Vaccine hesitancy and risk communication — formative SAQs

SAQ 1 — Definition and 3Cs (10 marks)

A practice nurse asks you to "deal with the anti-vax family" booked for a six-week check. The infant is well. Records show no vaccines given. The parents say vaccines are available at your clinic but they "want to wait until he is older."[1]

Questions

1. Define vaccine hesitancy using the SAGE Working Group concept and explain why this family fits or does not fit that definition. (3 marks)
2. Map this encounter to the SAGE 3Cs (confidence, complacency, convenience) with one assessment question for each C. (4 marks)
3. Give a one-sentence problem representation suitable for the case notes. (3 marks) [1]

Model answer — must-hit points

Definition (3): Delay in acceptance or refusal of vaccines despite availability of vaccination services; continuum rather than binary anti-vax label. This family has available services and is delaying → hesitancy, not pure access failure.[1]

3Cs (4):

• Confidence — "What have you heard that makes vaccines feel unsafe?"
• Complacency — "What do you know about the diseases these vaccines prevent in babies?"
• Convenience — "If we book a return visit, what would make it hard to attend?" At least one tailored hypothesis for this family under two Cs (e.g. complacency if "older is safer"; confidence if safety fears).[1]

Problem representation (3): Six-week-old infant with zero doses; parental request to delay despite available clinic vaccination; likely confidence/complacency mix; relationship and on-time primary series at risk.[1]

SAQ 2 — Communication plan for MMR delay (10 marks)

Parents of a 12-month-old accept all vaccines except MMR. They fear autism. There is no true medical contraindication. Local measles cases have been reported.[1]

Questions

1. Outline a stepwise communication approach for this visit (opening style, elicitation, response, plan). (5 marks)
2. Explain one evidence-based caution about myth-correction messaging. (2 marks)
3. List documentation and safety-net elements if they still refuse today. (3 marks) [5]

Model answer — must-hit points

Stepwise approach (5): Clear recommendation for MMR today; elicit dominant concern in their words; affirm shared goal of protecting the child; brief accurate response (MMR not causally linked to autism as framed in anti-vaccine narratives — keep language careful and non-humiliating); avoid opening with "that myth is wrong"; offer same-day MMR; if delay insisted, time-bound booked revisit rather than open-ended deferral; consider MI skills if ambivalence high.[2][5][3]

Caution (2): Some message strategies that correct misperceptions do not increase intention and may backfire in subgroups (Nyhan trial implication) — order and tone matter; empathy before facts.[3]

Documentation/safety-net (3): Document discussion, specific concern, refusal, disease education (measles symptoms/when to seek care), outbreak context, offer to revisit, maintain ongoing care relationship per ethical process guidance.[4]