key: cord-0986308-g0jncw72 authors: Meyer, Brittney A.; Viskupič, Filip; Wiltse, David L. title: Pharmacists to partner with religious leaders to overcome vaccine hesitancy among Christians date: 2021-08-26 journal: J Am Pharm Assoc (2003) DOI: 10.1016/j.japh.2021.08.025 sha: e3789d6e433acba40a0fd433b9889d1fafbd88d8 doc_id: 986308 cord_uid: g0jncw72 As pharmacists work to increase vaccine confidence and continued uptake, it is recommended to partner with trusted leaders to communicate these important messages. Evidence exists that religious leaders are effective messengers when it comes to encouraging coronavirus disease 2019 vaccination. Motivational interviewing employs empathy and reflective listening to promote self-change and is used to overcome vaccine hesitancy. Pharmacists are advised to work with religious leaders in their communities to reach the most vaccine-hesitant population through the shared resource of motivational interviewing. Pharmacists can refer interested religious leaders to available online resources to learn more about this effective tool. As pharmacists work to increase vaccine confidence and continued uptake, it is recommended to partner with trusted leaders to communicate these important messages. Evidence exists that religious leaders are effective messengers when it comes to encouraging coronavirus disease 2019 vaccination. Motivational interviewing employs empathy and reflective listening to promote self-change and is used to overcome vaccine hesitancy. Pharmacists are advised to work with religious leaders in their communities to reach the most vaccine-hesitant population through the shared resource of motivational interviewing. Pharmacists can refer interested religious leaders to available online resources to learn more about this effective tool. © 2021 American Pharmacists Association ® . Published by Elsevier Inc. All rights reserved. Overcoming vaccine hesitancy to reach the necessary threshold for community protection against coronavirus disease 2019 (COVID-19) requires a multifaceted approach. Pharmacists play a key role in this process through administering vaccinations and educating the public. Nevertheless, increasing the trust and confidence of the public in vaccines is not an easy task, particularly given the prevalence of conspiracy theories and posts on social media downplaying the seriousness of the pandemic or the effectiveness of vaccines. To increase vaccine confidence, specifically through communication and community engagement, the National Forum on COVID-19 Vaccine has outlined 9 tips. 1 These are highlighted on the Community Outreach Tools page within American Pharmacists Association's (APhA's) Vaccine Confident website. 2 Implementation of all these considerations is expected to be time-and resource-intensive. Where should pharmacists focus their efforts to increase the confidence of the public in vaccines? Recent studies demonstrate that carefully composed messages can help overcome COVID-19 vaccine hesitancy. 3, 4 Pharmacists need to be cognizant that vaccination messages do not cause polarization, lead to further confusion, or trigger misinterpretation of terms such as "herd immunity." 5 Who presents that message is critical for its effectiveness. One of the 9 tips from the National Forum on COVID-19 Vaccine suggests to "use trusted messengers to share clear, credible communication" and encourages identification of specific people, organizations, and communication channels within the community. 1 According to research in social and behavioral sciences, the messenger may have a greater impact on influencing people's opinions than the actual message itself. 6, 7 Trusted messengers might be key to encouraging COVID-19 vaccination uptake. But which messengers should pharmacists partner with to promote COVID-19 vaccination? In April 2021, a survey experiment was conducted in South Dakota to investigate how the messenger affects the effectiveness of a message encouraging vaccination. 8 The experiment was embedded in a statewide poll using a random sample of registered voters. Unvaccinated respondents (n ¼ 709) were randomly assigned to 1 of 3 treatment arms, which received the same message promoting vaccination by different messengers (political, medical, or religious leader) or a control group, which received a message of similar length on an unrelated topic. The results showed that messaging from a religious leader had the largest positive effect on respondents' interest in getting a COVID-19 vaccine relative to the other groups ( Figure 1) . A multivariate analysis revealed a statistically significant difference between the religious leader group Journal of the American Pharmacists Association j o u r n a l h o m e p a g e : w w w .j a p h a . o r g (t ¼ 3.10; P ¼ 0.002) and the control group, whereas no such effect was observed for the other groups. There were some obvious limitations to these findings with the study only being conducted in a homogeneous state such as South Dakota; however, South Dakota has a large self-identified Evangelical population, making it a good case study on vaccine hesitancy within this community. This finding suggests that pharmacists could be most successful in encouraging COVID-19 vaccination uptake when partnering with religious leaders. 8 These results are likely underestimating the potential role of religious leaders in promoting vaccination since a single religious leader was chosen as a messenger. If the messenger could be matched to a respondent's own religious affiliation, it would likely evoke an even stronger response. This may be particularly important for those who self-identify as Evangelical Christians since extant research suggests that they display more hesitancy than non-Evangelicals. 9 The totality of these results suggest that clergy and other religious figures might be key players who pharmacists should partner with when advising this specific resistant population to receive the vaccination. These data support the Centers for Disease Control and Prevention strategy to partner with community and faithbased organizations. Many successful collaborations have already occurred, including one featured on APhA's Vaccine Confidence webpage titled "Vaccine Confidence: The Value of a Trusted Advisor and a Familiar Location" highlighting Reverend Diana Wingeler-Rayo who encouraged her church members to receive the vaccination at their place of worship in her Latinx community. 