Group medical information for parents: A COVID-19 experience between fear of the pandemic and vaccine hesitancy

Even though children and adolescents usually exhibit a milder course of COVID-19, they can develop myocarditis, multisystem inflammatory syndromes in children (MIS-C), and, exceptionally, fatalities. Furthermore, they have often suffered the effects of confinement more than adults. Therefore, when mRNA vaccines against SARS-CoV-2 became available to children, health authorities recommended vaccination to reduce the infection risks and allow the easing of social distancing measures with the resumption of live school activities.1 At the same time, the public was overwhelmed by information on COVID-19 and innovative vaccines, resulting in a mix of awareness and confusion. Parents might feel more hesitant to vaccinate children rather than to vaccinate themselves, possibly due to the less clear benefit–risk balance in this age group and to their concerns about unpredictable long-term adverse effects. From August 2021 to February 2022, we hold the Info-Vax service, a medical initiative designed to inform families about COVID-19 vaccination and to answer their questions, either in small group meetings or by phone. The service was promoted by the institutional website of the Hospital and by local televisions. A dedicated working group was built, with physicians (paediatricians and child neuropsychiatrists) assigned to hold the meetings, and biologists dedicated to update on significant scientific advances on the topic and on popular controversies on social media. This model was chosen to allow participants to ask their questions and express their fears and doubts. The speakers tried to establish an empathic and direct relationship with participants, taking into consideration their emerging emotions, regardless of the individual choices, opinions, and personal beliefs, according to the Motivational Interviewing method.2 Overall, communication aimed to address the concerns of the participants, rather than influencing their choice to vaccinate by exploiting their fears. The initiative's impact on the decision to vaccinate and on the fear of the pandemic was analysed by an online survey proposed to participants in February 2022, 1–6 month after the meeting had been held. Overall, 195 subjects (all parents of one or more children) referred to the Info-Vax service, 117 in the groups and 78 by phone. The meeting had a mean size of a dozen participants (10–15) and lasted an average 70 min. Eighty-five subjects (71 female) took part in the survey, 66 out of 117 who participated in the group (56.4%), and 19 out of 78 contacted the service by phone (24.3%). Seventy-four participants stated that both parents were already vaccinated, but 8 declared that only one of them had been vaccinated and in 3 cases both parents were unvaccinated. Only six participants had a story of severe COVID-19 in their family, while 38 reported mild cases. All subjects declared that the information they received was sufficiently clear (Table 1). Based on the answers to Frequently Asked Questions during the meetings, two topics were considered of greater importance by most of the subjects involved. Firstly, the consideration that the most worrying adverse events reported after vaccination could occur with higher frequency and severity after COVID-19 infection, such as myocarditis2 (65 answers). Secondly, viruses are generally more harmful than vaccines (50 answers). Notably, most of the participants reported a reduced fear of vaccination after the Info-Vax meeting, while fear of COVID-19 infection did not change. Eventually, 77 out of 85 participants decided to vaccinate their children, and most of these (68) declared that the Info-Vax initiative had a ‘high’ impact on the decision, and in four cases one or more adults also decided to vaccinate. We further analysed the association between the main characteristics of the enrolled population and stress levels evaluated with the Perceived Stress Scale-10 (PSS-10). A mean PSS-10 score of 19.89 was consistent with a moderate level of perceived stress, which was slightly higher than recorded in the same period in the general Italian population (17.01).3 In bivariate analysis, a significantly higher PSS score was measured in females than in males (20.42 vs. 17.30), partly due to a higher score for the ‘difficulties of coping with all the things to do’ option (2.93 in females vs. 2.23 in males), which might reflect the challenge of childcare following pandemic rules. This is likely due to the fact that Italian women spend nearly twice as much time of men in family duties and childcare. A significantly higher PSS-10 score was also found in subjects who had received information from a general practitioner or other trusted doctor vs other sources (23.25 vs. 18.89). While people who were already more stressed about COVID-19 and vaccinations might have been more actively seeking information from their doctors, it should be also considered that some physicians may have had suboptimal skills in providing balanced recommendations on COVID-19 vaccination, due to the rapid development of new vaccines.4 No other significant correlation was found between the PSS-10 score and other variables in the questionnaire, including a previous story of COVID-19 in the family. This study presents several biases. First, participants in the Info-Vax events may have been more well-disposed to consider vaccination compared to the general population, since most of them were already vaccinated. Nevertheless, some parents had conflicting views on vaccination, which in most cases could be reconciled after participation. However, it must be acknowledged that some vaccine-sceptic parents could have little confidence in seeking the opinion of scientists at a hospital and might have avoided taking part in the program. Second, the subjects who decided to fill out the questionnaire (overall 46% of participants) could represent those most satisfied with the meeting experience, resulting in a rather high approval rating for the event. However, it is worth noting that the response rate is in line with what is expected for online surveys. In conclusion, our experience confirmed that physician-led initiatives, with an interactive format halfway between medical counselling and scientific information, are feasible and can result in a reduction of vaccine fear in participants, helping to fill the information gap for vaccine-hesitant parents even in a context characterised by significant perceived stress. Our experience may also be valuable for other paediatric vaccinations.5 Remarkably, informing parents about vaccine safety seemed more effective than pointing out the potential severity of the infection. In fact, leveraging severity to incentivise the vaccine in young people could generate confusion and distrust, given the mild course of the disease in young people. In contrast, emphasising the vaccine's safety made it acceptable even for preventing a mild disease, which nevertheless had a major impact on the social lives of young people. Dr. E.V. had a primary role in promoting the Info-Vax event, assuring scientific updates, discussed results and corrected the manuscript. Dr. S. N. contributed to the conduction of Info-Vax events, discussion of results and correction of the manuscript. Dr. L.R. contributed to discussion of results and data analysis. Dr. G.A. had a primary responsibility in the neuropsychiatric studies and contributed to the discussion of results. Dr A.T. had primary responsibility for protocol development and supervision of the manuscript. This work was supported by the Italian Ministry of Health, with the contribution provided to the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy, RC#30/22. Open access funding provided by BIBLIOSAN. We declare no conflict of interest. The authors thank Martina Bradaschia for the English revision of the manuscript.