Frontline Staff Vaccine Communication During Pediatric Well-Child Encounters: A Mixed-Methods Study

Evidence-based vaccine communication from clinicians is associated with improved parental vaccine acceptance. However, vaccine communication practices of frontline staff, including medical assistants (MAs) and receptionists, remain largely unknown. We aimed to characterize these practices during well-child encounters in pediatric primary care.

We conducted a mixed-methods study with direct observations of frontline staff in 2 pediatric practices in Denver, CO, during well-child encounters in the summer (no influenza vaccine available) and fall (influenza vaccine available) of 2024, recording the frequency and format of vaccine communication. Following the observations, we conducted semi-structured interviews with MAs to explore their vaccine communication practices, perceived roles, comfort, and training.

We observed 174 encounters (127 MA-parent, 47 receptionist-parent interactions). Vaccine communication occurred in at least 51% (95% CI, 43%-60%) of MA interactions vs 6% of receptionist interactions (P < .001). When vaccines were recommended, MAs used a presumptive format in 46% (95% CI, 34%-59%) of encounters overall, but far less during influenza season (21% vs 76%; P < .001). Interviews revealed that MA communication styles evolved through on-the-job experience and peer-to-peer learning rather than formal training, with influenza vaccines treated as optional rather than routinely recommended.

MAs frequently communicate with parents about vaccines during well-child encounters but underutilize evidence-based presumptive communication, particularly for influenza vaccines. Communication practices are learned informally through peer-to-peer learning, highlighting a significant opportunity for targeted training to support team-based vaccine communication in pediatric primary care.