10 However, not all faith leaders may be comfortable promoting vaccination to their congregations without the perceived necessary medical knowledge to feel confident in their endorsement. Pharmacists can provide assurance to faith leaders that they do not need all the answers and can empower them to help their parishioners initiate self-change through motivational interviewing (MI). MI was cofounded by clinical psychologists William R. Miller and Stephen Rollnick for substance-use disorder treatment and is used in counseling and spans professions. 11 MI has been identified as a helpful tool for addressing vaccine hesitancy. 12, 13 The APhA Pharmacy-based Immunization Certificate Training Program incorporates aspects of MI when it comes to communicating with patients. Pharmacists not only engage in this method when counseling patients on getting vaccinated but when encouraging healthy lifestyle changes and medication adherence, as well. This training makes pharmacists well suited for working with religious leaders on how to promote COVID-19 vaccine uptake. MI puts people first so the change, or in this case the choice to vaccinate, comes from the patient and not imposed on them from others. 11 The first process of MI is "Engaging" where a relationship is built. This relationship likely already exists between religious leaders and their constituents. A major principle of MI is to express empathy and compassion, which may be more readily conveyed by a religious leader. When the person is ready to learn more or seek vaccination, they can be referred to the pharmacy for more information. If the pharmacist available is also a member of that place of worship, it could potentially enhance the already high level of trust the public has in their pharmacist. With the knowledge that Evangelical Christians are likely resistant to receiving the COVID-19 vaccination but may be accepting of recommendations from religious messengers to How likely is it that you will get the COVID-19 vaccine? Background: Challenges persist in encouraging specific populations to get vaccinated. Pharmacists are encouraged to partner with community and faith-based organizations to reach vaccine-hesitant patients. The messenger may be just as important as the message when encouraging vaccination. People were more responsive to seeking a vaccine after reading a message from a religious leader compared with a medical or political leader. Motivational interviewing training encouraged by pharmacists may be a helpful tool for religious leaders to encourage vaccine uptake for resistant populations. do so, pharmacists are encouraged to work with religious leaders and educate them on the use of MI as a tool to evoke personal change. Many religious leaders receive formal training on counseling and require continuing pharmacy education. They may be interested in learning the fundamentals of MI to help aid in difficult conversations, including ones beyond getting a COVID-19 vaccine. Pharmacists can easily access resources online to further their own training on MI or to recommend for an interested religious leader. Pharmacists can review The National Library of Medicine's free learning modules on MI as part of their Clinical Conversations Training Program. 14 Training events with clergy included as target audience members are available from the Motivational Interviewing Network of Trainers professional organization. 15 The North American Association of Christians in Social Work have a training titled "Christian Spiritual Approaches to Motivational Interviewing" available on their website, as well. 16 It seems fitting to end with the Motivational Interviewing Prayer written by William Miller, PhD 11 He was encouraged by a tribal member leader to include a prayer, song, or dance when teaching MI to American Indians. May it be a helpful reminder as we work with vaccine hesitant patients. Guide me to be a patient companion, to listen with a heart as open as the sky. Grant me vision to see through her eyes and eager ears to hear her story. Create a safe and open mesa on which we may walk together. Make me a clear pool in which she may reflect. Guide me to find in her your beauty and wisdom, knowing your desire for her to be in harmony: healthy, loving, and strong. Let me honor and respect her choosing of her own path, and bless her to walk it freely. May I know once again that although she and I are different, yet there is a peaceful place where we are one. National Forum on COVID-19 vaccine: increasing vaccine confidence through communication and community engagement Vaccine confident: pharmacists strengthening vaccine confidence in their patients and communities e community outreach tools Effect of information about COVID-19 vaccine effectiveness and side effects on behavioural intentions: two online experiments. Vaccines (Basel) Encouraging COVID-19 vaccine uptake through effective health communication Words matter: vaccine hesitancy, vaccine demand, vaccine confidence, herd immunity and mandatory vaccination On hearing and interpreting political messages: a cautionary tale of citizen cue-taking Collaborative partner or opponent: how the messenger influences the deaf effect in IT projects Messaging from religious leaders most effective at encouraging South Dakotans to get vaccinated Millions of white evangelicals do not intend to get vaccinated. The New York Times Vaccine confident: pharmacists strengthening vaccine confidence in their patients and communities e videos Motivational Interviewing: Helping People Change Motivational interviewing: a promising tool to address vaccine hesitancy. Vaccine Motivational interviewing: a powerful tool to address vaccine hesitancy Clin Convers Train Program Motivational Interviewing Pittsburgh Available at: https:// motivationalinterviewing.org/motivational-interviewing-training Christian spiritual approaches to motivational interviewing. Palos Heights, IL: North American Association of Christians in Social Work