Generating more informed, empathetic conversations with patients and parents that also address misinformation about vaccines has strong potential to improve uptake and reverse the gradual reduction in childhood vaccination coverage nationally over the past decade.
The spinout social enterprise builds on years of University of Bristol-led research by a multidisciplinary expert team determined to answer the question: what drives vaccine hesitancy and how can it be effectively overcome?
Dr Dawn Holford, Lecturer in Psychology at the University of Bristol, led an international study which showed for the first time how using an approach called the Empathetic Refutational Interview (ERI) to address misinformation among vaccine-hesitant patients can significantly improve attitudes towards vaccination – and potentially boost vaccine uptake.
It found that more than two-thirds (around 69%) of vaccine-hesitant study participants who received empathetic engagement from a healthcare professional preferred this compared with a group who were just told the facts.
These encouraging results motivated Dr Holford and fellow researcher and chartered health psychologist Dr Emma Anderson to pilot a training programme to teach health workers with vaccination roles the ERI technique to equip them to have better conversations about vaccines, addressing patients' misconceptions.
Dr Holford said: "Lower uptake, especially for routine childhood vaccinations such as the MMR vaccine, is a serious public health issue nationally and internationally. Recent outbreaks of measles demonstrate this and show how more work is needed to help address people's reservations and combat increasingly prevalent misinformation.
"It's great to be putting exciting learnings from our research into public health practice. We know health workers are keen to have better conversations with patients which will improve vaccine confidence and their response to the training so far is really encouraging."
The pilot programme, supported by UK Health Security Agency (UKHSA) and NHS England (NHSE) London trained more than 100 health workers in London with vaccination roles, such as nurses and midwives, in 2024.
Researchers measured the trainee's confidence and skills in using the ERI before and after the training. The findings, which have just been published in the journal Public Health, showed the health workers went from being somewhat confident to highly confident.
ERI is a framework with four key steps: eliciting concerns, affirming the individual, correcting misconceptions, and informing with facts, all underpinned by an understanding of the psychological drivers, known as 'attitude roots', behind people's vaccine concerns. The training was most effective at helping improve empathy and building rapport, with the proportion of health workers demonstrating these skills up to tripling after training. Levels of knowledge in the ERI were also significantly strengthened – more than doubling from 37% before the training to 76% on average after. In follow-up surveys, most respondents reported having used what they learned from the workshop in practice.
Dr Leonora Weil, who led this programme as Director at the NHSE London Legacy and Health Equity Partnership, said: "There was strong demand for the training across London, drawing in a wide range of health professionals, and it was clear how much they valued being able to respond to different vaccination concerns in a more tailored way, so people feel listened to."
Dr Holford added: "The results are really promising. Some health workers also tried to pass on skills they learned to other colleagues, but said they had limited capacity to teach others which highlighted the need for a more sustainable solution to keep the training going."
Following the research findings, a successful pilot and ongoing demand for training, the University of Bristol launched a spinout non-profit social enterprise called JITSUVAX Training last summer, offering ERI training sessions nationwide to local authorities and NHS Trusts.
Led by Dr Anderson and Dr Ginny Gould from the research project team, JITSUVAX Training has so far delivered more than 30 in-person workshops, upskilling more than 400 health workers.
Dr Anderson, who is now Executive Director and training lead for JITSUVAX Training, said: "Vaccines save lives, but only if people accept them. Health workers have the most important role in influencing people's vaccine decisions, yet are often ill-equipped for tricky conversations when there is so much misinformation around.
"It is a privilege to be able to continue the work from the JITSUVAX project, ensuring quality training in the Empathetic Refutational Interview is available to support health workers to have better vaccine conversations. We have considerable demand for our training from across the UK and beyond, and trainees consistently give very strong, positive feedback as well as reports of real-world clinical impact."
In January the UK Parliament House of Lords Childhood Vaccinations Committee launched an inquiry to understand the evidence on uptake of routine childhood vaccination in England, why there has been a gradual decline in coverage over the last decade, and what needs to happen to reverse the decline and reduce disparities in coverage.
Professor Stephan Lewandowsky, Chair in Cognitive Psychology at the University of Bristol, and non-executive director of JITSUVAX Training, who co-authored both ERI-related research papers, said: "The aftermath of COVID-19 and huge proliferation of misinformation, especially online, has significantly impacted people's attitudes towards vaccinations, undermining trust and confidence. It's great that evidence-based approaches are now being deployed to help tackle this, which will hopefully in turn help ensure people make well-informed decisions about vaccines for themselves and their families."
The University of Bristol School of Psychological Science has recently been designated a World Health Organization (WHO) Collaborating Research Centre for Empowering Health Care Professionals with Behavioural Insights. This research will support the collaboration, working with the WHO to support healthcare professionals in dealing with major global health challenges, including vaccine hesitancy.
Paper
'Implementing psychology-based Empathetic Refutational Interview training to support vaccine confident conversations for health workers' by D. Holford et al. in Public Health
