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Motivational Interviewing for Vaccines
Beyond the Recommendation: Using Motivational Interviewing to Navigate Vaccine Hesitancy

Released: August 10, 2026

Julie Ann Justo
Julie Ann Justo, PharmD, MS, FIDSA, BCPS
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To practice talking to the patient mentioned in this ClinicalThought through an interactive case simulation, click here. To see other interactive cases about vaccine communication, click here. 

A common adult vaccine counseling scenario is discussion of vaccine safety. Patients in this setting will often be concerned that vaccine adverse effects may outweigh the benefits of the vaccine itself or the negative outcomes of the disease it prevents. In these cases, it is important to acknowledge and validate concerns to make patients feel heard and understood before seeking to correct any misinformation. As demonstrated in a study by Zolezzi and colleagues on COVID-19 vaccination, a proven method for doing so is motivational interviewing. 

In this ClinicalThought, I explore how to use motivational interviewing to discuss respiratory syncytial virus (RSV) vaccination with a hesitant patient.

Clinical Scenario: Margaret is a 77-year-old woman with heart failure, hypertension, and hyperlipidemia. She is concerned about RSV vaccine safety after seeing conflicting information online. She is especially concerned about newer vaccine technologies.

When I am caring for a patient who displays apparent signs of vaccine hesitancy, I would start with motivational interviewing. The overarching themes of motivational interviewing are partnership with the patient, acceptance of their views, compassion, and respect for their autonomy in making decisions concerning their health.

Letting OARS Steer the Conversation
To maintain those motivational interviewing principles, I often employ the OARS framework. OARS is an acronym that stands for: Open-Ended Questions, Affirmations, Reflective Listening, and Summarizing.

In practice, I might begin with an open-ended question, “I understand you have some concerns regarding the safety of the RSV vaccine. Can you tell me about them?” That simple question immediately sets the tone. Instead of short “yes” or “no” responses or entering a debate, we are working together to understand the patient’s concerns.

Affirmations are equally important. If patients tell me they have encountered conflicting information online, I acknowledge their strengths and offer encouragement toward change. For instance, I can affirm the effort they are making to stay informed: “I appreciate that you’re trying to understand the information and make the best decision for your health.” Statements like these validate the patient’s intentions without reinforcing misinformation through repetition. They help establish trust and affirm that we are working toward the same goal.

Next, I employ reflective listening, which involves verbally rephrasing patients’ statements and/or concerns to demonstrate an understanding of their views and to allow them to hear their thoughts in a different format. This can further support patients’ internal motivation for eventual change.

For example, if patients were to say they were concerned about allergic reactions following vaccination, I could reflect back, “I understand that you are very concerned about allergies, and I agree there are some reports of allergic reactions with the vaccine…” I could then transition into asking for permission to provide more data, such as, “Yet those reports remain very rare from the studies I’ve seen. May I provide you with some general numbers?” Requesting permission to share information maintains patients’ sense autonomy over the conversation, and it signals that I am accepting of where they are.

Then, asking another open-ended question such as “I hear that you are concerned about potential vaccine side effects. What in particular have you heard?” builds a cadence of open-ended questions, affirmations, and reflective listening. It results in a productive conversation centered on motivational interviewing principles.

Summarizing is the final technique in the OARS framework. I summarize at key points of the conversation before moving onto another topic but especially at the end of the conversation to help guide patients in weighing their personal benefits and risks for a given health decision, such as potentially accepting RSV vaccination.

Change Talk
Whereas OARS helps establish trust, motivational interviewing also involves “change talk.” This principle helps patients articulate their own reasons for considering a different course of action, and it ideally moves the conversation towards productive change. “Change talk” involves 4 main components: Displaying Empathy, Developing Discrepancy, Rolling With Resistance, and Supporting Self-efficacy.

I ask patients about their goals, like what they want to do or accomplish over the next several months. Patients often answer with personal goals: “I want to spend more time with my grandchildren,” or “I want to stay healthy and avoid another hospitalization.” Displaying empathy is accomplished via open-ended questions, affirmations, and reflective listening as outlined above. The empathy these strategies imparts invites change on behalf of the patient, rather than installing change in a prescriptive manner.

Once patients’ goals are established, the conversation naturally shifts toward whether their current decisions align with those priorities. This is the step of developing discrepancy. If avoiding hospitalization is important to the patient, I ask if I can offer information on how RSV vaccination affects hospitalization rates. If allowed, I then describe how RSV vaccination helps support the goal and how avoiding RSV vaccination is less likely to achieve the goal. This iterative approach for each expressed goal can help generate a list of pros and cons for a given health decision—further characterizing the benefits and risks for the individual patient—and can help you gauge patients’ readiness for change.

Rolling With Resistance
Continued resistance often occurs despite our best efforts, but it should not be viewed as failure. A critical aspect of “change talk” is rolling with resistance, rather than fighting it. In my experience, a patient may acknowledge the potential benefits of vaccination but still have concerns.

For example, she may respond with a statement like, “Yes, but I have heard that this mRNA vaccine technology will change the DNA of my cells.” It is important then to roll with that resistance, again affirming, “I hear you. It makes sense that when new technologies emerge, people need more information to understand how they work and their benefits and risks. Is it okay if I share what I know regarding mRNA technology?” Rolling with that resistance and asking permission to share information helps maintain trust throughout the conversation.

Supporting Confidence While Making a Clear Recommendation
The final component of motivational interviewing is supporting self-efficacy. Part of that involves discussing what a patient can realistically expect after vaccination, and explaining the rates of common and rare serious adverse effects, including allergic reactions and nerve disorders like Guillain-Barré syndrome.

Supporting self-efficacy can also include empowering patients with tools to take a more active role in vaccine safety monitoring. In addition to talking about the Vaccine Adverse Event Reporting System (VAERS) database, which healthcare professionals (HCPs) use to report vaccine adverse effects, I may show them V-safe, which patients can use to directly report any adverse effects they experience. This is particularly useful for patients who want to be actively engaged in the monitoring/reporting process.

This “change talk” strategy can be remarkably effective because the motivation comes from the patient rather than the HCP. Ultimately, combined use of the OARS framework and the “change talk” strategy concurrently shapes an open dialogue with the patient, and it grounds conversations in acceptance and compassion.

Eventually, however, there comes a point where HCPs should make a clear recommendation. After listening carefully, establishing trust, and summarizing patients’ goals and concerns, I tell patients where I stand.

For patients who are appropriate candidates, I explain that I recommend the RSV vaccine because I believe its benefits outweigh its risks for their individual case. I will mention their specific goals from earlier, as appropriate. I discuss its role in reducing RSV-related hospitalization and answer any remaining questions before asking how they feel about moving forward that day.

Sometimes they are ready, and sometimes they are not. Both outcomes are acceptable. Change often occurs gradually, and the key is that every conversation can be meaningful, incremental progress toward change. If they are not ready to be vaccinated today, I verbally accept their decision, plan for a follow-up, and leave the door open for future conversations.

Your Thoughts
What are some examples of rolling with resistance that you have encountered in your clinical practice? Or what are some situations where you could envision using that technique? Leave a comment to join the discussion! 

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