Table 2 Qualitative Constructs and Themes

COVID-19 misinformation has altered the patient-provider relationship

Misinformation brought to appointments creates barriers to discuss science-based recommendations; providers face increasingly “dug in” perspectives.

Interpersonal

There’s a lot of misinformation, even the people who got the vaccine…I can’t in a few minutes visit just prove it or bring out all the data. I’m not even sure if that would help… I have that discussion with [people] that have very firm beliefs…It’s almost impossible to get through. (Nurse practitioner, Illinois)

At this point, it’s almost like they’re dug in, and they would be embarrassed that they’ve

changed their mind. And I don’t know how to get through to them to let them know that would be good. (Doctor, North Carolina)

Some patients believe the information made available to providers is wrong – increasing doubt in unbiased science and medicine

Interpersonal

They trust us as their physicians. They trust that we’re in good faith trying to give them the best information we can. It’s just that they’ve been somehow misled that the information that we have as medical professionals is incorrect and they feel like… They’ve got access to truth that the medical professionals don’t. (Doctor, North Carolina)

It’s not that they think that I have a hidden agenda and that I’m part of an evil conspiracy, it’s that they think that the doctors are actually misinformed. They think we believe what we’re telling them, we’re just wrong and they have a better source than we do. (Doctor, North Carolina)

A paradigm shift for some providers in how they comprehend and communicate new medical information

Intrapersonal

I’ve had patients share information that they’ve discovered that’s contrary to what we’ve been taught to teach through the years. It’s been sort of paradigm changing for me. To be this old in medicine and to feel like my paradigm has changed. So, it becomes harder to talk to patients when you get different information than what you had your whole life.

(Unvaccinated doctor, Pennsylvania)

I’ve definitely taken to heart more concerns and anecdotal stories that patients have brought either from their own vaccine stories or from loved ones. It’s really easy to blow some of these things off and point to studies. Well, you got people flooding in with all these stories that you start taking [them] to heart, especially something that’s been so newly released and not very well studied. You kind of internalize that. It’s hard not to bring that to other patients that you interact with. (Unvaccinated doctor, Wisconsin)

Strategies for successful vaccine communication during patient interactions

Tailoring information and recommendations to the patient’s medical history and concerns

Interpersonal and Intrapersonal

Knowing what their literacy level governs a lot on the terminology that we use… give them a chance to ask questions, and the pros and the cons that type of thing… You really have to know the background of the people, and that makes a big difference. (Nurse practitioner, Massachusetts)

Testimonials from other patients and peers

Interpersonal

I said it in a conversation… “I just lost a patient on the vent with COVID,“ and the lady went down that day and got the vaccine. So, some of [their choices] are personal. (Nurse practitioner, Indiana)

I asked her if she would go in and speak with a woman who received her first [dose]. They just had a conversation and found out that they went to the same college. They actually exchanged numbers and became friends right there. I thanked her for making her feel comfortable and telling her that you didn’t have any side effects. So, sometimes I use that method. (Registered nurse, Texas)

Time, multiple appointments, patience and empathy

Intrapersonal (with organizational barriers due to health care access, appointment-making policies, etc.)

It’s an ongoing conversation. I tell them [to] think about what we talked about, and we can discuss it again. If you change your mind or if you want to discuss this further, we can always address it out at a later time… so they don’t feel pressured. (Nurse practitioner, New York)

Information resources that support provider vaccine communication

Local and frequent updates

Community, Organizational and Policy

Our local public health department disseminates our information a couple times a week… and they recap the new CDC guidelines and what the State of Iowa’s Department of Public Health recommends. (Nurse practitioner, Iowa)

Resources and materials provided by employers

Organizational

I work for a huge hospital so the epidemiologist at the hospital would send out daily updates, and they were translating the information that was in the media and on the CDC website. It was very simple to follow, it also included instructions for patients on what to tell them… regarding vaccines, side effects, protocols, and step-by-step approach on how to navigate the world of COVID. I found that very helpful. (Nurse practitioner, Utah)

An increased need for patient-facing materials to navigate new COVID-19 information

Community and Organizational

I would like to really have a resource to provide to families and patients…in a format that’s really easy to follow… A lot of us don’t have a ton of time to explain to families, but to give them an opportunity to…do a little bit of research on their own without maybe digging through the CDC website. (Nurse practitioner, Texas)

Environmental and policy level recommendations to support vaccine acceptance outside the clinical setting

Removing financial barriers to vaccination

Policy

…I am in a pediatric private practice…we do have a lot of parents asking the same thing, “is it covered by insurance?”… (Nurse practitioner, Indiana)

A need for a more centralized and unified response to COVID-19 vaccinations

Organizational and Policy

Other countries are doing a much - I don’t want to say a better - but a different job of [communicating] this is just for the good of the population, and… try to get people to get more into that community mentality. (Nurse practitioner, Indiana)

Multiple outlets for information and vaccination

Community, Organizational and Policy

We’ve gone to COVID clinics… at different churches. So, I think as far as culture is concerned some people they really look at their priests, their minister, their pastor, for guidance… If you could get him… on board to endorse the vaccines, I think you will get more participants. I really do. (Registered nurse, Texas)

Who speaks to the different groups? Maybe our current administration doesn’t speak to everybody but somebody speaks to everybody. Somebody reaches. Every person out there has somebody they respect or that they know and trust. And, maybe we need to move away from the national speakers that everybody’s seen on TV all the time. Maybe regionally, they need to look for people of different race, color, interests, backgrounds and find somebody to speak locally or regionally to those that are hesitant. I mean, that’s the only thing I can think of is to better reach individuals. (Doctor, Nebraska)