    • "Has a specific experience influenced your views?" 
• Humanize Yourself
  • Share personal stories and lived experiences to build trust and credibility. 
• Play the Long Game 
  • Changing minds is often a gradual process. Be patient and revisit the conversation later if necessary.

Closing Thoughts

Key Takeaways:

• Gut reactions come first, rationalization second.
• Be aware of your "elephant" and recognize irrational triggers.
• Use values-based communication by aligning with moral foundations.
• Focus on curiosity, empathy, and patience—it’s a long game.

Questions and Wrap-Up

Audience Q&A

Macy: "What values resonate most with religious groups in value-based messaging?"
Deborah: Religious communities often emphasize care for the vulnerable, but definitions of vulnerability can vary. Take time to understand individual viewpoints using curious conversations.

Madeline: "What if there’s not enough time for in-depth conversations with patients?"
Deborah: Focus on your role as a credible authority. Provide materials for follow-up, validate patient questions, and offer to discuss further during their next visit.

Paige: “Sharing my personal health condition has been effective.”
Deborah: Absolutely! Humanizing yourself builds trust. Showing authenticity strengthens credibility.

Closing Remarks:
Thank you for attending this presentation. Remember, people can be persuaded—don’t give up hope. Give them space if needed, and revisit the conversation later. Let’s work together toward meaningful communication and impactful change!

Patagonia Health Note: If you’d like to learn more about Patagonia Health and our EHR solutions, visit www.patagoniahealth.com. Have a great day!